3 total
Claims for chiropractic services and chronic pain assessment denied as not reasonable and necessary.
The applicant sought entitlement to statutory accident benefits for chiropractic services and a chronic pain assessment following a motor vehicle accident.
The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, relying on the respondent's section 44 assessors who concluded the applicant had reached maximal medical recovery for his minor injuries and that his heel pain was pre-existing.
The Tribunal also dismissed the claims for an award under section 10 of Regulation 664 and interest, as no benefits were overdue.
Application for accident benefits dismissed as proposed physiotherapy and chronic pain assessment were not reasonable and necessary.
The applicant sought statutory accident benefits for physiotherapy and a chronic pain assessment following a motor vehicle accident.
The insurer had removed the applicant from the Minor Injury Guideline due to a pre-existing psychological condition but denied the specific treatment plans.
The Licence Appeal Tribunal found that the applicant failed to prove the treatments were reasonable and necessary, preferring the evidence of the insurer's physiatrist over the applicant's psychologist regarding physical injuries.
The Tribunal also noted the applicant's high level of physical activity, such as skiing and golfing, which contradicted a chronic pain condition.
The application was dismissed.
Reconsideration request dismissed; new evidence rejected and no significant error of fact found.
The applicant sought reconsideration of a Licence Appeal Tribunal decision denying entitlement to two chiropractic treatment plans.
The applicant argued the Tribunal made significant errors of fact and sought to introduce new medical evidence.
The Vice-Chair dismissed the request, finding the proposed new evidence was either reasonably available prior to the hearing or would not have impacted the outcome.
The Vice-Chair further held that the Tribunal's weighing of the medical evidence, including assigning less weight to expert reports that lacked full medical history or relied on conjecture, was open to it on the evidence and did not constitute an error of fact.
