Dr. D. Direnfeld

The applicant was involved in a motor vehicle accident and sought income replacement benefits (IRBs) beyond the 104-week mark.

The respondent insurer denied the benefits, arguing the applicant was able to return to work, and sought repayment for IRBs paid during a brief period when the applicant attempted to work.

The Tribunal found that the applicant suffered a complete inability to engage in employment for which he was reasonably suited by education, training, or experience, given his history of heavy labour and ongoing physical and psychological impairments.

The Tribunal held that the applicant's unsuccessful attempts to return to work did not disentitle him to IRBs, but rather entitled the respondent to deduct 70% of his post-accident earnings.

The applicant was awarded ongoing IRBs with interest, and the respondent's claim for repayment was dismissed.

The applicant sought statutory accident benefits for various chiropractic and chronic pain treatment plans following a motor vehicle accident.

The Tribunal found the applicant was statute-barred from disputing one treatment plan due to the expiry of the two-year limitation period.

For another plan, the respondent failed to provide adequate medical reasons for its denial under s. 38(8) of the Schedule, making it liable for the incurred costs.

The remaining treatment plans were found not to be reasonable and necessary, as the medical evidence did not support the requested frequency of treatment or the need for a chronic pain program.

The applicant's claim for an award for unreasonably withheld benefits was dismissed.