Jennifer Peacock

The minor applicant was involved in a motor vehicle accident and sought statutory accident benefits for optical, speech and language, and psychological assessments.

The respondent insurer denied the treatment plans.

The adjudicator found that the applicant failed to provide sufficient objective medical evidence to prove on a balance of probabilities that the proposed assessments were reasonable and necessary as a result of the accident.

The adjudicator accepted the respondent's medical evidence that the applicant's impairments were related to pre-existing diagnoses of Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder, rather than the accident.

The application was dismissed.

The applicant, who sustained a catastrophic impairment including a traumatic brain injury in a motor vehicle accident, sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The insurer denied several treatment plans for physiotherapy, occupational therapy, speech-language therapy, and a multi-disciplinary residential program in the United States.

The arbitrator found that the insurer improperly relied on outdated or flawed assessor reports and failed to give adequate weight to the objective evidence of the applicant's treating professionals.

All disputed treatment plans were found to be reasonable and necessary, and the applicant was awarded the claimed benefits with interest.