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Applicant v. Wawanesa Mutual Insurance Company (17-005427)

  • June 1, 2018

The claimant sought entitlement to an income replacement benefit from the time the benefit was terminated approximately one year and one month following the accident onward, and entitlement to medical benefits for chiropractic services, psychological services, and custom orthotics. Adjudicator Sewrattan held that the claimant was not entitled to any of the benefits in dispute. While the claimant advanced evidence to suggest he may have required further counseling and displayed emotional difficulty during an EUO, the evidence did not prove that the claimant was unable to perform the essential tasks of his pre-accident employment. The claimant failed to prove that the chiropractic treatment plans were reasonable and necessary as the goals of the plans were not linked to the claimant’s injuries. The psychological treatment plan was not analyzed because the insurer subsequently approved more sessions of the same treatment in dispute. Lastly, Adjudicator Sewrattan held the claimant was not entitled to payment for custom orthotics because he incurred the expense before submitting a treatment plan.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Medical Benefits
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