3 total
Applicant entitled to closed period of IRBs reduced to zero by EI benefits; other claims dismissed.
The applicant sought statutory accident benefits following a rear-end motor vehicle collision, claiming entitlement to income replacement benefits (IRBs), attendant care benefits (ACBs), and various medical assessments.
The Tribunal found that the applicant suffered a temporary exacerbation of pre-existing shoulder and neck issues, entitling her to IRBs for a closed period until December 31, 2024.
However, the quantum payable was reduced to zero because the applicant received employment insurance sickness benefits that fully offset the IRB amount.
The claims for ACBs and medical benefits were dismissed, as surveillance evidence and medical assessments demonstrated the applicant could perform her pre-accident activities and did not require the claimed assistance or further assessments.
Applicant's injuries fall within the Minor Injury Guideline; insurer must pay for treatment plans during non-compliant denial periods.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied several treatment plans and income replacement benefits.
The Tribunal found that the respondent failed to provide adequate notice under s. 38(8) of the Schedule for several treatment plans, requiring the respondent to pay for those plans during the periods of non-compliance.
However, the Tribunal concluded that the applicant's injuries fell within the Minor Injury Guideline (MIG), as he failed to prove a pre-existing condition, post-concussive syndrome, chronic pain, or a psychological impairment that would remove him from the MIG.
The Tribunal also dismissed the applicant's claim for income replacement benefits, finding he did not suffer a substantial inability to perform the essential tasks of his employment.
The claim for a special award was dismissed.
Treatment plans denied as not reasonable and necessary, but incurred costs awarded for non-compliant denial.
The applicant sought statutory accident benefits for an impairment assessment, a physiatry assessment, and a treatment plan for physiotherapy and massage therapy following a motor vehicle accident.
The adjudicator found that the impairment assessment and the physiotherapy treatment plan were not reasonable and necessary, noting the applicant's return to full-time work and independence in self-care.
While the physiatry assessment was also found not to be reasonable and necessary, the adjudicator held that the respondent failed to provide a compliant denial under section 38(8) of the Schedule.
Consequently, the applicant was entitled to the incurred costs of the physiatry assessment along with interest.
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