Dr. Stephen Halman

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including chiropractic services, acupuncture, an attendant care assessment, and a catastrophic impairment assessment.

The Tribunal found that the applicant failed to prove the treatments and assessments were reasonable and necessary.

The Tribunal also found the respondent provided sufficient medical reasons for denying the treatment plans under s. 38(8) of the Schedule.

All claims, including requests for an award and interest, were dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The Tribunal found that the applicant's lower extremity neurological symptoms were related to a pre-existing condition and not caused by the accident.

However, the Tribunal concluded that the applicant's accident-related psychological impairments and pain in his head, neck, and shoulders resulted in a complete inability to carry on a normal life, entitling him to non-earner benefits.

Claims for attendant care benefits and various treatment plans were dismissed due to insufficient evidence that the expenses were incurred or reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a physiatry assessment and chiropractic services.

The respondent insurer denied the treatment plans based on insurer's examinations indicating the applicant had reached maximum medical recovery and that his shoulder issues stemmed from a pre-existing hockey injury.

The Tribunal applied the 'but for' test for causation and accepted the medical evidence that the applicant's ongoing impairments were not caused by the accident.

The Tribunal found the proposed treatment plans were neither reasonable nor necessary.

The application was dismissed.

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

The respondent denied certain medical and assessment benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that a pre-existing knee condition, a concussion, and psychological impairments warranted removal from the MIG.

The Tribunal found insufficient evidence of a pre-existing condition precluding recovery, no medical diagnosis of a concussion, and preferred the respondent's psychological assessment which found no DSM-5 diagnosis.

The application was dismissed as the MIG limits were exhausted.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a motor vehicle accident, along with claims for income replacement benefits, medical benefits for physiotherapy, housekeeping benefits, and cost of examinations.

The Tribunal found that the applicant's shoulder impairments were largely due to pre-existing conditions and natural degeneration, not the accident.

The Tribunal rejected the applicant's whole person impairment rating of 55%, finding that the assessors improperly included a 3% rating for medication use related to a pre-existing heart condition and an 18% rating for speculative future surgery.

The Tribunal also dismissed the claim for income replacement benefits, finding the applicant was not actively self-employed at the time of the accident due to a recent heart attack.

All claims were dismissed.

The insurer brought an application to vary a consent order that required it to pay ongoing income replacement benefits to the insured.

The insurer argued that the change in the test for entitlement to income replacement benefits at the 104-week mark constituted a material change in circumstances justifying a variation of the order.

The arbitrator dismissed the application, finding that the change in the test for entitlement, in isolation, did not constitute a material change in circumstances, especially since the insurer had consented to the order shortly before the 104-week mark without insisting on a time limit and later conceded that the insured met the post-104-week test.

The applicant was injured in a motor vehicle accident and received income replacement benefits.

Following a consent order requiring the insurer to pay ongoing benefits, the insurer unilaterally terminated the benefits based on new medical information, arguing the test for entitlement had changed at the 104-week mark.

The arbitrator found that the insurer acted unreasonably by terminating benefits in contravention of the consent order and section 287 of the Insurance Act, which requires an insurer to continue payments until a variation order is obtained.

The arbitrator ordered the insurer to pay a special award of $6,000 for unreasonably withholding payments.