Dr. Chizen

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

The respondent denied several treatment plans and expenses on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant's physical injuries were soft tissue in nature and that she failed to establish removal from the MIG on the basis of chronic pain or psychological impairment.

The Tribunal preferred the respondent's section 44 psychological assessment over the applicant's section 25 assessment.

As the applicant remained within the MIG, the disputed treatment plans and expenses were not payable.

Both parties appealed an Arbitrator's decision regarding statutory accident benefits following a motor vehicle accident.

The Director's Delegate found that the Arbitrator breached procedural fairness by failing to provide adequate reasons for awarding attendant care, housekeeping, medical/rehabilitation benefits, and the cost of assessments.

The Delegate upheld the Arbitrator's finding that the accident caused the insured's shoulder injury and the award of income replacement benefits, but found no evidentiary basis for limiting the benefits to a three-month post-surgery period.

The Delegate also found the Arbitrator's dismissal of a special award to be self-contradictory given the finding that the insurer unreasonably withheld benefits.

The unsupported and unreasoned portions of the decision were rescinded and remitted for rehearing.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, attendant care, and housekeeping benefits.

The insurer denied the benefits, arguing the accident was not severe enough to cause the impairments.

The Arbitrator found that the applicant's shoulder tear was caused by the accident and required surgery.

The Arbitrator awarded income replacement, housekeeping, and attendant care benefits for a fixed period surrounding the surgery and recovery, as well as medical benefits and costs of examinations.

The claim for a special award was dismissed because the insurer's initial denial was based on inconclusive evidence at the time.