Category: Medical Benefits

The claimant sought entitlement to a chronic pain assessment. Adjudicator Ferguson held that the insurer’s denials were compliant with section 38 of the SABS, and that the claimant had not proven that the assessment was reasonable and necessary. He noted that the claimant had reported a steady improvement in symptoms, and had returned to normal activities. The assessment was not awarded.

The claimant sought entitlement to a number of treatment plans the insurer denied. On review of the medical evidence, Adjudicator Billeh Hamud held that some of the plans were payable. The treatment plans that were denied were denied due to a lack of evidence substantiating the plans as reasonable a necessary. While the claimant sought a special award, no award was granted given that no evidence was tendered to support the claim.

The claimant sought entitlement to one treatment plan for physiotherapy services. The respondent relied upon the orthopaedic IE report of Dr. Yousif, in which he concluded that the claimant did not require further treatment. The claimant provided only two documents with his written submissions: the Motor Vehicle Accident Report prepared by the police and the OCF-18 in dispute, which provided no information with respect to the claimant’s prognosis. Adjudicator Maedel found the IE report more comprehensive and persuasive than the claimant’s evidence, given the scope and detail provided. The adjudicator concluded that the claimant was not entitled to the medical benefit, as he had not met his onus of establishing that the disputed treatment plan was reasonable and necessary.

The non-MIG claimant sought entitlement to various medical benefits and examinations. Adjudicator Maedel rejected all of the claims. He accepted the opinions of the insurer’s assessors over the claimant’s assessors due to the specificity of testing and multiple examinations of the claimant. He also wrote that the claimant’s submissions often lacked specific evidence in support of the need for the claimed medical benefits.

The claimant sought entitlement to a number of medical treatment plans. On review of the medical evidence, Adjudicator Chris Sewrattan determined that the claimant suffered from both physical and psychological impairments, and that a choice was available with respect to the modality of treatment to reduce pain. Pain relief and increasing strength were considered reasonable and necessary goals of the treatment. The treatment plans aimed at achieving these goals were awarded with interest in accordance with section 51.