Dr. Larry Tuff

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 was injured in a motor vehicle accident, resulting in finger amputations and post-traumatic stress disorder, preventing him from returning to his pre-accident work as a construction labourer.

The insurer paid loss of earning capacity benefits based on a residual earning capacity (REC) of $25,301.00 annually for entry-level clerical work, as determined by a DAC assessment.

The applicant disputed this REC, arguing that clerical work was unsuitable given his personal and vocational characteristics and the possibility of psychological deterioration.

The arbitrator found that the proposed clerical occupation met the criteria under section 30 of the Schedule, noting that the applicant's young age, lack of specialized transferable skills, and social competence made the occupation suitable despite his lack of interest and the lower income compared to his pre-accident earnings.

The REC was confirmed at $25,301.00 annually.