The claimant sought entitlement to medical treatment plans. The insurer denied payment and maintained a MIG defense. On review of the evidence, Adjudicator Rebecca Hines determined the claimant did not provide compelling evidence to warrant removal from the MIG. It was also noted the claimant did not consume treatment previously approved. Accordingly, the treatment plans were found not payable.
The claimant sought entitlement to medical treatment plans. The insurer denied payment and maintained a MIG defense. On review of the evidence, Adjudicator Rebecca Hines determined the claimant did not provide compelling evidence to warrant removal from the MIG. It was also noted the claimant did not consume treatment previously approved. Accordingly, the treatment plans were found not payable.
The claimant sought entitlement to a treatment plan in which the claimant and her attendant care provider would fly to Iran to visit family. The insurer denied the benefit as not being reasonable as contemplated under section 16. Adjudicator Chris Sewrattan agreed with the insurer. A two-person trip to Iran was considered outside the scope of the rehabilitative process. Moreover, transportation as contemplated by the section was for the purpose of going “to and from counselling and training sessions” and not for any type of psychological benefit of seeing family abroad.
The claimant suffered a non-minor injury and sought entitlement to one treatment plan for physiotherapy. The insurer argued that the treatment was not reasonable and necessary. As a preliminary issue, the insurer argued that the claimant submitted her materials to the LAT four days late, and that the materials should be excluded. Adjudicator Hines allowed the materials to be considered, reasoning that no prejudice was suffered by the insurer, and the hearing was being held in writing. In terms of the treatment claim, Adjudicator Hines concluded that the treatment was not reasonable and necessary for multiple reasons: first, the claimant was relying on outdated medical assessment; second, one would expect injuries and symptoms to improve over time; third, a diagnosis of chronic pain does not automatically entitle an insured to unlimited treatment without proving an ongoing impairment; and fourth, the insurer’s IE assessment was more current and demonstrated the claimant’s improvement over the five years since the accident.
The claimant sought entitlement to medical benefits. The insurer asserted a MIG designation. On review, Adjudicator Sewrattan determined that the pre-existing back pain of the claimant would not prevent recovery under the MIG. The claimant’s injuries were deemed minor and the treatment plans were denied.
The claimant sought entitlement to non-earner benefits and 11 treatment plans. On review of the medical evidence, Adjudicator Hines awarded five treatment plans. Additionally, Adjudicator Hines ruled that the mere filing of a disability certificate was insufficient to demonstrate entitlement to non-earner benefits; NEBs were denied.
The claimant sought entitlement to medical benefits. At the outset, the insurer sought a dismissal of the claimant’s application for arbitration based on non-compliance with disclosure requirements. Adjudicator Ferguson noted there was no authority under Rule 9 of the LAT Rules to dismiss an application for failing to comply with Tribunal disclosure rules. Moreover, the insurer failed to demonstrate how non-disclosure by the claimant would cause prejudice. On the merits, Adjudicator Ferguson held the treatment plans claimed were reasonable and necessary.
The claimant sought entitlement to income replacement benefits and three treatment plans. The insurer advanced a limitations defence. Vice Chair Flude noted there was no evidence presented to refute the validity of the insurer’s denials. The notices were deemed compliant with the requirements of Smith v Co-Operators and the claimant was considered outside of the limitations period. The application for arbitration was dismissed.
The claimant sought entitlement to four medical treatment plans. At the hearing the claimant also sought to add a claim for a special award and interest. On review, Adjudicator Bickley refused to allow the additional issues. After examining the medical evidence, one treatment plan was found reasonable and necessary. Because the treatment plan was originally partially approved up to MIG limits, the subsequent removal from the MIG precluded the insurer from taking the position the plan was unreasonable. The rest of the claims, however, were dismissed on the merits.
The claimant sought removal from the MIG and entitlement to five treatment plans based on a spinal compression fracture identified two years after the accident. The insurer argued that the claimant had not proven that the compression fracture was related to the accident. Adjudicator Shapiro agreed with the insurer and concluded that the claimant had not met his onus of proof in demonstrating that the fracture was accident-related.
150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP Disclaimer | Privacy Policy | Statement of Principles
Subscribe to get TGP’s case summaries straight to your inbox
Subscribe to get TGP’s case summaries straight to your inbox
150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP