Dr. Cobrin

Certas Home and Auto Insurance Company appealed an arbitration decision regarding loss transfer indemnification from Intact Insurance Company for statutory accident benefits paid to an insured.

The arbitrator found Certas had grossly mishandled the claim by failing to follow its own adjusting plan and continuing benefits despite medical opinions and the insured's completion of vocational training.

The Superior Court of Justice upheld the arbitrator's decision, finding no palpable and overriding error in the arbitrator's conclusion that Certas grossly mismanaged the claim, thereby limiting Intact's indemnification obligation.

The applicant was injured in a motor vehicle accident and sought payment for two chiropractic treatment plans totaling approximately $7,100.

The respondent insurer denied the plans, arguing the applicant had reached maximum recovery and further facility-based treatment was not medically indicated.

The Tribunal found the treatment plans were reasonable and necessary, preferring the clinical records of the applicant's treating family physician over the respondent's independent medical assessors.

The Tribunal noted the applicant experienced ongoing pain that improved with physical therapy.

The applicant was awarded entitlement to both treatment plans with interest.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

The respondent insurer removed the applicant from the Minor Injury Guideline (MIG) due to psychological impairments but denied several treatment plans.

The Tribunal found that the physical treatment plans were not reasonable and necessary as the physical injuries were predominantly minor.

However, the Tribunal approved the psychological treatment and assessments at reduced rates in accordance with the Professional Fee Guideline, and approved a chronic pain assessment to investigate the connection between the applicant's subjective pain and psychological diagnoses.