Dr. Fiati

The applicant sought entitlement to statutory accident benefits for medical treatment, assessments, and other expenses following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant's proposed physiotherapy treatment plans were reasonable and necessary to address his chronic pain, preferring the evidence of his chronic pain specialist over the insurer's assessor.

However, the Tribunal dismissed the claims for additional psychological services, an orthopedic assessment, a duplicate chronic pain assessment, an accounting report, and prescription expenses, finding the applicant failed to meet his evidentiary burden for those items.

The applicant sought caregiver and housekeeping benefits following a motor vehicle accident.

The insurer denied the claims, arguing the applicant was permanently disentitled for failing to submit a Disability Certificate (OCF-3) in a timely manner.

The Arbitrator held that the applicant was disentitled to housekeeping benefits because she never submitted an OCF-3 for that claim.

However, the insurer could not rely on the late submission of the caregiver OCF-3 to deny benefits because it failed to clearly communicate the consequence of permanent disentitlement to the applicant.

On the merits, the Arbitrator dismissed the caregiver claim, finding the applicant's evidence regarding her pre-accident caregiving responsibilities and post-accident needs to be inconsistent and unreliable.