Dr. John Heitzner

The applicant, who was injured in a motor vehicle accident, sought statutory accident benefits for social worker support, an in-home occupational therapy assessment, and travel costs for a service provider.

The Licence Appeal Tribunal found that the social worker support duplicated an already approved psychological treatment plan and was therefore not reasonable and necessary.

The Tribunal also found the in-home assessment was not reasonable and necessary based on independent medical examinations.

Finally, the Tribunal held that the Statutory Accident Benefits Schedule does not require insurers to pay travel costs for service providers.

The application was dismissed.

The applicant, who was 9 years old at the time of the motor vehicle accident, sought statutory accident benefits for social worker support, an in-home occupational therapy assessment, and travel costs for a service provider.

The Licence Appeal Tribunal dismissed the claims, finding that the social worker support duplicated an already approved psychological treatment plan, and the in-home assessment was not reasonable and necessary given the applicant's functional independence.

The Tribunal also held that the Statutory Accident Benefits Schedule does not mandate insurers to pay for the travel expenses of service providers.

The applicant sought income replacement benefits (IRBs) and the cost of an orthopaedic assessment following a motor vehicle accident.

The insurer denied the benefits based on insurer examinations and surveillance video, arguing the applicant did not suffer a substantial inability to perform his pre-accident employment as a truck driver assistant and that his injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical and psychological impairments, combined with the heavy physical demands of his pre-accident employment, entitled him to IRBs.

The Tribunal also found the orthopaedic assessment was reasonable and necessary as the applicant's injuries fell outside the MIG.

Both parties' requests for costs were denied.

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

The parties settled the claims for income replacement and medical benefits, leaving only the issue of whether the applicant was entitled to a Special Award under s. 282(10) of the Insurance Act for the insurer's initial denial of benefits.

The arbitrator found that the insurer acted reasonably at all relevant times based on the medical information available, which supported a theory that the applicant's impairments were due to pre-existing degenerative disc disease rather than the accident.

The claim for a Special Award was dismissed.