Dr. Rajgopal

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 sought entitlement to various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident, including a massaging bathtub, a lightweight vacuum cleaner, physiotherapy, massage therapy, and a BrainEx group therapy program.

The respondent denied the treatment plans on the basis that they were not reasonable and necessary.

The Tribunal dismissed the application, finding that the applicant failed to meet her burden of proof.

The Tribunal preferred the objective medical evidence of the respondent's assessors, noting that the applicant's ongoing symptoms were largely attributable to pre-existing conditions such as fibromyalgia and chronic migraines, and that the requested treatments were either excessive in cost, unsupported by medical evidence, or unnecessary given the applicant's medical history.