Dr. Earl Magder

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

The respondent denied several treatment plans, arguing that the applicant's right ankle fracture was caused by a subsequent fall and relying on section 44 assessments to deny other treatments.

The Tribunal found that the right ankle fracture was caused by the accident.

The Tribunal also found the treatment plans for an ADL assessment, physiotherapy, and a neurological assessment were reasonable and necessary, noting the respondent's assessors failed to review the complete medical file.

Furthermore, the Tribunal ordered payment for psychological services because the respondent failed to provide a compliant denial notice under section 38(8) of the Schedule.

The applicant sought statutory accident benefits for dental treatment, claiming a motor vehicle accident exacerbated prior damage to a tooth, requiring an implant or bridge.

The respondent denied the claim, arguing the treatment was not reasonable and necessary and that the tooth was already irreparably damaged before the accident.

The Tribunal found that the applicant failed to prove the dental treatment would not have been required but for the accident, as his own dentist's records did not connect the damage to the accident and the respondent's expert concluded the tooth needed replacement prior to the accident.

The application was dismissed.

The applicant was injured in a severe motor vehicle accident that resulted in the death of her brother and severe injuries to her mother.

She applied for catastrophic impairment designation based on physical and psychological impairments, including chronic pain, PTSD, and depression.

The arbitrator found that the applicant sustained a catastrophic impairment, meeting both the 55% whole person impairment threshold and the Class 4 marked impairment threshold for mental and behavioural disorders.

The arbitrator rejected the insurer's psychological assessment, finding it ignored relevant medical history and evidence of significant functional limitations.

Claims for attendant care and housekeeping benefits were dismissed because the expenses were not 'incurred' as required by the Schedule, as no invoices were submitted and family members did not establish economic loss.

The applicant was awarded $1,440 for travel expenses and interest on overdue benefits, but the claim for a special award was dismissed.