Dr. Aiello

The applicant requested a reconsideration of a decision that dismissed her claims for catastrophic impairment and other benefits following a motor vehicle accident.

She argued the adjudicator made errors of law and fact and violated procedural fairness by misapprehending medical evidence and disregarding witness testimony.

The adjudicator dismissed the request, finding that while one minor factual omission occurred regarding the cause of the applicant's mobility issues, it would not have changed the outcome.

The adjudicator concluded that the original findings regarding the applicant's pre-existing conditions, credibility, and lack of accident-related impairments were supported by the evidence.

The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought payment for various medical and rehabilitation benefits, including a 3D mattress system, a portable modulation stimulator, naturopathic treatments, and an infrared sauna.

The respondent denied the claims primarily on the basis that the expenses were incurred prior to the submission of treatment plans (OCF-18s) or were experimental and not reasonable and necessary.

The Tribunal found that section 38 of the Schedule barred recovery for most of the expenses incurred prior to submission.

The Tribunal also accepted the respondent's expert evidence that certain treatments were experimental.

The application was allowed in part for an eye exam and specific wellness products, but the majority of the claims and the request for costs were dismissed.

Aviva appealed an arbitrator's decision that found the claimant was entitled to a medical benefit of $1,822.04 for an occupational therapy assessment.

Aviva argued the arbitrator misinterpreted the Schedule, failed to provide adequate reasons, improperly refused to qualify its doctor as an expert, and made findings of fact without evidence.

The Director's Delegate dismissed the appeal, finding the arbitrator correctly applied the law, provided sufficient reasons, properly exercised discretion in not qualifying the expert, and made factual findings supported by evidence.

Aviva was ordered to pay $7,500 in costs.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries fell outside the Minor Injury Guideline (MIG) due to a pre-existing high blood pressure condition, psychological impairment, post-concussion syndrome, and chronic pain.

The respondent denied the claims, arguing the injuries were predominantly minor.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing condition prevented maximal recovery or that he suffered from a non-minor psychological or physical impairment caused by the accident.

Consequently, the Tribunal held that the applicant's injuries fell within the MIG, limiting his entitlement to medical and rehabilitation benefits to $3,500, and dismissed his claims for attendant care benefits, various assessments, and an award for unreasonably delayed payments.

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.