Dr. Paul Ranelli

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming the unapproved balance of a treatment plan for psychological services and funding for a catastrophic impairment assessment.

The insurer partially denied the psychological services plan on the basis that the proposed hourly rate for a social worker exceeded the maximum permitted under the Professional Services Guideline, and denied the catastrophic assessment plan.

The Tribunal found that the insurer's denial letter complied with the notice requirements under s. 38(8) of the Schedule.

The Tribunal further held that the applicant failed to prove the unapproved psychological services were reasonable and necessary, and failed to demonstrate that her impairments warranted further investigation for a possible catastrophic impairment.

The application was dismissed.

The plaintiff, a person under disability following a severe motor vehicle accident, sought court approval of a $487,500 tort settlement and associated legal fees under Rule 7.08.

The court approved the settlement amount, noting it was on the low end of reasonable but acceptable given the outstanding accident benefits claim.

However, the court rejected the proposed legal fees based on a 30% contingency agreement, finding them unreasonable given the lack of liability risk and early settlement.

The court reduced the fees to slightly above docketed time and ordered a portion of the funds to be structured with a case manager appointed to oversee the plaintiff's treatment plan.

The decision also provides a comprehensive checklist for counsel filing Rule 7.08 applications.