Dr. Irving Grosfield

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

The insurer denied income replacement benefits (IRBs) and medical benefits, arguing the applicant was not employed at the time of the accident and her injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant failed to prove she was employed pre-accident, dismissing the IRB claim.

However, the Tribunal determined the applicant sustained a concussion, removing her from the MIG.

The Tribunal denied a chiropractic treatment plan as not reasonable and necessary, but approved a psychological assessment treatment plan, reducing the hourly rate to comply with FSCO Guidelines, and awarded $1,847.46 plus interest.

The insurer appealed an arbitrator's decision awarding the insured non-earner benefits, prescription costs, and the cost of a medical report following a motor vehicle accident.

The insurer argued the arbitrator erred by relying on the evidence of the insured's husband, who had previously assisted the insured in providing inaccurate histories to medical assessors.

The Director's Delegate dismissed the appeal, finding that the arbitrator's credibility assessments and weighing of the evidence were fact-driven determinations entitled to deference.

The arbitrator had a sufficient evidentiary basis, including evidence from the treating psychologist and the insurer's own examining psychiatrist, to conclude that the accident significantly exacerbated the insured's pre-existing depression and prevented her from engaging in substantially all of her pre-accident activities.

The insurer brought a motion seeking an order that the claimant attend a neurological and psychiatric assessment under s. 42(3) of the Statutory Accident Benefits Schedule, and for an adjournment of the upcoming arbitration hearing.

The claimant opposed, arguing the assessment was sought for evidentiary purposes rather than to adjust the file.

The arbitrator found that the insurer had been aware of the potential need for such assessments since 2002 but failed to request them until shortly before the hearing, and offered to cancel the assessment if the claimant abandoned her neuropsychological claims.

The arbitrator concluded the assessment was sought to bolster the insurer's case at arbitration and was not reasonably necessary.

The motion was dismissed, and the insurer was ordered to pay $500 in expenses.