Dr. John C. Clifford

The applicant was injured in motor vehicle accidents in 1997 and 2003, developing chronic pain.

She sought payment for massage therapy incurred between 2002 and 2008, which the insurer denied on the basis that ongoing passive therapy was not reasonable and necessary.

The arbitrator found that the massage therapy was reasonable and necessary as supportive care to manage the applicant's chronic pain and allow her to maintain her function and participate in active therapies.

The insurer was ordered to pay $57,078.50 for the incurred massage therapy, plus interest.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them.

The applicant applied for arbitration, claiming ongoing entitlement due to complete inability to engage in employment.

The arbitrator found that the accident materially contributed to the applicant's disability, exacerbating pre-existing injuries and causing chronic pain and depression.

The applicant was awarded income replacement benefits for both the pre- and post-104 week periods, along with interest and arbitration expenses.

The applicant was injured in a motor vehicle accident and received income replacement benefits for 104 weeks.

The insurer terminated benefits on the basis that the applicant did not meet the post-104 week test of suffering a complete inability to engage in any suitable employment.

The arbitrator found that the applicant failed to make a bona fide effort to find suitable alternative employment and intentionally limited his job search.

Furthermore, surveillance evidence and inconsistencies in the applicant's testimony severely undermined his credibility regarding his alleged chronic pain and deterioration.

The arbitrator concluded that the applicant failed to establish a prima facie case of total disability and that the insurer had identified suitable alternative occupations.

The application for ongoing income replacement benefits was dismissed.

The insurer appealed an arbitration decision awarding the respondent additional weekly income benefits and a special award.

The insurer argued the arbitrator erred in law by admitting oral testimony from the respondent's medical expert that went beyond his written reports, causing unfair surprise.

The Director's Delegate dismissed the appeal, finding that the expert's testimony regarding the respondent's medication and physical limitations was a reasonable amplification of his reports and the medical record.

Furthermore, the insurer's counsel did not object to the testimony at the hearing, chose to cross-examine the expert, and did not request an adjournment to call responding evidence, thereby waiving the right to claim procedural unfairness.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them.

The applicant sought ongoing weekly income benefits and a special award.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of her pre-accident employment and was continuously prevented from engaging in any suitable employment due to chronic pain and severe depression.

The arbitrator also ordered the insurer to pay a $20,000 special award because it unreasonably withheld benefits by ignoring the recommendations of its own medical experts.

The applicant was injured in a minor rear-end motor vehicle accident and subsequently developed chronic pain and fibromyalgia.

The insurer terminated his weekly income replacement benefits after a DAC assessment concluded he could return to work.

The arbitrator found that the applicant sustained an impairment in his lower back arising from the accident, which caused a substantial inability to perform the essential tasks of his employment as an assembly line worker.

The arbitrator also found that the applicant suffered from post-traumatic fibromyalgia.

The applicant was awarded ongoing income replacement benefits, costs for a physical fitness programme, expenses for attending a Fibromyalgia Outpatient Programme, partial housekeeping expenses, interest, and arbitration expenses.

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

The insurer terminated benefits after 156 weeks, arguing the applicant was not continuously prevented from engaging in suitable employment.

The arbitrator found the applicant was substantially unable to perform his pre-accident work as a tile setter.

However, the arbitrator concluded there were suitable alternative occupations available, specifically a cashier position following a work conditioning program.

The arbitrator also allowed the applicant to recalculate his pre-accident income using the completion method of accounting, which increased his weekly benefit to the $600 maximum.

The applicant was awarded outstanding benefits up to the date he would have completed the work conditioning program, plus interest.

The applicant was struck by a car and claimed ongoing income replacement benefits (IRBs) due to a left knee injury.

The insurer terminated benefits after the applicant failed to attend a scheduled medical examination and refused to participate in rehabilitation.

The arbitrator found that the applicant was not disabled from her pre-accident employment beyond April 6, 1995, relying on medical evidence and surveillance footage showing her performing physical tasks.

However, the arbitrator awarded full IRBs for a brief one-week period because the insurer had prematurely terminated benefits prior to the scheduled examination date.

The applicant was awarded 50% of her arbitration expenses.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including weekly income and supplementary medical benefits, until April 1994.

She applied for arbitration to reinstate these benefits, claiming she suffered from chronic pain that prevented her from returning to her pre-accident job as a security guard.

The arbitrator reviewed medical evidence and video surveillance showing the applicant performing various physical activities, including shopping and shoveling snow.

The arbitrator preferred the evidence of the insurer's rehabilitation specialist and concluded the applicant no longer suffered a substantial inability to perform the essential tasks of her employment.

The claims for ongoing benefits were dismissed, though the applicant was awarded her arbitration expenses.

The applicant was injured in a motor vehicle accident and received weekly income benefits from the insurer.

After 156 weeks, the insurer terminated the benefits, arguing the applicant did not meet the stricter test under section 12(5)(b) of the Statutory Accident Benefits Schedule, which requires that the injury continuously prevents the insured from engaging in any occupation or employment for which they are reasonably suited by education, training, or experience.

The applicant, a former nurse, argued she suffered from chronic pain syndrome and was retraining as a counsellor.

The arbitrator found the applicant's decision to retrain was reasonable and supported by her treating physicians.

The arbitrator concluded that the applicant's injuries continuously prevented her from engaging in suitable employment and ordered the insurer to pay ongoing weekly income benefits from the date of termination, along with arbitration expenses.

The applicant was injured in a motor vehicle accident and received weekly income benefits and rehabilitation benefits from the insurer.

The insurer terminated the weekly benefits, arguing the applicant was no longer substantially unable to perform the essential tasks of her pre-accident employment as a sales clerk.

The arbitrator found that the medical evidence, including the insurer's own medical examination, supported the applicant's ongoing inability to work due to chronic pain and fibromyalgia.

The arbitrator ordered the insurer to pay ongoing weekly income benefits and outstanding rehabilitation expenses.

Furthermore, the arbitrator awarded a special award of $3,000 against the insurer for unreasonably withholding and delaying the payment of benefits, noting the insurer's refusal to share medical reports and its inappropriate reliance on a medical report that actually recommended further rehabilitation.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for university residence fees, arguing her injuries prevented her from commuting from home as originally planned.

The insurer paid for the first two years but disputed entitlement for subsequent years, alternatively arguing for a deduction of hypothetical commuting and meal costs.

The arbitrator found that the applicant's physical and psychological injuries, including whiplash and post-traumatic stress disorder, rendered her unable to commute daily.

The residence fees were deemed a reasonable rehabilitation expense under section 6 of the Statutory Accident Benefits Schedule.

The arbitrator also rejected the insurer's request to deduct hypothetical commuting costs, finding them speculative.

The Applicant suffered catastrophic injuries in a motorcycle accident, resulting in paraplegia.

He applied for no-fault benefits, including home renovations and a suitably modified motor vehicle.

The Insurer refused to provide a vehicle, arguing it was only liable for transportation costs to and from treatment.

The arbitrator held that a modified mini van was a reasonable expense resulting from the accident under section 6(1)(f) of the No-Fault Benefits Schedule, as it was necessary for the Applicant's rehabilitation and independence.

The arbitrator dismissed the Applicant's claim for a special award under section 282(10) of the Insurance Act, finding that the Insurer had not unreasonably withheld or delayed payments.