Dr. Adrian Joaquin

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for caregiving, housekeeping, attendant care, and medical treatments.

The insurer denied most of the claims, citing discrepancies in the evidence and surveillance footage that contradicted the applicant's reported limitations.

The arbitrator found the applicant and her husband lacked credibility, noting significant inconsistencies between their testimony, the submitted invoices, and the surveillance evidence.

The claims for caregiver, housekeeping, and attendant care benefits were dismissed due to insufficient reliable evidence that the expenses were incurred or that the applicant met the test for substantial inability.

The arbitrator partially allowed the claim for medical benefits, awarding $2,384.59 for treatment plans that were deemed reasonable and necessary or were deemed approved due to the insurer's failure to respond.

The claim for a special award was dismissed as the insurer did not unreasonably withhold payments.

The applicant sought statutory accident benefits following a motor vehicle accident, including medical benefits, housekeeping expenses, and the cost of a functional abilities evaluation.

The insurer denied the claims, arguing that the applicant's ongoing impairments were caused by a subsequent workplace assault and robbery, not the motor vehicle accident.

The arbitrator dismissed the application, finding that the medical documentation contemporaneous with the workplace assault attributed the applicant's injuries to that event.

The arbitrator concluded that the disputed treatment plans and assessments were not reasonable or necessary, and the applicant failed to prove a substantial inability to perform pre-accident housekeeping tasks as a result of the motor vehicle accident.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied her claims for income replacement, medical, attendant care, and housekeeping benefits.

At arbitration, the arbitrator found that the applicant's injuries, which included her left hand, wrist, and knee, took her impairments outside the Pre-Approved Framework Guideline.

The arbitrator awarded income replacement benefits for a specific period of disability, medical benefits for chiropractic and physiotherapy treatment, and attendant care and housekeeping benefits, finding the expenses were reasonable, necessary, and adequately supported by medical evidence.

Interest was also awarded on the overdue benefits.

The applicant sought statutory accident benefits for caregiving, housekeeping, and medical expenses following a motor vehicle accident.

The arbitrator dismissed the claims, finding the applicant's evidence regarding his inability to perform housekeeping and caregiving tasks lacked credibility, particularly given his continued full-time employment as a transport truck driver and surveillance evidence showing him performing activities he claimed he could not do.

The arbitrator preferred the insurer's medical expert, concluding the applicant's injuries did not warrant treatment beyond the Pre-Approved Framework.

The applicants, a mother and daughter, were injured in a motor vehicle accident and sought statutory accident benefits from their insurer.

The insurer denied further medical treatment, housekeeping benefits, and the cost of in-home assessments.

The arbitrator found that the insurer's procedural breaches in denying the treatment plans did not automatically entitle the applicants to the benefits.

The arbitrator denied the majority of the claimed medical benefits, preferring the opinions of the Designated Assessment Centres that further facility-based passive treatment was not reasonable and necessary.

The daughter was awarded a small amount for a home exercise program and an unpaid balance of an uncontradicted treatment plan.

The mother was awarded housekeeping benefits at a reduced rate for a limited period, but the daughter's housekeeping claim was denied due to lack of evidence that she performed such duties pre-accident.

The claims for in-home assessments were denied as they were conducted at a residence where the applicants did not live at the time.