Dr. Zalzal

The applicant sought an income replacement benefit and funding for a psychological treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was not entitled to an income replacement benefit because her physical limitations were caused by pre-existing knee osteoarthritis, not the accident, and her psychological impairments did not cause a substantial inability to perform her employment tasks.

The Tribunal also found that the balance of the psychological treatment plan was not reasonable and necessary, as the rates charged were excessive and not in accordance with the Guideline.

However, the Tribunal held that the insurer had waived the signature requirement for the treatment plan by partially approving it.

The applicant was awarded interest on the partially approved psychotherapy sessions but was denied a special award under O. Reg. 664.

The applicant, a pedestrian injured in a motor vehicle accident, applied for non-earner benefits after the respondent insurer terminated them.

The adjudicator applied the Heath test to determine whether the applicant suffered a complete inability to carry on a normal life.

Finding that the applicant's pain and physical limitations practically prevented her from engaging in substantially all of her pre-accident activities, including walking, housekeeping, and caring for her grandchildren, the adjudicator concluded she met the test.

The applicant was awarded ongoing non-earner benefits and interest on overdue payments.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from the insurer.

The insurer terminated income replacement and housekeeping benefits, arguing that the applicant's ongoing impairments were related to pre-existing conditions rather than the accident.

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

The arbitrator concluded that the applicant suffered a complete inability to engage in any employment for which he was reasonably suited and awarded ongoing income replacement benefits, housekeeping benefits, and various medical and rehabilitation benefits.

The claim for a special award was dismissed as the insurer's reliance on incorrectly completed disability certificates was not unreasonable.