3 total
Application for accident benefits dismissed as proposed treatments and assessments were not reasonable and necessary.
The applicant sought medical benefits for physiotherapy, a TMJ assessment, and an orthopedic assessment following a motor vehicle accident.
The Licence Appeal Tribunal found that the applicant failed to prove the proposed treatments and assessments were reasonable and necessary.
The evidence showed physiotherapy had not been helpful, there was no indication of a jaw injury from the accident, and the orthopedic assessment would be duplicative of previous assessments.
The application was dismissed.
Applicant denied IRBs and ACBs but granted funding for assistive devices and psychological services.
The applicant was involved in a motor vehicle accident and sought various statutory accident benefits, including income replacement benefits (IRBs), attendant care benefits (ACBs), medical benefits, and cost of examination expenses.
The insurer denied the benefits.
The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment as an Uber driver, dismissing the IRB claim.
The ACB claim was also dismissed as the applicant failed to establish the benefits were reasonable and necessary beyond the period already paid.
The Tribunal granted funding for assistive devices and an in-home assessment, preferring the evidence of the applicant's in-home assessor.
The claim for psychological services was partially granted due to the insurer's deficient notice under s. 38(8) of the Schedule.
Claims for physiotherapy, chiropractic, dental services, and other assessments were dismissed for lack of persuasive medical evidence.
The request for an award for unreasonably withheld payments was denied.
Application for catastrophic impairment and statutory accident benefits dismissed due to lack of credibility.
The applicant sought various statutory accident benefits and a catastrophic impairment (CAT) designation following a 2016 motor vehicle accident.
The Licence Appeal Tribunal found that while the accident contributed to the applicant's psychological impairment, the applicant's self-reports were not credible due to significant inconsistencies regarding his pre-accident health and functional status.
The Tribunal concluded the applicant did not suffer a marked impairment in three spheres of functioning and therefore did not meet the CAT threshold.
All claims for income replacement benefits, attendant care, and medical benefits were dismissed as the applicant failed to prove they were reasonable, necessary, or incurred.
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