2 total
Application for medical benefits dismissed as applicant failed to prove treatments were reasonable and necessary.
The applicant sought medical benefits for chiropractic, physiotherapy, and occupational therapy services following a motor vehicle accident.
The respondent denied the benefits, initially arguing the injuries fell within the Minor Injury Guideline (MIG), though it later removed the applicant from the MIG.
The Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary.
The evidence showed the applicant had returned to work and regular activities shortly after the accident, and there was insufficient current medical evidence to support the need for the proposed passive therapies and assessments months or years post-accident.
The application was dismissed.
Application for attendant care benefits dismissed; insurer did not unreasonably withhold payment.
The applicant sought attendant care benefits following a motor vehicle accident.
The respondent insurer initially paid the benefits but terminated them after an insurer's examination by an occupational therapist concluded there was no ongoing need.
The applicant argued the expenses should be deemed incurred because the respondent unreasonably withheld payment.
The Tribunal found that the respondent's reliance on its assessor's report was not unreasonable and dismissed the application, finding the applicant was not entitled to the disputed benefits.
