Dr. Ronald Kaplan

The applicant sought statutory accident benefits following a 2016 motor vehicle accident that occurred while he was being transported in a correctional vehicle.

He claimed entitlement to two neuropsychological assessments and physiotherapy services, as well as an award for unreasonable delay.

The Tribunal found the applicant was entitled to partial payment of $2,200 for the initial neuropsychological assessment, as there was a reasonable possibility of cognitive impairment stemming from accident-related chronic pain.

However, the Tribunal dismissed the claims for the subsequent neuropsychological assessment and physiotherapy services due to insufficient evidence of reasonableness and necessity.

The claim for a special award was also dismissed.

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

The Tribunal found that the applicant sustained an accident-related psychological impairment, removing her from the Minor Injury Guideline.

The Tribunal awarded two psychological treatment plans and an income replacement benefit, finding that the exacerbation of her pre-accident sleep issues caused a substantial and complete inability to perform her pre-accident employment as a postal clerk.

Claims for an award for unreasonable delay were dismissed, but interest on overdue payments was granted.

The applicant was injured in a 2018 motor vehicle accident and sought ongoing income replacement benefits (IRBs) beyond the 104-week mark, along with medical benefits, an award, and costs.

The respondent denied the IRBs, arguing the applicant could work part-time in alternative roles.

The Tribunal found that the applicant met the post-104 week test for IRBs because the alternative employment proposed by the respondent offered significantly less income and status than her pre-accident work, and her psychological impairments limited her to working only 6 to 10 hours per week.

However, the Tribunal dismissed the claims for metabolic testing, neuromonitoring, and physiotherapy due to insufficient evidence regarding their necessity and reasonable costs.

The claims for a special award and costs were also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, housekeeping, and attendant care benefits, which the insurer had terminated.

The insurer argued the applicant had removed herself from the workforce prior to the accident due to pre-existing psychological issues.

The arbitrator applied the material contribution test and found that the accident materially contributed to the applicant's pain disorder and exacerbated her depression and anxiety, resulting in a complete inability to engage in employment.

The arbitrator awarded ongoing income replacement benefits and partial housekeeping benefits, but denied attendant care benefits and a special award, finding the insurer's reliance on its medical assessments was not unreasonable.

The applicant, a registered nurse, was struck by a school bus and claimed catastrophic impairment due to physical, cognitive, and psychological injuries.

The insurer disputed the catastrophic designation and denied ongoing attendant care and housekeeping benefits.

The arbitrator found the applicant sustained a catastrophic impairment under both the marked mental/behavioural impairment threshold and the 55% whole person impairment threshold, preferring the evidence of the applicant's experts who properly accounted for her severe depression and chronic pain.

The arbitrator awarded ongoing attendant care, housekeeping benefits, the cost of a cellphone, and a special award due to the insurer's unreasonable delay in reinstating income replacement benefits.

The applicant, a five-year-old pedestrian, was struck by a vehicle and sustained severe injuries, including a Glasgow Coma Scale (GCS) score of 9 recorded by paramedics shortly after the accident.

The insurer argued the low GCS score was caused by hemodynamic instability due to blood loss rather than a brain impairment.

The arbitrator found that the applicant suffered a brain impairment as a result of the accident, as the massive blood loss deprived the brain of oxygen, impairing its function and resulting in the GCS score of 9.

The arbitrator concluded the applicant met the definition of catastrophic impairment under subsection 2(1.1)(e)(i) of the Statutory Accident Benefits Schedule.

The applicant, injured in a motor vehicle accident, sought a determination of catastrophic impairment.

The insurer requested that the applicant attend in-person multidisciplinary examinations under section 44 of the Statutory Accident Benefits Schedule to assist in its determination.

The applicant refused, arguing the insurer's request was an abuse of process because it had previously denied funding for her own assessments based on flawed paper reviews.

The Arbitrator held that while the insurer's handling of the file raised concerns, it was not seeking the assessments for the dominant purpose of litigation.

Applying the Ramalingam factors, the Arbitrator found the insurer was entitled to conduct two or more in-person assessments to respond to the applicant's new medical information.

The applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment.

The insurer's Designated Assessment Centre concluded she did not suffer a catastrophic impairment.

The arbitrator found that the applicant suffered a marked impairment in social functioning due to the accident, satisfying the definition of catastrophic impairment under section 2(1)(g) of the Schedule.

The arbitrator also assessed her physical impairments at 52% WPI, which combined with her psychological impairment would exceed the 55% threshold.

The applicant was awarded her expenses of the arbitration.

The applicant, who was struck by a car as a pedestrian, sought medical benefits for chiropractic, physiotherapy, and psychological treatments under the Statutory Accident Benefits Schedule.

The insurer denied the benefits, arguing the impairments were not caused by the accident.

The arbitrator found that the accident materially contributed to the applicant's chronic pain and depression.

The arbitrator awarded the cost of an initial course of chiropractic treatment and the psychological treatment, finding them reasonable and necessary.

The claims for further chiropractic treatment and physiotherapy were dismissed as they were not shown to be effective.

The insurer was ordered to pay the applicant's arbitration expenses and interest on overdue payments.

The insurer appealed an arbitration decision that reinstated the insured's income replacement benefits and ordered a $7,500 special award.

The insured developed spasmodic torticollis following a rear-end motor vehicle accident.

The Director's Delegate upheld the arbitrator's refusal to stay the hearing for a late-scheduled independent medical examination, finding the insurer's delay unreasonable.

The Delegate also affirmed the arbitrator's conclusion that the accident materially contributed to the insured's condition, and upheld the special award on the basis that the insurer unreasonably relied on a qualified Designated Assessment Centre report without arranging necessary neurological follow-up.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them, alleging she failed to follow through with rehabilitation recommendations.

The applicant sought arbitration for weekly income benefits, rehabilitation benefits, and a special award.

The arbitrator found that the applicant was disabled from returning to her pre-accident employment as a bar-maid, noting the insurer's experts relied on a flawed job description.

The arbitrator also found the applicant was continuously disabled from engaging in any occupation for which she was reasonably suited by education, training, or experience.

The applicant was awarded weekly income benefits and partial rehabilitation benefits for a functional assessment and work trials, but the claim for a special award was dismissed.

The applicant was injured in a motor vehicle accident when struck as a pedestrian.

She received statutory accident benefits until the insurer terminated her weekly income benefits.

The applicant sought arbitration, claiming ongoing entitlement to weekly income benefits, supplementary medical benefits for expert reports, and a special award.

The arbitrator dismissed the claim for ongoing weekly income benefits, finding the applicant failed to establish on a balance of probabilities that her ongoing physical and psychological symptoms were causally related to the accident or that they substantially disabled her from returning to her pre-accident employment.

The claim for a special award was also dismissed.

However, the arbitrator awarded the applicant her expenses for the arbitration, including the costs of the medical reports.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits.

The Insurer terminated weekly income benefits, and the parties proceeded to arbitration.

The arbitrator found that the Applicant's physical injuries had largely resolved, but she continued to suffer a substantial inability to perform the essential tasks of her occupation due to psychological injuries until March 24, 1993.

The Applicant was awarded weekly income benefits up to that date, as well as supplementary medical and rehabilitation benefits for her residual psychological injuries.

The Insurer was entitled to repayment of weekly income benefits paid after March 24, 1993.