Dr. Lawrence P. Tuff

The applicant was injured in a motor vehicle accident and sought accident benefits, including an attendant care assessment and a psychological assessment.

The insurer initially denied the assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and there was insufficient medical documentation.

The arbitrator found that the applicant had compelling pre-existing conditions, including a prior brain injury and psychiatric diagnoses, which took him outside the MIG.

The arbitrator held that the requested assessments were reasonable and necessary to determine the applicant's entitlement to benefits.

Furthermore, the arbitrator ordered the insurer to pay a special award of $1,083.42, finding that the insurer had unreasonably delayed and withheld payments despite having sufficient information about the pre-existing conditions early on.

The applicant, a minor who sustained a catastrophic brain injury in a motor vehicle accident, sought statutory accident benefits for private school tuition and rehabilitation support worker services.

The insurer denied the claims based on its own medical examinations.

The arbitrator found the insurer's denials unreasonable, preferring the evidence of the applicant's treating team that the services were necessary for his social reintegration and cognitive development.

The arbitrator awarded the claimed benefits, interest, and a $28,000 special award against the insurer for unreasonably withholding payments.