Dr. Yen-Fu Chen

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a physiotherapy treatment plan for a vertigo assessment and a chronic pain assessment.

The respondent insurer denied the benefits.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

The evidence indicated that the applicant's vertigo symptoms were resolved or managed with medication, and the chronic pain diagnosis was not corroborated by the clinical notes and records of her treating physicians.

The Tribunal also dismissed the claims for an award for unreasonable delay and interest, finding the insurer's conduct was reasonable.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal first denied the applicant's request for a sealing order and anonymity, finding the applicant failed to meet the high threshold established in Sherman Estate.

On the merits, the Tribunal found the applicant was entitled to a gym membership, once-weekly personal training, a progress report, and a physiatry assessment, as these were reasonable and necessary to address his ongoing physical and psychological impairments.

The Tribunal denied the remaining claims for 90-minute psychological sessions and occupational therapy assessments.

The applicant's claim for a section 10 award for unreasonable withholding of benefits was also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied various treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to a concussion, psychological impairments, and pre-existing conditions.

The Tribunal found insufficient evidence of a concussion or accident-related psychological impairment, preferring the respondent's psychological assessment.

The Tribunal also found that the applicant failed to prove her pre-existing conditions would prevent maximal recovery within the MIG limits.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a pre-existing right shoulder injury, multiple morbidities, and chronic pain.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions would preclude maximal recovery within the MIG.

Furthermore, applying the AMA Guides, the Tribunal concluded the applicant did not demonstrate chronic pain with functional impairment.

The disputed treatment plans for chiropractic services and the cost of an OCF-3 were deemed not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's chronic left shoulder pain and resulting functional limitations removed him from the MIG.

The Tribunal preferred the evidence of the applicant's physiatrist and treating physicians over the respondent's section 44 assessors.

The applicant was awarded all disputed treatment plans for chiropractic services and a physiatry assessment, plus interest on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident.

The insurer denied various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries were predominantly minor soft tissue injuries that had resolved, and she failed to provide compelling evidence that pre-existing conditions or chronic pain warranted removal from the MIG.

The Tribunal also rejected the applicant's psychological claims, finding her depression and anxiety were caused by her husband's terminal illness and death, not the accident.

As the MIG limit was exhausted, all claims for treatment plans, medication, interest, and a section 10 award were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer denied a treatment plan for chiropractic services and goods, as well as a physiatry assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the assessment was unnecessary due to a prior insurer's examination.

The Tribunal found the respondent's denial notice for the treatment plan was medically deficient under s. 38(8) of the Schedule, entitling the applicant to the benefits under s. 38(11).

The Tribunal also found the physiatry assessment was reasonable and necessary because the applicant's condition had substantively deteriorated since the prior examination, with new physical and psychological diagnoses emerging.

The applicant was awarded the disputed benefits and interest.

The applicant was struck by a minivan while crossing the street and sought statutory accident benefits, including non-earner benefits, attendant care, housekeeping, and medical benefits for assistive devices.

The Tribunal dismissed the claims for non-earner and attendant care benefits, finding the applicant failed to provide sufficient evidence of her pre- and post-accident activities or that attendant care expenses were incurred.

The claim for a mattress topper was statute-barred as it was purchased before a treatment plan was submitted.

However, the Tribunal found the anti-fatigue mat was reasonable and necessary, and ordered the respondent to pay for it.

The applicant was injured in a motor vehicle accident and sought medical benefits and the cost of an assessment from the respondent insurer.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline limit of $3,500.

The adjudicator found that the applicant's injuries did not fall within the Guideline because she suffered from chronic pain that was more than a sequelae of a predominantly minor injury.

The adjudicator approved four of the six disputed treatment plans as reasonable and necessary, noting they provided pain relief and increased function, but denied two plans that were either duplicative or showed minimal progress.

The applicant was awarded interest on overdue payments, and both parties' requests for costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer denied treatment plans for chiropractic care and a physiatry assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly soft tissue injuries and failed to establish any underlying neurological disorder that would warrant removal from the MIG.

As the injuries were minor, the applicant was limited to the $3,500 funding cap, and the Tribunal did not need to assess the reasonableness or necessity of the disputed treatment plans.