Natalie Spinelli

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

The respondent insurer denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline.

The applicant challenged the denials, arguing that the respondent's notices failed to comply with the medical reasons requirement under s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that the initial denial letters for a psychological assessment, chiropractic services, and a chronic pain assessment were non-compliant, triggering the consequences under s. 38(11) and making the expenses payable until the defective notices were cured.

However, the denial for psychological treatment was found to be compliant.

The Tribunal awarded interest on the overdue benefits but declined to order an award under s. 10 of Reg. 664, finding the insurer's non-compliance was a wrong adjusting decision rather than unreasonable conduct.

The applicant sought statutory accident benefits for chiropractic treatment following a 2018 motor vehicle accident.

The respondent denied the treatment plan, arguing it was not reasonable and necessary and was related to a subsequent 2021 accident.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting a lack of contemporaneous medical evidence of ongoing impairment from the 2018 accident and relying on an insurer's examination which concluded the injuries had healed.

The application for benefits and interest was dismissed.

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

The respondent insurer denied three treatment plans, taking the position that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the respondent failed to comply with the notice requirements under s. 38(8) of the Schedule by only posting denials to the HCAI system, providing late notices, and failing to provide medical reasons.

Consequently, the applicant was removed from the MIG.

The Tribunal further found that the respondent unreasonably delayed payment of the benefits, deeming them incurred under s. 3(8).

The applicant was awarded the disputed treatment plans, interest, and a 25% award under s. 10 of Reg. 664 for the insurer's cavalier and inflexible handling of the claim.