2 total
Applicant entitled to initial chiropractic treatment but denied subsequent plan for failing to attend insurer examination.
The applicant sought statutory accident benefits for chiropractic treatments and assessments following a motor vehicle accident.
The Tribunal found the applicant entitled to a $3,349.08 chiropractic treatment plan, as medical evidence supported that pain reduction was a reasonable and necessary goal.
However, a subsequent $2,585.50 chiropractic plan was denied because the applicant failed to attend a reasonably necessary insurer examination, precluding her from proceeding to a hearing on that issue.
A psychiatric assessment was denied because it was incurred before the treatment plan was submitted.
The respondent conceded entitlement to a physiatry assessment.
Interest was awarded on the overdue benefits.
Application for catastrophic impairment assessment funding dismissed as the constituent assessments were not reasonable and necessary.
The applicant was injured in a rear-end motor vehicle accident and sought payment for a multi-disciplinary catastrophic impairment assessment under the Statutory Accident Benefits Schedule.
The respondent insurer denied the treatment plan on the basis that it was not reasonable and necessary.
The applicant argued that the insurer was required to pay for any reasonable fee charged for a catastrophic impairment assessment, regardless of necessity.
The Tribunal rejected this argument, holding that each constituent assessment making up the multi-disciplinary assessment must be proven to be reasonable and necessary.
Upon reviewing the medical evidence, the Tribunal found that the applicant failed to prove on a balance of probabilities that any of the proposed assessments were reasonable and necessary.
The application was dismissed.
