The claimant sought entitlement to a psychological assessment. Adjudicator Norris held that the proposed assessment was reasonable and necessary. He relied upon the claimant’s consistency of reporting, prescription for antidepressants, and more than one medical practitioner opining that the claimant may suffer a psychological disorder.
The claimant sought entitlement to ongoing NEBs and two proposed treatment plans for physiotherapy. Adjudicator Baker denied entitlement to NEBs but awarded the treatment plans. In terms of NEBs, Adjudicator Baker wrote that the claimant had submitted only limited evidence about his pre-accident and post-accident life, which did not support entitlement to NEBs. He also wrote that the activities set out in the insurer’s IE (as reported by the claimant) suggested that the claimant did not suffer a complete inability to live a normal life. In terms of the treatment plans, Adjudicator Baker held that further physical therapy was reasonable and necessary for the claimant’s soft tissue pain particularly given that it allowed the claimant to be more active in her day to day tasks.
The claimant disputed his entitlement to income replacement benefits (IRBs), medical benefits and the MIG. Adjudicator Treksler concluded that the claimant’s injuries fell outside of the MIG due a post-accident psychological impairment and diagnosis of chronic pain syndrome. In her reasons, Adjudicator Treksler noted that she preferred the evidence of the claimant’s family physician to the IE assessors and concluded that there was sufficient evidence in the claimant’s clinical notes and records of a psychological impairment and chronic pain syndrome to warrant the claimant’s removal from the MIG. Adjudicator Treksler also found that the disputed psychological assessment was payable. With respect to his dispute over IRBs, Adjudicator Treksler concluded that the claimant met the pre-104 week IRB disability test. Adjudicator Treksler noted that the claimant’s pre-accident employment was physical in nature and concluded that she preferred the s. 25 assessors’ conclusions that the claimant could not return to work to the opinions of the s. 44 assessors.
The claimant sought entitlement to two treatment plans for dental work. Adjudicator Gosio rejected both claims. He held that the claimant had not submitted medical evidence in support of the claim (such as clinical notes and records, medical reports, or the treatment plans themselves) and that his counsel’s submissions were not evidence. Adjudicator Gosio also noted that the claimant’s dental pain appeared to have started four years prior to the motor vehicle accident.
The claimant sought removal from the MIG and entitlement to one treatment plan. Adjudicator Anwar held that the claimant’s suffered pre-existing conditions that would prevent maximal recovery under the MIG and development of chronic pain. He relied upon the expert reports completed for the claimant, which detailed pre-existing injuries. The insurer argued that the Tribunal could not remove the claimant from the MIG without actually receiving and reviewing the clinical records from the claimant’s physician (which had not been provided to the insurer either). Adjudicator Anwar disagreed with the insurer, and wrote that the claimant’s experts had sufficiently detailed the pre-existing issues. He also noted that the insurer had not made any attempt to obtain the claimant’s clinical notes and records at any point (including the Case Conference). The adjudicator did not award the claimed treatment plan because the claimant did not explain what made the passive treatment reasonable and necessary, particularly given the claimant’s failure to respond to earlier passive treatment.
The claimant sought removal from the MIG and entitlement to two treatment plans. Adjudicator Sewrattan concluded that the claimant suffered minor injuries in the accident. He wrote that neither of the claimant’s experts had diagnosed the claimant with a psychological disorder or chronic pain. He also held that the insurer’s denials satisfied the requirements of section 38 of the SABS. Adjudicator Sewrattan went on to state that he would not have awarded the claimed treatment plans because the claimant did not suffer a psychological disorder, and the treatment plan for chronic pain did not specify what the goals of the proposed treatment were.
The claimant sought entitlement to a medical treatment plan. Adjudicator Derek Grant reviewed the medical evidence and noted that the mere submission of a treatment plan is not enough to establish entitlement. Rather, supporting medical documentation, recommending the treatment sought is critical. In this matter, the claimant failed to provide the necessary supporting evidence and as a result, the treatment plan was found not payable.
The claimant sought entitlement to a treatment plan. The insurer denied payment and asserted a MIG designation. The claimant countered and argued the insurer failed to respond to the treatment plan within the prescribed time. Adjudicator Brian Norris reviewed the chronology of events and determined the insurer had responded to the treatment plan in time. Adjudicator Norris also determined that the claimant’s impairments were minor and that no pre-existing conditions warranted removal from the MIG. The claims were dismissed.
The claimant sought entitlement to income replacement benefits as well as psychological treatment plans. The insurer denied IRBs and asserted the claimant’s inability to resume working was due to a pre-existing injury and not an MVA-related impairment. The psychological treatment was denied by the insurer as being not reasonable and necessary. Adjudicator Deborah Neilson reviewed the medical evidence and noted that neither party tendered evidence from medical practitioners that addressed the claimant’s pre-existing conditions. Moreover, the claimant did not testify. Accordingly, it was held that the claimant failed to establish her impairments were directly as a result of the accident and prevented her from working. In the alternative, Adjudicator Neilson determined that the claimant failed to establish that she was substantially unable to resume working. As it pertained to the claim for psychological treatment, Adjudicator Neilson found that the treatment plan was necessary to address the claimant’s issues; however, based on the fees listed by the provider the plan was deemed unreasonable and therefore not payable.
The claimant sought entitlement to a number of medical benefits, as well as income replacement and attendant care benefits. The insurer denied entitlement and also asserted a MIG position. Adjudicator Christopher Ferguson reviewed the medical evidence and determined that no compelling evidence was tendered by the claimant to support entitlement to any of the benefits claimed. The MIG was said to govern the claimant’s impairments and the matter dismissed.
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416.507.1850