Dr. B. Cook

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRB) and a psychological treatment plan.

The respondent insurer delayed paying the IRB for over a year, demanding documentation that was not required to determine eligibility, despite having received the necessary OCF-2 and OCF-3 forms.

The Tribunal found the respondent's conduct in withholding the IRB to be imprudent, stubborn, and inflexible, and ordered an award of 50% of the delayed IRB amount under s. 10 of Regulation 664.

The Tribunal also found the disputed psychological treatment plan to be reasonable and necessary, noting it was not duplicative of the applicant's psychiatric consultations, and ordered it payable with interest.

The applicant sought statutory accident benefits for psychological treatment following a motor vehicle accident.

The insurer denied two treatment plans for psychological services, relying on an insurer's examination which concluded that the applicant's symptoms were resolving and only a limited number of additional sessions were required.

The Tribunal found that the applicant failed to prove the disputed treatment plans were reasonable and necessary, noting that the applicant had already returned to normal activities and the proposed plans did not reflect his apparent improvements.

The application was dismissed, and claims for interest and a special award were consequently denied.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), medical benefits for chiropractic and psychological treatment, and an award for unreasonable delay.

The Tribunal found the applicant was not entitled to IRBs, as medical evidence and surveillance footage showing the applicant performing heavy lifting for his pre-accident employer contradicted his claim of substantial inability to work.

The claim for chiropractic treatment was dismissed as duplicative of an already approved plan.

However, the Tribunal granted the unapproved portion of the psychological treatment plan, preferring the treating providers' recommendation of 1.5-hour sessions over the insurer's examination assessor's unexplained recommendation of 1.0-hour sessions.

The claim for an award was dismissed, but interest was awarded on the overdue psychological benefit.

The applicant sought reconsideration of a Tribunal decision finding she did not prove entitlement to treatment beyond the Minor Injury Guideline (MIG).

The applicant argued the Tribunal erred in law by finding the insurer's denial notices complied with s. 38(8) and s. 38(9) of the Statutory Accident Benefits Schedule.

The Adjudicator found no error regarding s. 38(9) as the issue was not raised at the hearing.

However, the Adjudicator found a significant error of law regarding s. 38(8), as the insurer failed to provide sufficient medical reasons for denying two treatment plans.

Consequently, under s. 38(11), the insurer is prohibited from taking the position that the MIG applies and must pay for the disputed treatment plans.

The appellant sought leave to appeal a preliminary arbitration order requiring him to attend two insurer medical examinations (IMEs) to assess his entitlement to post-104 week income replacement benefits.

The Director's Delegate declined to exercise discretion under Rule 50.2 of the Dispute Resolution Practice Code to accept the appeal.

The Delegate found that the arbitrator's decision was a preliminary procedural order, and accepting the appeal would add expense and delay rather than facilitate a cost-effective resolution.

The arbitrator had properly considered the relevant criteria for IME requests, including the change in the disability test and procedural fairness, and the appeal did not raise novel or important issues warranting intervention.