Dr. J Frank

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and a chronic pain assessment.

The respondent insurer denied the treatment plans.

The Tribunal found that the applicant met her onus of proving the physiotherapy plans were reasonable and necessary, relying on her family doctor's records showing ongoing pain and benefit from treatment.

The Tribunal also approved the chronic pain assessment, noting the respondent's own medical examiner acknowledged the applicant's ongoing pain, but reduced the assessment cost to the $2,000 maximum under s. 25(5) of the Schedule.

The applicant was awarded the treatment plans and interest.

The applicant sought a determination that she was catastrophically impaired following a motor vehicle accident, claiming marked or extreme impairment due to a mental or behavioural disorder, or alternatively, a 55% or more whole person impairment (WPI).

The arbitrator found that the applicant did not suffer a marked or extreme mental or behavioural impairment.

After evaluating conflicting medical evidence regarding her physical and cognitive injuries, the arbitrator assessed her combined WPI at 28%, well below the 55% threshold.

The applicant was awarded $6,000 for the costs of catastrophic assessments, but her claims for attendant care benefits were dismissed.

The insurer was awarded its arbitration expenses.