The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of attendant care benefits and several treatment plans for physiotherapy and a gym membership.
The Licence Appeal Tribunal found the applicant was not entitled to attendant care benefits because the expenses were not incurred and the required Form 1 was not submitted prior to the claim period.
The Tribunal granted three of the disputed physiotherapy treatment plans, finding one payable due to the insurer's failure to provide medical reasons for denial under s. 38(8) of the Schedule, and two others reasonable and necessary based on medical evidence of ongoing shoulder limitations.
The remaining treatment plans were dismissed as the applicant failed to meet the evidentiary burden to prove they were reasonable and necessary.
