Melanie Robbins

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits for various treatment plans, including rehabilitation, occupational therapy, rehabilitation support worker, and psychological services.

The Insurer denied the plans based on assessments from its own experts.

The Arbitrator found the Applicant's experts, who diagnosed chronic pain syndrome and severe depression, to be more credible and qualified than the Insurer's assessors.

All six treatment plans were deemed reasonable and necessary and were approved.

However, the Arbitrator declined to order a special award, finding that the Insurer had not acted unreasonably in requesting assessments and denying the claims given the circumstances.

The applicant was involved in two serious motor vehicle accidents, the first in December 2010 and the second in June 2011, which rendered him a paraplegic.

He applied for attendant care benefits from the Motor Vehicle Accident Claims Fund for the first accident while receiving benefits from another insurer for the second.

The arbitrator found the applicant was not entitled to benefits for the period between the two accidents because he failed to prove the expenses were incurred and the Fund did not unreasonably withhold payment.

For the period after the second accident, the arbitrator determined the applicant required 24-hour care and was entitled to $9,432.25 per month, subject to deduction of amounts received from the other insurer to prevent double recovery.

Claims for retroactive benefits, hospital stay benefits, interest, and a special award were dismissed.