Dr. K. Zakzanis

The applicant sought statutory accident benefits following a motor vehicle accident, arguing he should be removed from the Minor Injury Guideline (MIG) due to chronic pain and a psychological condition.

The Tribunal found that the applicant failed to establish chronic pain, noting a lack of specialist referrals, imaging, or functional impairment.

The Tribunal also found no evidence of a psychological condition caused by the accident, relying on s. 44 assessments that concluded the applicant did not meet DSM criteria for any psychological diagnosis.

As the applicant's injuries were deemed predominantly minor, he remained subject to the $3,500 MIG limit, rendering the disputed treatment plans moot.

The application was dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The respondent insurer denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's diagnosed psychological injury (Adjustment Disorder) removed them from the MIG, despite the applicant's reported disinterest in psychological treatment.

While the Tribunal approved the psychological assessment and treatment plans, it denied the physiotherapy, assistive devices, and chronic pain plans, finding them not reasonable and necessary based on the medical evidence.

The Tribunal also ordered the respondent to pay an award of $1,110.95 under O. Reg. 664 for unreasonably withholding the psychological benefits by misinterpreting the Schedule.

The applicant was injured in a motor vehicle accident and sought income replacement benefits and a determination of catastrophic impairment.

The insurer denied the benefits, arguing the applicant's psychological impairments were caused by pre-existing conditions, including a history of sexual abuse.

The arbitrator found that the applicant was functioning as a productive member of society prior to the accident and that, but for the accident, she would not be in her current condition.

The arbitrator preferred the evidence of the applicant's expert, finding the applicant suffered a complete inability to engage in employment and sustained a catastrophic impairment due to marked psychological impairments.

The insurer appealed an Arbitrator's decision awarding the insured a special award for unreasonably withholding income replacement benefits.

The insurer argued it reasonably relied on its own medical experts who opined the insured did not meet the post-104-week disability test.

The Director's Delegate dismissed the appeal, finding no error of law in the Arbitrator's conclusion that the insurer failed to consider all available information, including contradictory reports from its own vocational expert and the insured's treatment providers.

The Delegate also upheld the quantum of the special award, noting that while expressed as a percentage, it was readily convertible to a lump sum of approximately $7,700, which was not disproportionate to the insurer's conduct.

The insurer terminated the applicant's income replacement benefits and subsequently requested that she attend a neuropsychological assessment under s. 42 of the Schedule.

The applicant refused, arguing the request was not reasonably required.

The arbitrator found that the insurer's request was not timely, as it was made 13 months after receiving the applicant's neuropsychological report and appeared to be for the purpose of bolstering its position at arbitration rather than adjusting the claim.

The proposed examination was deemed not reasonably required.

The applicant sought ongoing income replacement benefits (IRBs) and payment for a medical assessment following a motor vehicle accident.

The insurer sought repayment of IRBs, alleging the applicant had been working full-time while claiming complete disability.

The arbitrator found overwhelming evidence, including surveillance and employment records, that the applicant had been employed full-time installing GPS units while simultaneously telling medical assessors he was completely disabled.

The arbitrator concluded the applicant obtained benefits through deliberate and material fraud.

The insurer was relieved of its obligation to pay ongoing IRBs and was awarded repayment of all IRBs paid since December 9, 2002, with interest.

The applicant's claim for the cost of a medical report was dismissed because the report was rendered useless by his intentional misrepresentations.