The claimant had sustained a catastrophic impairment and sought entitlement to rehabilitation benefits funding a trip to Florida and Disney World. Adjudicator Lester held that the proposed treatment did not fall within the scope of activities set out in section 16 of the SABS, and dismissed the claim.
The claimant sought an order for NEBs, and medical benefits. As a preliminary issue, the insurer sought the exclusion of documents not produced in accordance with the Case Conference Order. Adjudicator Truong held that the Tribunal could set deadlines that were more stringent than those in the LAT Rules. The documents were excluded and the claims for NEBs and medical benefits were dismissed.
The claimant sought entitlement to NEBs and two medical benefits. Adjudicator Bass denied all claims as not meeting the requisite test for entitlement.
The claimant sought entitlement to medical benefits and removal from the MIG. Adjudicator Leslie concluded that the insurer had not complied with section 38 of the SABS in the denial timeline, and that the insurer was therefore prohibited from taking the position that the MIG applied. One of the claimed treatment plans was awarded.
The claimant sought entitlement to further medical benefits. Adjudicator Bass concluded that no further passive therapy was reasonable and necessary, and that the claimant did not require further psychological treatment.
The claimant sought IRBs and medical marijuana. The adjudicator dismissed the IRBs claim because the claimant had refused to provide post-accident income records. The claim for medical marijuana was dismissed because the claimant did not provide a proper “medical document” supporting the need for medical marijuana. The term “medical document” is defined in the federal Marihuana for Medical Purposes Regulations.
The claimant sought entitlement to three medical benefits. As a preliminary issue, the insurer sought exclusion of the claimant’s submissions due to late filing. Adjudicator Treksler held that a large and liberal interpretation of Rule 3.1 allowed the late filing of submissions in this case. The adjudicator found the disputed treatment plans reasonable and necessary.
The claimant sought entitlement to two medical benefits. Adjudicator Sewrattan dismissed the claim. He wrote that reports in favour of a treatment plan failed to provide sufficient detail explaining why the specific treatment request was reasonable and necessary. Simply showing a treatment is “necessary” was not enough. More was required to discharge the claimant’s onus.
Following an accident, the self-employed claimant stopped operating his business in January 2016. Adjudicator Sewrattan concluded that the IRB calculation could not take into account business losses, as the claimant did not have business losses (as calculated by the Income Tax Act) after he ceased operations of his business. In terms of medical benefits, the adjudicator concluded that the claimant’s injuries did not fall in the MIG and wrote that pain reduction is a valid goal when assessing whether a treatment plan is reasonable and necessary.
The claimant sought entitlement to six treatment plans. Adjudicator Sewrattan adopted FSCO case law on the legitimacy of pain relief being a reasonable and necessary goal of treatment, and awarded all six treatment plans. The adjudicator also rejected the insurer’s position that surveillance could accurately capture the sensation of pain.
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Toronto, Ontario M5H 3S5
416.507.1850
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850