Rui (Ricky) Shen

The applicant sought entitlement to statutory accident benefits for a multi-disciplinary chronic pain program and psychological services following a 2014 motor vehicle accident.

The Tribunal drew an adverse inference against the applicant for failing to comply with a production order for clinical notes and records.

The Tribunal dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary, relying instead on the respondent's insurer examinations which concluded the applicant had reached maximum medical recovery and did not suffer from a psychological impairment.

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

The insurer denied treatment plans for a psychological assessment and physiotherapy services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove his injuries warranted removal from the MIG.

However, the Tribunal held that the insurer's denial notices failed to comply with s. 38(8) of the Schedule because they did not provide adequate medical reasons or identify the specific assessments being denied.

Consequently, under s. 38(11), the insurer was prohibited from relying on the MIG to deny the specific treatment plans, and the plans were ordered payable.

The applicant's claim for an award for unreasonable delay was dismissed.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent denied the benefits because the applicant failed to submit a completed OCF-3 (Disability Certificate) within 104 weeks of the accident.

The Tribunal found that the initial OCF-3 submitted was incomplete as it was not filled out by a health practitioner.

The applicant did not provide a reasonable explanation for the delay in submitting a completed OCF-3.

The Tribunal held that the applicant is barred from proceeding with her claim for income replacement benefits.