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Applicant entitled to various medical benefits and a special award for insurer's unreasonable denials.
The applicant, who sustained a catastrophic impairment in a 2017 motor vehicle accident, sought attendant care benefits (ACBs) and various medical and rehabilitation benefits.
The Tribunal found the applicant entitled to ACBs for specific periods based on his psychological impairments, but held the benefits were not payable because the applicant failed to prove they were incurred.
The Tribunal partially approved treatment plans for social work, aquatherapy, concussion treatment, and a home renovation assessment, while denying others that were reasonably available through OHIP.
The Tribunal ordered Aviva to pay a special award of $9,041.12 under s. 10 of Regulation 664, finding that the insurer acted unreasonably and in bad faith by pre-emptively denying treatment plans and failing to comply with procedural timelines.
Application for catastrophic impairment dismissed; chiropractor not qualified to make determination and surveillance contradicted claimed impairments.
The applicant sought a determination of catastrophic impairment under Criterion 6 of the Statutory Accident Benefits Schedule following a motor vehicle accident.
The applicant relied on a revised assessment by an orthopedic surgeon, which incorporated a whole person impairment rating from a chiropractor.
The Tribunal found the chiropractor was not qualified to make a catastrophic impairment determination and gave little weight to the revised assessment.
Relying on the respondent's orthopedic assessment and surveillance evidence showing the applicant functioning without walking aids, the Tribunal concluded the applicant did not meet the 55% whole person impairment threshold.
The application was dismissed, and no award for unreasonable delay was granted.
Father's motion for interim primary residence based on parental alienation dismissed due to highly contested facts.
The moving party father brought a motion for interim primary residential care of the parties' three children, alleging that the responding party mother had alienated the children from him following a child protection intervention.
The mother and the Office of the Children's Lawyer opposed the motion, arguing that the children wished to remain with the mother and that a forced separation could be traumatic.
The court dismissed the father's motion, finding that the facts regarding the family's history and the allegations of alienation were highly contested and could not be resolved on a written record alone.
The court maintained the status quo of the mother having interim sole custody, ordered reunification counselling, and expedited the matter for trial.
Insurer's defective notice precluded MIG reliance, but treatment plan denied as not reasonable and necessary.
The applicant sought statutory accident benefits following a rear-end motor vehicle collision.
The insurer denied a $5,185 treatment plan for chiropractic services on the basis of insurer examinations.
The Tribunal found that the insurer's denial notice failed to comply with s. 38(8) of the SABS because it did not state whether the MIG applied, precluding the insurer from relying on the MIG limit.
However, the Tribunal concluded the proposed treatment was not reasonable and necessary, preferring the evidence of the insurer's assessors that the applicant's accident-related injuries had resolved and his ongoing complaints stemmed from pre-existing degenerative disc disease.
Due to the defective notice, the insurer was ordered to pay any amounts the applicant had already expended on the treatment plan.
Sexual harassment complaint dismissed as allegations of sexual advances and offensive behaviour were unproved.
The complainant alleged that her employer sexually harassed her by making sexual advances, touching her inappropriately, and engaging in offensive verbal behaviour.
The Board of Inquiry dismissed the complaint, finding the complainant's testimony to be uncorroborated and inconsistent.
The Board preferred the respondent's evidence, concluding that while the workplace language was occasionally coarse, no sexual solicitation or harassment occurred.