Dr. M. Rathbone

The applicant was injured in a 2017 motor vehicle accident and sought various statutory accident benefits, including attendant care, psychological treatments, and medical assessments.

The respondent denied the benefits and brought a preliminary motion arguing the applicant was statute-barred for failing to attend insurer's examinations (IEs).

The Tribunal granted the respondent's motion, finding the applicant failed to attend the scheduled IEs.

In the alternative, the Tribunal found the applicant failed to establish entitlement to any of the substantive benefits, as she did not prove the attendant care expenses were incurred and failed to show the proposed treatments and assessments were reasonable and necessary given her pre-existing conditions and post-accident level of functioning.

The application was dismissed.

The plaintiff brought an action against her insurer claiming entitlement to a non-earner benefit following a motor vehicle accident.

The defendant insurer moved for summary judgment to dismiss the action, arguing there was no genuine issue requiring a trial.

The court applied the principles from Hryniak v. Mauldin and Heath v. Economical Mutual Insurance Co., concluding that the evidence provided on the motion was insufficient to make the necessary qualitative findings of fact regarding the plaintiff's post-accident impairments.

The motion for summary judgment was dismissed, as a trial was required to achieve a fair and just adjudication.

The insurer appealed an arbitration decision reinstating the insured's income replacement benefits, arguing the Arbitrator failed to apply the 'crumbling skull' rule to the insured's pre-existing heart condition.

The Director's Delegate dismissed the appeal, finding the Arbitrator correctly applied the 'significant or material contribution' test from Athey v. Leonati.

The Arbitrator's factual finding that the insured's heart condition did not deteriorate significantly after the accident and did not impact his functional ability was supported by the evidence and not reviewable as an error of law.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on a disability assessment.

The applicant sought ongoing benefits, arguing that accident-related headaches, neck, and back pain prevented him from working full-time as a travel agent.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment due to chronic pain from soft-tissue injuries and aggravated pre-existing conditions.

The arbitrator ordered the insurer to pay ongoing income replacement benefits but denied the applicant's claim for a special award, finding the insurer's termination of benefits was not unreasonable.

The applicant was injured in two motor vehicle accidents in 1993 and received statutory accident benefits.

She returned to work as a secretary for several months before her temporary position ended, after which she sought further weekly income benefits, a medical rehabilitation case manager, and active physiotherapy.

The arbitrator dismissed the claim for weekly income benefits, finding that the applicant's soft tissue and finger injuries were relatively minor and did not disable her from performing the essential tasks of her employment.

The request for a case manager was also denied as unnecessary.

However, the arbitrator ordered the insurer to pay for four months of active physiotherapy and granted a special award of 10 per cent of the physiotherapy cost, finding that the insurer had unreasonably withheld payment for this "pay now, dispute later" benefit.