2 total
Application for accident benefits dismissed as applicant failed to prove treatment plans were reasonable and necessary.
The applicant sought entitlement to multiple treatment plans for chiropractic services, various assessments (psychological, neurological, cognitive, chronic pain, FAE, attendant care), and assistive devices following a motor vehicle accident.
The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the proposed treatments and assessments were reasonable and necessary.
The Tribunal noted a lack of objective medical evidence, reliance on self-reports, and failure to provide clinic treatment records or progress reports to justify the ongoing identical treatment plans.
Caregiver benefits denied because the applicant was not the primary caregiver for his children.
The applicant was injured in a motor vehicle accident and applied for weekly caregiver benefits, claiming he was the primary caregiver for his two young children.
The insurer denied the claim.
At arbitration, the evidence showed that while the applicant was an involved father, he worked full-time in a limousine business, whereas his wife was a full-time homemaker who handled the majority of day-to-day childcare tasks.
The arbitrator concluded that the applicant's wife, not the applicant, was the primary caregiver at the time of the accident.
As caregiver benefits are only available to the primary caregiver, the application was dismissed.
No co-appearing lawyers found.
No judges found.