Dr. K. Sequeira

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued he suffered from chronic pain and had a pre-existing condition that precluded his recovery within the MIG.

The Tribunal found that the applicant failed to establish chronic pain or a pre-existing condition on a balance of probabilities.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit.

The application for a treatment plan, an award, interest, and costs was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule for post-concussion syndrome and physical injuries.

The respondent insurer denied several treatment plans.

The Licence Appeal Tribunal found that the applicant was entitled to an in-home assessment, occupational therapy, a portion of a neuropsychological assessment, and assistive devices, as these were reasonable and necessary to address her cognitive and emotional symptoms.

However, claims for massage therapy, physiotherapy, and a rehabilitation support worker were dismissed because the applicant had reached maximum medical improvement from an orthopedic perspective and passive treatments provided only temporary relief.

The appellant insurer appealed an arbitration decision awarding the respondent insured various statutory accident benefits, including attendant care, a hot tub, massage therapy, psychological counseling, and ergonomic equipment, as well as a special award and legal expenses.

The Director's Delegate dismissed most of the appeal, finding no errors of law in the Arbitrator's awards for the benefits, interest, and the special award, noting the insurer unreasonably withheld payments by relying on flawed medical assessments that applied incorrect legal tests.

The Delegate found the Arbitrator erred by failing to provide reasons for allowing an increased claim for ergonomic equipment and for awarding legal expenses.

With the parties' consent, the Delegate redetermined these issues, denying the increased equipment costs but awarding the original amount plus HST, and fixing the respondent's arbitration legal expenses at $95,633.79 and appeal legal expenses at $24,179.67.

The insurer appealed an arbitration decision awarding the insured various statutory accident benefits, including attendant care, a hot tub, massage therapy, psychological counselling, occupational therapy, and a special award.

The insurer brought a preliminary motion to stay the Arbitrator's orders pending the appeal.

Applying the three-part test for a stay, the Director's Delegate granted a stay regarding the hot tub expense, the increased cost portion of the occupational therapy equipment, and the special award, finding substantive grounds for appeal on those issues.

The request to stay the remaining benefit awards and the accrual of interest was dismissed, as the insurer failed to demonstrate that the hardship of payment outweighed the hardship of non-payment to the insured.