Joe Kositsky

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

The Respondent denied claims for attendant care benefits, an accounting report, various treatment plans, and prescription cannabis.

The Tribunal found that the attendant care benefits were not incurred and the accounting report was not reasonably required.

The disputed treatment plans were found not reasonable and necessary, largely based on uncontroverted insurer's examination reports indicating the Applicant had reached maximum medical recovery or that further facility-based treatment was not supported.

The Respondent agreed to pay for one treatment plan and the incurred prescription cannabis expenses.

The claim for an award for unreasonable delay was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and medical benefits for various treatments.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The Tribunal found the applicant was not entitled to non-earner benefits because they returned to work two days after the accident and did not suffer a complete inability to carry on a normal life.

The Tribunal also held the applicant failed to prove their injuries, including alleged chronic pain and pre-existing conditions, warranted removal from the MIG.

As the MIG funding limit was exhausted, the disputed treatment plans and examination costs were not payable.

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

The respondent insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The Tribunal found that the applicant suffered from chronic pain and psychological impairments that caused functional disability, removing him from the MIG.

The Tribunal concluded that all disputed treatment plans, including chiropractic services, psychological services, and various assessments, were reasonable and necessary.

The applicant was awarded the claimed benefits and interest on overdue payments.

The respondent insurer brought a preliminary issue seeking to dismiss the applicant's claim for income replacement benefits as statute-barred.

The insurer argued that it sent a letter terminating benefits more than two years before the application was commenced.

The applicant and his counsel denied receiving the termination letter.

The adjudicator applied the discoverability principle and found that the limitation period began to run when the applicant's counsel received a subsequent letter from the insurer indicating that benefits had been stopped.

Based on this date of discoverability, the application was commenced within the two-year limitation period.

The insurer's motion to dismiss was denied, and its request for expenses was dismissed.