Dr. Fielden

The applicant sought an award under s. 10 of Regulation 664, arguing the respondent insurer unreasonably withheld and delayed income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found the respondent acted unreasonably by relying solely on an insurer examination report that contradicted other medical evidence, and by failing to reassess the claim when new medical information, including surgical records, was provided.

The Tribunal awarded the applicant a lump sum of 35% of the withheld IRBs plus interest.

The applicant's request for costs was denied.

The applicant sought various statutory accident benefits following a motor vehicle accident, including treatment plans for assistive devices, psychological services, hydrotherapy, chiropractic services, and catastrophic impairment assessments.

The insurer denied the benefits, arguing the applicant's ongoing issues were related to a significant pre-existing back condition and opioid dependence, not the accident.

The adjudicator dismissed the application, finding the applicant failed to provide sufficient medical evidence to prove the treatments were reasonable and necessary, and preferred the insurer's medical assessors who concluded the accident did not exacerbate the pre-existing condition.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that found the applicant entitled to Non-Earner Benefits (NEBs) following a motor vehicle accident.

The insurer argued that the Tribunal failed to consider evidence of the applicant's ability to participate in pre-accident activities, improperly focused on only two areas of her life, and ignored her pre-existing psychological trauma.

The Executive Chair dismissed the request, finding that the Tribunal properly applied the legal test, weighed the evidence, and provided sufficient reasons for its conclusion that the applicant suffered a complete inability to carry on a normal life.

The applicant, a personal support worker, was injured while riding as a passenger on a bus that was struck by a car.

She sought income replacement benefits (IRBs), medical benefits, and attendant care benefits (ACBs) after the insurer terminated them.

The arbitrator found the applicant was entitled to IRBs for both the pre-104 week and post-104 week periods, as well as the disputed medical benefits, but denied the claim for ongoing ACBs.

The arbitrator also ordered the insurer to pay a $6,500 special award for unreasonably terminating the applicant's IRBs despite objective medical evidence of a severe knee condition.

In a preliminary ruling, the arbitrator removed the insurer's in-house legal department as representatives of record due to a disqualifying conflict of interest, finding that the mandatory firewall between the insurer's accident benefits and tort files had been breached.