Kiro Soliman

The applicant requested a reconsideration of a Tribunal decision that denied payment for a $14,804.51 treatment plan.

The applicant argued the Tribunal erred in law and fact by finding the treatment plan was not reasonable and necessary, and by misapplying the notice requirements under s. 38 of the Schedule.

The Vice-Chair dismissed the request, finding no error in the adjudicator's determination that the insurer cured its defective notice and that the applicant failed to provide evidence of incurred treatment during the period of non-compliance.

The Tribunal's finding that the treatment plan was not reasonable and necessary was upheld.

The applicant sought a medical and rehabilitation benefit of $14,804.51 for a multidisciplinary chronic pain program following a motor vehicle accident.

The adjudicator found that the insurer's initial notices of denial were defective under s. 38(8) of the Schedule because they lacked medical reasons and failed to include the required Insurer Examination reports.

Consequently, the insurer was liable to pay for any treatment incurred between the date the notice was due and the date the defect was cured.

However, on the substantive issue, the adjudicator concluded that the treatment plan was not reasonable and necessary, as the applicant had reached maximum medical recovery, returned to full-time work, and showed no ongoing musculoskeletal or psychological impairments.

Claims for an award and costs were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG) and upheld the insurer's denial of two treatment plans.

Prior to the reconsideration decision, the insurer revised its position, approved full payment for both treatment plans, and removed the applicant from the MIG.

The only remaining issue was whether the applicant was entitled to interest on the outstanding benefits.

The Executive Chair granted the reconsideration in part, ordering the insurer to pay interest on the overdue payments in accordance with the Statutory Accident Benefits Schedule.

The applicant sought medical benefits for chiropractic treatment following a motor vehicle accident.

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

The applicant argued the respondent's denial notices were defective under s. 38(8) of the Schedule and that a pre-existing condition of chronic chest pain warranted treatment outside the MIG.

The Tribunal found the denial notices were compliant and that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery under the MIG.

The claims for medical benefits, interest, a special award, and costs were dismissed.