Dr. P. H. Waxer

The applicant sought statutory accident benefits following a motor vehicle accident, specifically requesting $2,486.00 for a psychological assessment.

The insurer denied the treatment plan, arguing it was a duplication of services and that there was no chronic pain issue to investigate.

The Tribunal found that the applicant's ongoing pain, medication use, and psychological symptoms warranted further investigation.

The Tribunal ordered that the psychological assessment was reasonable and necessary, and payable once incurred, with interest applicable on any overdue benefits.

The applicant sought post-104 week income replacement benefits following a motor vehicle accident.

The insurer denied the benefits based on insurer's examinations concluding the applicant did not suffer a substantial inability to perform his pre-accident employment.

The Tribunal found the applicant failed to prove on a balance of probabilities that he suffered a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience.

The Tribunal preferred the evidence of the insurer's experts, noting the applicant exaggerated his pain symptoms and his alleged impairments lacked an objective basis causally linked to the accident.

The application was dismissed.

The applicant sought a non-earner benefit and a medical benefit following a motor vehicle accident.

The Tribunal found that the insurer failed to provide a compliant denial notice for the non-earner benefit until November 26, 2016, and ordered payment of the benefit from the end of the 26-week deductible period until that date.

However, the Tribunal dismissed the claim for ongoing non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life.

The claim for a medical benefit was also dismissed as the proposed treatment was not reasonable and necessary, given the applicant's extensive pre-existing back issues.

A claim for a special award under O. Reg 664 was dismissed.