Dr. F. Langer

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

The insurer terminated income replacement benefits and, over four years later, requested that the applicant undergo a medical examination by an orthopaedic surgeon under section 42 of the Statutory Accident Benefits Schedule.

The applicant refused, arguing the examination was not reasonably necessary.

The arbitrator found that the insurer had already conducted multiple assessments by other specialists, including a neurosurgeon and an occupational medicine physician, none of whom recommended an orthopaedic evaluation.

The insurer failed to establish that the proposed examination was reasonably necessary or that its previous assessments were not meaningful evaluations of the applicant's physical condition.

The insurer's request was denied, and the applicant was awarded the expenses of the preliminary issue hearing.

The applicant, a heavy equipment mechanic, was injured in a 1993 motor vehicle accident and received statutory accident benefits until the insurer terminated them in June 1996.

The applicant sought ongoing weekly income benefits and medical/rehabilitation benefits, claiming disability due to a tremor, chronic pain, dizziness, and psychological issues.

The arbitrator found that while the applicant was disabled from his pre-accident employment, his ongoing disability was caused by significant pre-existing degenerative conditions and an essential tremor unrelated to the accident.

The claim for ongoing weekly income benefits was dismissed.

The arbitrator awarded $1,129.75 for medical and rehabilitation expenses incurred prior to the termination date, plus a $100 special award for the insurer's unreasonable withholding of pay-pending-dispute benefits.

The applicant was injured in three motor vehicle accidents in 1995 and sought ongoing income replacement, caregiver, and medical benefits.

The arbitrator found the applicant's evidence regarding his pre-accident income and ongoing disability to be highly exaggerated and unreliable.

However, the arbitrator concluded the applicant was physically disabled from working as a paralegal for a closed period until January 1996 and awarded income replacement benefits for that period.

A special award was also granted because the insurer unreasonably required the self-employed applicant to prove a negative (that he was not earning post-accident income) before paying benefits.

As the total awarded was less than a $15,000 settlement previously paid and rescinded, the awarded amounts were set off against the settlement, and the applicant was ordered to repay the balance to prevent an abuse of process.

The Applicant was injured in a motor vehicle accident when struck as a pedestrian.

She received weekly income benefits until July 27, 1993, and subsequently applied for arbitration claiming ongoing entitlement and payment for a medical report.

The arbitrator found that the Applicant was substantially able to perform the essential tasks of her pre-accident job as an industrial sewing machine operator, preferring the evidence of orthopaedic surgeons over her pain management physician.

The claim for the medical report was also dismissed as it was deemed a medicolegal report rather than a certificate under the Schedule.

The Applicant was awarded her arbitration expenses.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for a Kenko Sleep System (a magnetic mattress and pillow) costing $1,607.70.

The insurer denied the claim, arguing the device was experimental and not a medical device.

The arbitrator found that while the system qualified as a medical device under the Schedule, the applicant failed to prove it was a reasonable and necessary treatment for her accident-related impairment.

The medical evidence did not support the therapeutic value of the device for her soft tissue injuries.

The application for arbitration was dismissed, and no expenses were awarded.