Dr. S. Blitzer

The applicant, an international student who was struck by a vehicle while cycling, sought income replacement benefits, medical benefits, and lost educational expenses from the respondent insurer.

The adjudicator dismissed the applicant's claims, finding that he failed to establish his pre-accident employment and income, and did not provide compelling medical evidence of disability.

The claims for medical benefits were dismissed because the applicant had exhausted the $65,000 non-catastrophic funding limit.

Furthermore, the adjudicator ordered the applicant to repay $10,513.56 in overpaid income replacement benefits, concluding that the applicant committed wilful misrepresentation by failing to disclose his return to work and post-accident earnings.

The applicant was involved in three motor vehicle accidents in 2010 and 2011 and sought statutory accident benefits from the insurer, including income replacement benefits and medical benefits for various chiropractic and physiotherapy treatment plans.

The insurer denied the claims, arguing that the applicant did not suffer a substantial inability to perform the essential tasks of his employment and that his injuries fell within the Minor Injury Guideline.

The arbitrator dismissed the applicant's claims, finding that he provided virtually no evidence regarding his pre-accident employment or the extent of his injuries.

The arbitrator relied on the insurer's medical assessments, which concluded that the applicant's injuries were minor and did not warrant treatment outside the Minor Injury Guideline.

The insurer was awarded $4,000 in arbitration expenses.

The appellant appealed an arbitrator's decision finding that her 1999 motor vehicle accident did not cause her 2001 discectomy and chronic pain, and that she did not sustain a catastrophic impairment.

The Director's Delegate upheld the arbitrator's factual findings on causation, noting they were supported by evidence and not based on a misapprehension of law.

However, the Delegate found that the arbitrator erred by failing to follow the required methodology under the AMA Guides to calculate the appellant's Whole Person Impairment (WPI) for her other impairments.

The matter was remitted to the arbitrator to determine the specific impairment ratings and whether they combine to 55% or more WPI.