2 total
Application for accident benefits dismissed as ongoing physiotherapy and chiropractic treatments were not reasonable and necessary.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and chiropractic treatment plans.
The respondent insurer denied the treatment plans.
The Licence Appeal Tribunal found that the applicant failed to provide compelling contemporaneous medical evidence to support the ongoing treatment.
The applicant's medical records and the insurer's examination report indicated she had reached maximal medical recovery for her physical injuries and had successfully reintegrated into her community.
The application was dismissed, and no interest was payable.
Accident benefits claims dismissed as applicant's injuries fell within the Minor Injury Guideline.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied funding for a psychological assessment and physiotherapy treatment.
The Tribunal found that the applicant sustained predominantly minor injuries, relying on the insurer's examination reports which outweighed the applicant's chiropractic assessment.
The Tribunal dismissed the claims for treatment plans as they fell outside the MIG, denied payment for pre-screening invoices because they were incurred prior to submission, and denied interest as no payments were overdue.
