Dr. Hershberg

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued his injuries were severe and that a pre-existing back condition precluded his recovery within the MIG limits.

The Tribunal found the applicant's medical evidence, which included sporadic visits to his general practitioner and a failure to act on referrals, insufficient to prove his injuries fell outside the MIG.

The Tribunal preferred the reports of the respondent's independent medical assessors, who concluded the applicant's physical and psychological injuries were treatable within the MIG.

The application for treatment plans beyond the $3,500 limit and for an award under s. 10 of O. Reg. 664 was dismissed.

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

The respondent denied certain benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor, preferring the evidence of the respondent's independent medical examiners over the applicant's assessors.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant failed to establish a complete inability to carry on a normal life, as his pain was manageable and did not practically prevent him from engaging in his pre-accident activities.

The application was dismissed.

The applicant sought to vary a previous arbitration order to increase his attendant care benefits to cover 24/7 care, alleging a material change in circumstances due to worsening mental and physical health following a 2003 motor vehicle accident.

The Director's Delegate found that while the applicant's mental and behavioural disorders had worsened, constituting a material change, he was far less disabled than he presented.

Relying on surveillance evidence and the respondent's occupational therapist, the Delegate concluded that 24/7 care was not reasonable or necessary, as the applicant did not pose a danger to himself or others and demonstrated independent functionality.

The Delegate increased the attendant care benefits to $1,445.75 per month to account for increased emotional support and cuing needs, but dismissed the claim for a special award.

The applicant sought to vary a previous arbitration order to increase his attendant care benefits to provide for 24/7 care, alleging a material change in circumstances due to worsening mental and behavioral disorders following a 2003 motor vehicle accident.

The Director's Delegate found a material change in circumstances based on a new anxiety disorder diagnosis and worsening psychological symptoms, but rejected the need for 24/7 care, relying on surveillance evidence and an occupational therapist's assessment showing the applicant was less disabled than claimed.

Attendant care benefits were increased to $1,445.75 per month to account for additional emotional support and cuing.

The claim for a special award was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and the cost of a psychological assessment.

The adjudicator found that the applicant failed to prove that her inability to work was caused by the accident, noting significant pre-accident and post-accident medical issues unrelated to the collision.

The adjudicator accepted the respondent's medical assessments that the applicant could perform the essential tasks of her pre-accident employment.

While the adjudicator found the psychological assessment was necessary, the claim was dismissed because the applicant failed to prove the proposed fees were reasonable under the Professional Services Guideline.

The application was dismissed.

The plaintiff, Beate Nkunda-Batware, was awarded $418,330 by a jury in a motor vehicle personal injury action.

The defendants brought a threshold motion, arguing that the plaintiff's injuries did not meet the statutory exceptions under subsections 267.5(3) and (5) of the Insurance Act, requiring a "permanent, serious impairment of an important, physical, mental or psychological function." The court found that the plaintiff, a "thin skull" individual with a pre-existing predisposition to depression, suffered whiplash injuries that evolved into a chronic pain syndrome directly caused by the accident.

The court preferred the plaintiff's medical experts and concluded that the plaintiff's impairments were permanent and serious, substantially interfering with her employment and daily functioning.

The defendants' threshold motion was dismissed.

The applicant was seriously injured in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder.

The insurer argued that her marked impairment was a manifestation of malingering or factitious disorder, pointing to an initial period of improvement followed by deterioration.

The arbitrator reviewed extensive medical and lay evidence, finding that the applicant's current presentation of severe depression, anxiety, and pain focus was a direct result of the accident.

The arbitrator rejected the insurer's allegations of malingering, noting the lack of pre-existing conditions and the consistency of the applicant's presentation over time.

The arbitrator concluded the applicant suffered a catastrophic impairment.