Charles D. Matheson

The applicant was injured in a motor vehicle accident and sought accident benefits from the insurer.

The insurer denied a medical benefit of $1,822.04 for an occupational therapy treatment plan, arguing the applicant's injuries fell within the Minor Injury Guidelines (MIG).

The arbitrator found that the insurer had sufficient medical information, including hospital records indicating a concussion, to remove the applicant from the MIG much earlier.

The arbitrator refused to qualify the insurer's medical examiner as an expert and concluded the treatment plan was reasonable and necessary.

The applicant was awarded the medical benefit and interest, but the claim for a special award was dismissed as the insurer's conduct did not rise to the required level of unreasonableness.

The Applicant sought a determination that he sustained a catastrophic impairment due to a mental or behavioural disorder following a motor vehicle accident.

The Insurer argued his impairment was only moderate (Class 3).

The Arbitrator preferred the evidence of the Applicant's expert, who conducted a robust 14-hour assessment including collateral interviews and cognitive testing, over the Insurer's experts whose assessments were brief and lacked collateral information.

The Arbitrator found that the Applicant's chronic pain and psychological conditions significantly impeded his useful functioning, meeting the criteria for a Class 4 Marked Impairment.

The Applicant was deemed catastrophically impaired.

The applicant, a minor injured in a motor vehicle accident, sought attendant care benefits for care provided by her father and stepmother.

The insurer paid the benefits but deducted 30% from the claimed economic loss, arguing that the Schedule only indemnifies 'net' income loss, not 'gross' wages.

The arbitrator held that the Schedule does not define 'economic loss' or provide a formula for deducting statutory payroll deductions.

The arbitrator found the insurer's arbitrary 30% deduction was incorrect and unreasonable, ordering the insurer to pay the overdue amount of $1,791.11, plus interest, a 35% special award, and the applicant's arbitration expenses.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries fell outside the Minor Injury Guidelines (MIG) due to chronic pain and psychological impairments.

The arbitrator found the applicant lacked credibility, having provided inconsistent and inaccurate information to various medical assessors, including failing to disclose a subsequent eye surgery.

The arbitrator concluded the applicant did not prove his injuries fell outside the MIG.

Consequently, the claims for multidisciplinary treatment plans and a psychological assessment were dismissed.

The applicant was also ordered to repay an erroneous payment of $135.60 to the insurer.

The Applicant was injured in a motor vehicle accident and received Non-Earner Benefits until the Insurer terminated them on November 30, 2011, issuing an Explanation of Benefits (OCF-9) on November 23, 2011.

The Applicant applied for mediation on March 13, 2014, beyond the two-year limitation period.

The Applicant argued the OCF-9 was invalid because it cited the wrong section of the Statutory Accident Benefits Schedule.

The Arbitrator held that the refusal was clear, unequivocal, and sufficient to trigger the limitation period, as perfection is not required.

The Applicant is therefore statute-barred from proceeding to arbitration for further Non-Earner Benefits.

The Applicant was injured in a motor vehicle accident and sought various statutory accident benefits.

The Insurer terminated Income Replacement Benefits, Housekeeping and Home Maintenance Benefits, and denied several treatment plans and assessments.

The Applicant applied for arbitration, and the Insurer raised a preliminary issue that the claims were statute-barred due to the expiry of the two-year limitation period.

The Arbitrator found that the Insurer provided valid termination notices for the Income Replacement Benefits, Housekeeping Benefits, and Dr. Houston's treatment plan, making those claims statute-barred.

However, the Arbitrator found that the Insurer failed to provide sufficient reasons for denying the Social Work and Psychological Assessments, rendering those denials invalid and allowing the Applicant to pursue them at arbitration.