Dr. A. Hanick

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

The insurer denied claims for attendant care, caregiver, and housekeeping benefits, arguing the applicant's injuries were minor and her presentation was not credible.

The arbitrator found that the applicant suffered significant psycho-emotional injuries, including chronic pain syndrome and post-traumatic stress disorder, resulting in a catastrophic impairment.

The arbitrator awarded attendant care benefits at the maximum rate of $6,000 per month, caregiver benefits for her younger son, and housekeeping benefits.

A claim for home modifications was denied as the renovations were planned prior to the accident.

The arbitrator also ordered a 10% special award against the insurer for unreasonably withholding payments without adequately assessing the medical evidence.

The applicant sought ongoing income replacement benefits (IRBs) and payment for a medical assessment following a motor vehicle accident.

The insurer sought repayment of IRBs, alleging the applicant had been working full-time while claiming complete disability.

The arbitrator found overwhelming evidence, including surveillance and employment records, that the applicant had been employed full-time installing GPS units while simultaneously telling medical assessors he was completely disabled.

The arbitrator concluded the applicant obtained benefits through deliberate and material fraud.

The insurer was relieved of its obligation to pay ongoing IRBs and was awarded repayment of all IRBs paid since December 9, 2002, with interest.

The applicant's claim for the cost of a medical report was dismissed because the report was rendered useless by his intentional misrepresentations.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them, alleging failure to cooperate with a Residual Earning Capacity Designated Assessment Centre (REC DAC).

The applicant applied for arbitration, seeking ongoing IRBs and attendant care benefits.

The arbitrator found that the REC DAC did not report a failure to cooperate, meaning the insurer improperly stopped the IRBs.

On the merits, the arbitrator preferred the evidence of the applicant's medical experts, finding that the applicant suffered from a psychotic disorder and post-concussion syndrome caused by the accident, rendering him substantially unable to perform his pre-accident employment.

The insurer's allegations of malingering were rejected.

However, the claim for attendant care benefits was dismissed due to insufficient evidence of need, particularly given surveillance showing the applicant driving and taking public transit independently.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them, arguing she was no longer disabled.

The applicant sought further income replacement benefits and payment for medical and rehabilitation expenses.

The arbitrator found that the applicant was not substantially unable to perform the essential tasks of her pre-accident employment, noting her refusal to attempt a return to work and relying on the opinions of her treating physician and psychologist.

The claim for income replacement benefits was dismissed.

However, the arbitrator allowed the claim for medical and rehabilitation expenses, finding the treatments reasonable and beneficial.