Deedra-Ann Lake

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline.

The matter proceeded to a written hearing.

The applicant failed to file any submissions or evidence, despite multiple notices from the Tribunal.

Proceeding in the applicant's absence under section 7(2) of the Statutory Powers Procedure Act, the adjudicator dismissed the application in its entirety, finding the applicant failed to meet her evidentiary burden to establish entitlement to the claimed benefits.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The Tribunal found that two of the treatment plans in dispute were barred by the doctrine of res judicata as they had been previously decided.

For the remaining claims submitted via OCF-6 forms, the Tribunal awarded $1,571.13 for massage, personal training, and osteopathic services, applying the Professional Services Guideline rate despite the absence of an approved OCF-18, as the treatments were for symptom relief during a denial period.

The Tribunal also awarded $346.20 for another OCF-6, limited to the remaining balance of a previously approved treatment plan.

The Tribunal granted a special award under s. 10 of O. Reg. 664 for the respondent's unreasonable delay in adjusting one of the OCF-6 claims, along with interest on overdue payments.

The applicant sought an income replacement benefit and funding for a physiotherapy treatment plan following a motor vehicle accident.

The respondent raised a preliminary issue that the applicant was barred from proceeding for failing to attend insurer's examinations.

The Tribunal found the respondent's notices of examination were non-compliant with the Schedule, allowing the hearing to proceed.

On the substantive issues, the Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of her employment due to inconsistencies in her evidence regarding her return to work.

The Tribunal also denied the treatment plan as the applicant failed to provide goals or corroborating medical evidence to establish it was reasonable and necessary.

The respondent insurer requested reconsideration of a decision granting the applicant entitlement to certain treatment plans and expenses.

The insurer argued the Tribunal erred in law by approving a massage therapy rate above the guideline maximum and by ordering reimbursement for expenses incurred before treatment plans were submitted.

The Tribunal dismissed the first ground, noting the insurer failed to raise the hourly rate issue in the original hearing.

However, the Tribunal granted reconsideration on the second ground, finding it erred in law by violating s. 38(2) of the Schedule.

The decision was varied to deny reimbursement for expenses incurred prior to the submission of the relevant treatment plans.

The applicant was injured in a motor vehicle accident and sought $2,456.20 for a chiropractic treatment plan under the Statutory Accident Benefits Schedule.

The respondent insurer denied the plan based on an insurer's examination report.

The Tribunal found the treatment plan was reasonable and necessary, placing significant weight on the clinical notes of the applicant's physiatrist and rehabilitation consultant, which confirmed the applicant derived benefit from the treatments.

The Tribunal ordered the respondent to pay the treatment plan along with interest on overdue amounts.

The applicant sought entitlement to statutory accident benefits for physiotherapy, massage therapy, and osteopathy following a motor vehicle accident.

The respondent denied the benefits based on an insurer's examination report which concluded further facility-based treatment would not provide improvement.

The Tribunal found the treatment plans reasonable and necessary, preferring the evidence of the applicant's treating practitioners who noted the treatments provided pain relief and functional maintenance.

The Tribunal granted entitlement to the treatment plans and certain incurred expenses, along with interest, but dismissed the claim for an award under s. 10 of Reg. 664, finding the respondent's reliance on its medical assessment was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the respondent insurer.

The respondent scheduled an insurer's examination under section 44 of the Schedule, which the applicant failed to attend on three separate occasions.

The Tribunal found that the notices of examination were compliant with section 44(5) and that the applicant failed to provide a reasonable explanation for his non-attendance.

Consequently, pursuant to section 55(1)2 of the Schedule, the applicant is barred from proceeding with his application to the Tribunal.