Dr. W.J. Oczkowski

The insurer brought a motion for an order permitting its medical expert to conduct an examination of the insured pursuant to section 42 of the Statutory Accident Benefits Schedule.

The insured, an 83-year-old man who suffered a catastrophic impairment in a motor vehicle accident, sought funding for home modifications to return home from a nursing home.

The medical/rehabilitation Designated Assessment Centre had failed to address the reasonableness and necessity of the treatment plans, instead improperly revisiting causation.

The arbitrator found that, given the DAC's failure to assess the treatment plans and the lack of a recent physical examination, the insurer's request for an examination was reasonable and necessary.

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.