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Tribunal awards IRBs finding no wilful misrepresentation of cash employment, but denies unsupported treatment plans.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied income replacement benefits (IRBs), alleging the applicant wilfully misrepresented his pre-accident employment and income.
The Tribunal found no wilful misrepresentation, noting the applicant's language difficulties and reliance on his employer's cash payment and tax remittance practices.
The Tribunal awarded IRBs based on the applicant's CRA Notice of Assessment and medical evidence showing a substantial inability to perform his pre-accident heavy labour tasks.
Claims for a vision assessment and a recliner chair were dismissed for lack of contemporaneous medical evidence.
A claim for a special award was also dismissed.
Application for statutory accident benefits dismissed; applicant failed to prove entitlement to non-earner benefits and treatment plans.
The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, various treatment plans for physiotherapy, occupational therapy, and dental services, as well as an ambulance fee, interest, and an award for unreasonable delay.
The Licence Appeal Tribunal dismissed the application in its entirety.
The Tribunal found the applicant failed to demonstrate a complete inability to carry on a normal life, relying on insurer examination reports indicating the applicant was independent in daily activities.
The Tribunal also found the applicant failed to prove the disputed treatment plans were reasonable and necessary, as the applicant did not provide the actual plans or compelling evidence to counter the respondent's medical assessments.
Claims for the ambulance fee, interest, and a special award were similarly dismissed.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from Minor Injury Guideline.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent insurer.
The applicant applied to the Licence Appeal Tribunal to dispute the denial of several treatment plans for chiropractic services.
The central issue was whether the applicant's injuries warranted removal from the Minor Injury Guideline (MIG) $3,500 funding limit.
The Tribunal found that the applicant failed to provide compelling medical evidence that his left rotator cuff tear was caused by the accident or that he suffered from a pre-existing condition preventing maximal recovery within the MIG.
Consequently, the applicant's injuries were deemed predominantly minor, and the disputed treatment plans were not payable as they exceeded the MIG limit.
The application was dismissed.
Application for physiotherapy and massage therapy treatment plan dismissed for lack of corroborating medical evidence.
The applicant sought entitlement to a treatment plan for physiotherapy and massage therapy in the amount of $1,849.55 following a motor vehicle accident.
The Licence Appeal Tribunal found that the applicant failed to provide contemporaneous medical evidence to support the necessity of the treatment plan.
Relying on the respondent's physiatry examination report, which concluded the applicant had reached maximum therapeutic benefit, the Tribunal held that the treatment plan was not reasonable and necessary.
No linked lawyers found.
No linked judges found.