Demetrios Kostadopoulos

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied several treatment plans, including requests for physiotherapy, occupational therapy, and various assistive devices such as a Kubota tractor, a lawn mower, and car repair tools.

As a preliminary issue, the adjudicator found the applicant was barred from disputing the treatment plan for the Kubota tractor under s. 55(1)2 of the Schedule because he failed to attend two reasonably necessary s. 44 insurer's examinations.

On the substantive issues, the adjudicator approved the physiotherapy treatment plan, finding it reasonable and necessary for pain relief despite the applicant's condition having plateaued.

The adjudicator also partially approved treatment plans for occupational therapy preparation time and knipex pliers to assist with car repairs.

The remaining claims for a mattress, a vehicle lift, an adjustable rolling creeper, and a John Deere lawn mower were dismissed for lack of sufficient medical evidence establishing their necessity.

The applicant sought a determination of catastrophic impairment following a motor vehicle accident.

The respondent scheduled psychological and occupational therapy insurer's examinations (IEs).

The applicant attended both, but the psychologist passed away before finalizing his report, and the applicant declined to participate in the situational portion of the occupational therapy IE.

The respondent scheduled a second set of IEs, which the applicant refused to attend.

The Tribunal found that a second in-person psychological IE was not reasonably necessary, as the respondent possessed the draft report and raw data.

However, the Tribunal found the situational occupational therapy assessment was reasonably necessary.

The Tribunal stayed the proceeding until the applicant complied with the situational assessment requirement.

The applicant was struck by a pickup truck while riding his bicycle, sustaining severe injuries to his left heel and ankle.

He applied for a determination of catastrophic impairment, which the insurer denied.

At arbitration, the arbitrator preferred the evidence of the applicant's experts, finding that his need for two crutches and a short leg brace resulted in a 55% Whole Person Impairment under the AMA Guides.

Furthermore, the arbitrator accepted that the applicant's chronic pain and depression resulted in a Class 4 marked impairment in at least one area of functioning.

The arbitrator concluded that the applicant sustained a catastrophic impairment under both paragraphs 2(1.2)(f) and (g) of the Schedule.