Megan Lewis

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and various treatment plans for occupational therapy, physiotherapy, social work, and a psychological assessment.

The Licence Appeal Tribunal denied the claim for attendant care, finding the applicant failed to prove an ongoing need.

However, the Tribunal approved several of the treatment plans, either in whole or in part, finding them reasonable and necessary.

The Tribunal also granted an award under s. 10 of O. Reg. 664, ordering the respondent to pay $600 (15% of the denied occupational therapy benefits) because it unreasonably maintained its denial despite its own assessor recommending the treatment.

Preliminary motions regarding page limits and striking portions of the applicant's reply submissions were also addressed.

The applicant, who sustained catastrophic impairments in a motorcycle accident, sought various statutory accident benefits denied by the respondent insurer.

The Licence Appeal Tribunal found the applicant entitled to attendant care benefits of $6,000 per month, preferring the evidence of the applicant's occupational therapists who accounted for his fluctuating daily functionality over the respondent's assessor.

The Tribunal also awarded $87,809 for home modifications and capped the assessment cost at $2,200, finding most proposed modifications reasonable and necessary.

The claim for dietician services was granted due to the applicant's accident-related appetite loss and blood sugar management issues.

However, the Tribunal denied funding for service dog training, finding insufficient evidence that it was a reasonable and necessary medical benefit, and declined to order a special award as the insurer's denials were not unreasonable.