Category: Medical Benefits

The claimant sought entitlement to two treatment plans. The insurer denied the plans and asserted neither was reasonable and necessary. The claimant also asserted that the IEs commissioned should have been paper reviews, and therefore not applicable to the insurer’s determination. Adjudicator Christopher Ferguson, on review of the medical evidence, determined that neither treatment plan was reasonable and necessary. The assertion that a paper review IE should have been commissioned, rather than in-person examination, was also rejected.

The claimant sought entitlement to treatment in the form of physical rehabilitation and acupuncture services. Adjudicator Cezary Paluch reviewed the medical evidence and determined that the injuries asserted by the claimant were as a result of the accident. On further review, the treatment sought was also deemed reasonable and necessary; the claims were found payable with applicable interest.

The claimant sought entitlement to three medical benefits for physiotherapy and chiropractic treatment. After reviewing the available medical evidence, Adjudicator Fricot held that the requested treatment plans were not reasonable and necessary. More specifically, the claimant’s accident-related injuries had largely resolved, and Adjudicator Fricot determined that further treatment was not warranted.

The claimant sought entitlement to two chiropractic treatment plans as well as an attendant care assessment. The insurer denied the claims and asserted none were reasonable and necessary. Adjudicator Marisa Victor determined that the claimant failed to provide sufficient medical evidence to establish the treatment plans were reasonable and necessary. Adjudicator Victor also favoured the medical evidence tendered by the insurer, and deemed an attendant care assessment not reasonable. The claims were dismissed.

The claimant sought entitlement to eight treatment plans for various physical and psychological treatment and assessments. Adjudicator White denied entitlement to all of the claims. She held that the claimant had sustained relatively minor injuries in the accident. She was critical of the claims for in-home treatment and the proposal for various assistive devices as not being supported by any evidence. She accepted the recommendations of the insurer’s assessors that further treatment was not reasonable and necessary.