Dr. W.J. Reynolds

The applicant sought payment for various medical and rehabilitation expenses following a motor vehicle accident.

The insurer denied the claims, arguing in part that the referring physician had an undisclosed conflict of interest regarding one of the treatment centres.

The arbitrator found that while the physician failed to disclose his ownership of the centre, the insurer had not previously approved the treatment plan, meaning the automatic exclusion under section 38(20) of the Schedule did not apply.

However, the arbitrator scrutinized the medical necessity of the treatments, awarding partial costs for acupuncture, the family physician's accident-related services, and certain diagnostic testing, while denying costs for structured physiotherapy.

The arbitrator also awarded overdue interest and dismissed the insurer's claim for repayment of disability benefits due to lack of proper notice.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a Loss of Earning Capacity (LECB) offer, medical expenses, transportation expenses, and attendant care/housekeeping benefits.

The insurer disputed the claims, arguing the applicant was not substantially disabled and that her psychological symptoms were the result of a pre-existing histrionic personality disorder rather than the accident.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of her employment due to a combination of physical and psychological factors, including fibromyalgia and depression.

Applying the thin skull rule, the arbitrator held that the accident materially contributed to her impairment, entitling her to an LECB offer.

The arbitrator also awarded transportation expenses and a modest amount of housekeeping benefits, but denied the claims for a cervical collar and orthotics.

The Applicant sought ongoing weekly income benefits and medical/rehabilitation benefits following a rear-end motor vehicle accident.

The Insurer had terminated benefits based on surveillance evidence showing the Applicant performing heavy lifting, which contradicted his presentation during medical assessments.

The Arbitrator found the Applicant lacked credibility and that his ongoing complaints were primarily attributable to pre-existing obesity, severe sleep apnea, and degenerative back changes, rather than the accident.

The Applicant's claims for ongoing benefits and a special award were dismissed.

The Insurer's claim for repayment of benefits was also dismissed, as the Applicant did not materially contribute to the overpayment through error or fraud.