Dr. Guerriero

The applicant was injured in a motor vehicle accident and sought payment for two orthopaedic assessments under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the assessments were reasonable and necessary, noting the absence of the actual treatment plans in evidence and preferring the insurer's medical evidence that the applicant suffered only soft tissue injuries.

The appeal was dismissed.

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

The insurer terminated benefits, arguing the applicant's injuries fell within the Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II (WAD II).

The arbitrator found that the applicant's impairments did not fall outside the WAD II Guideline, relying on independent assessments and surveillance evidence showing the applicant working and driving.

The arbitrator dismissed the claims for further medical treatment, income replacement, and housekeeping benefits, and ordered the applicant to repay an overpayment of income replacement benefits.

The claim for a special award was also dismissed as the insurer acted reasonably.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

Following a denial by the insurer, the applicant sought interim income replacement benefits and funding for a work-hardening programme pending the final arbitration hearing.

The arbitrator conducted an extensive review of the jurisprudence regarding interim orders under section 279(4.1) of the Insurance Act, rejecting the strict application of injunction tests such as 'irreparable harm' and 'prima facie case.' Instead, the arbitrator applied a holistic approach focused on the consumer protection mandate of the legislation.

Finding that the applicant's uncontradicted evidence and the medical reports supported the need for a transitional work programme, the arbitrator granted the interim benefits and ordered the insurer to fund the programme.

The request for an interim special award was deferred to the final hearing.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, including income replacement, rehabilitation, housekeeping, and dependant care benefits.

The insurer terminated benefits based on a disability DAC assessment by a chiropractor.

The arbitrator found that the applicant suffered from a severe TMJ disorder, chronic pain, and depression, rendering her substantially unable to perform the essential tasks of her pre-accident employment as a travel consultant.

The arbitrator awarded the claimed benefits and ordered the insurer to pay a $30,000 special award for unreasonably withholding benefits, noting the insurer's reliance on an assessor lacking expertise in TMJ disorders and its failure to re-evaluate its position in light of overwhelming medical evidence.