Dr. Diana Garcia

The applicant sought income replacement benefits (IRBs) and a special award under Regulation 664 following a motor vehicle accident.

The respondent insurer denied the benefits, arguing the applicant's impairments were based on subjective complaints and her evidence was unreliable.

The Tribunal found the applicant credible and determined she suffered a substantial inability to perform the essential tasks of her pre-accident employment as a gas bar attendant, entitling her to pre-104 week IRBs.

However, the Tribunal dismissed her claim for post-104 week IRBs, finding she failed to prove a complete inability to engage in suitable employment, as she had successfully worked part-time jobs post-accident and failed to prove her subsequent surgeries were accident-related.

The claim for a Regulation 664 award was also dismissed, as the insurer's delay in obtaining addendum reports was not unreasonable given the applicant's delay in providing requested documents.

The applicant, injured in a motor vehicle accident, sought a determination of catastrophic impairment.

The insurer requested that the applicant attend in-person multidisciplinary examinations under section 44 of the Statutory Accident Benefits Schedule to assist in its determination.

The applicant refused, arguing the insurer's request was an abuse of process because it had previously denied funding for her own assessments based on flawed paper reviews.

The Arbitrator held that while the insurer's handling of the file raised concerns, it was not seeking the assessments for the dominant purpose of litigation.

Applying the Ramalingam factors, the Arbitrator found the insurer was entitled to conduct two or more in-person assessments to respond to the applicant's new medical information.