Marlene Levy

The applicant sought statutory accident benefits following a single-vehicle motorcycle accident.

The insurer denied the benefits, arguing the applicant sustained no injuries and provided inconsistent accounts of the accident.

The Tribunal found the applicant's contemporaneous reports to first responders, which indicated a low-speed departure into a field without physical injury, to be the most reliable.

Consequently, claims for attendant care, physiotherapy, and an attendant care assessment were dismissed.

However, the Tribunal approved psychological treatment by a psychotherapist at a rate of $146.91 per hour, finding the insurer could not unilaterally impose a lower rate for an unregulated provider under the Guidelines.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) and various medical and rehabilitation benefits from the respondent insurer.

The insurer terminated the IRB and denied several treatment plans on the basis that the applicant no longer suffered a substantial inability to perform his pre-accident job tasks and that the treatments were not reasonable and necessary.

The Tribunal found that the applicant failed to prove a substantial inability to perform his employment tasks during the disputed period, relying on the insurer's expert assessments.

The Tribunal approved one chiropractic treatment plan as reasonable and necessary, noting the applicant's ongoing pain and the insurer's failure to conduct a timely examination, but denied the remaining plans for chiropractic, psychological, and occupational therapy services due to a lack of corroborating medical evidence.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $10,600 for a chronic pain treatment program, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant proved on a balance of probabilities that the treatment plan was reasonable and necessary, preferring the evidence of the applicant's experts who diagnosed chronic pain over the respondent's assessors who did not specifically evaluate for chronic pain.

The Tribunal ordered the respondent to pay for the treatment plan and interest on overdue amounts, but denied the applicant's request for a special award under Ontario Regulation 664, finding no evidence that the insurer unreasonably withheld or delayed payment.

The insurer appealed an arbitration decision awarding the claimant ongoing income replacement benefits, housekeeping benefits, assessment expenses, and a special award under the SABS-1996.

The Director's Delegate dismissed the appeal on the merits, finding no error in the arbitrator's preference for the claimant's medical and lay evidence over the insurer's experts.

The arbitrator's finding that the insurer unreasonably terminated benefits based on an incomplete functional abilities evaluation, justifying a special award, was also upheld.

The appeal was allowed in part only to revoke an inadvertent order regarding arbitration expenses.