Dr. Harold Becker

The applicant was injured in a motor vehicle accident and sought payment from her insurer for a catastrophic impairment assessment report and a psycho-vocational assessment.

The insurer denied payment, arguing the reports were not reasonable or necessary.

The arbitrator found that both assessments were reasonable and necessary under section 24 of the Statutory Accident Benefits Schedule.

The catastrophic impairment report was required to complete the application for determination of catastrophic impairment, and the psycho-vocational report was necessary to facilitate the applicant's reintegration into the labour market.

The insurer was ordered to pay the costs of both reports.

The applicant was injured in a motor vehicle accident and applied for enhanced statutory accident benefits, claiming a catastrophic impairment based on a brain impairment resulting in a Glasgow Coma Scale (GCS) score of 9 or less.

The insurer denied the claim, arguing the GCS scores were confounded by medical interventions and seizures, and that the applicant did not maintain the score for a reasonable time.

The arbitrator found that the applicant maintained a GCS score of 9 or less for about one hour after the accident, which was a reasonable time given the circumstances, and that the scores were not confounded by intubation during that period.

The applicant was designated as catastrophically impaired.

The applicant was involved in two motor vehicle accidents and sought ongoing income replacement and supplementary medical benefits (chiropractic treatments) from the insurer.

The insurer terminated benefits, arguing the applicant was no longer disabled or that any disability was due to pre-existing conditions or the second accident.

The arbitrator found that the applicant's pre-existing back and shoulder injuries from prior workplace falls were the true cause of his inability to work as a carpenter, and the accidents did not significantly exacerbate his condition.

The claim for ongoing chiropractic expenses was also dismissed as the applicant failed to prove the treatments were reasonable or effective in light of a negative DAC assessment.

The applicant was struck by a tow-truck after a motor vehicle accident and claimed statutory accident benefits.

The insurer terminated his weekly income replacement benefits in September 1995.

The applicant applied for arbitration, arguing he remained substantially disabled from his pre-accident employment as a gas station attendant due to physical and psychological injuries.

The arbitrator found that while the applicant was not physically disabled from working, he required psychological treatment to facilitate his return to the workplace.

The arbitrator concluded the applicant remained substantially disabled until his psychotherapy sessions concluded in March 1996, after which any residual restrictions were self-imposed or could be accommodated.

The applicant was awarded income replacement benefits for the closed period from September 1995 to March 1996.

The applicant sought ongoing weekly income benefits and medical-rehabilitation expenses following a 1991 motor vehicle accident.

The insurer had terminated benefits in 1995 and sought repayment of overpaid amounts.

The arbitrator found that the applicant, with the assistance of his doctor, had shifted responsibility for a pre-existing back condition to the minor 1991 accident.

Video surveillance demonstrated the applicant engaging in vigorous exercise inconsistent with his claimed disability.

The arbitrator dismissed the claims for ongoing benefits and expenses, determined the correct quantum of weekly benefits based on pre-accident income, and ordered the applicant to repay $66,967.56 in overpaid benefits plus interest, finding he had deliberately misled the insurer.

The Applicant was struck by a car and claimed statutory accident benefits, including weekly income benefits and supplementary medical and rehabilitation benefits.

The Insurer terminated weekly income benefits, arguing the Applicant could return to work as a car salesman.

The Applicant claimed ongoing disability due to a head injury causing cognitive and psychological impairments.

The Arbitrator found that the Applicant's ongoing impairments were rooted in a severe pre-existing personality disorder and not the accident.

Claims for weekly income benefits and case management services were dismissed.

However, the Arbitrator awarded certain transportation expenses and a special award of $100 because the Insurer unreasonably withheld payment of transportation expenses pending the dispute.

The applicant was severely injured in a motorcycle accident, resulting in the loss of several teeth.

He sought coverage for dental implants, but the insurer refused, offering only to pay for a removable denture.

The insurer maintained its refusal until the eve of the arbitration hearing, despite receiving multiple reports from the applicant's treating dentists and its own retained experts indicating that implants were reasonable and necessary.

The arbitrator found that the insurer unreasonably withheld the dental benefits and violated the 'pay pending dispute' provision of the Statutory Accident Benefits Schedule.

The arbitrator ordered the insurer to pay the $25,000 cost of the implants, awarded a $10,000 special award for the unreasonable delay, and ordered the payment of interest on the future expenses from the mid-point of the anticipated treatment period.