Dr. Peter Bernstein

The applicant, who sustained a catastrophic impairment including a traumatic brain injury in a motor vehicle accident, sought various statutory accident benefits.

The Licence Appeal Tribunal found the applicant was entitled to a non-earner benefit for a limited period, as she demonstrated a complete inability to carry on a normal life.

The Tribunal also approved a treatment plan for psychological services, finding it reasonable and necessary given her ongoing psychological impairments.

However, claims for a rehabilitation support worker, occupational therapy, kinesiology, and life skills training were dismissed due to insufficient evidence or because similar previously approved funds remained unutilized.

The claim for a special award was dismissed as the insurer did not act in bad faith.

The applicant, a Chinese tourist, was involved in a single-vehicle bus accident in Ontario and sought statutory accident benefits, claiming she sustained a catastrophic impairment including a traumatic brain injury and severe psychological impairments.

The respondent denied the benefits, arguing her ongoing impairments were related to pre-existing conditions and post-accident falls in China.

The Licence Appeal Tribunal found that the applicant failed to prove she sustained a traumatic brain injury in the accident, attributing her cognitive and physical decline to a probable cerebrovascular event and subsequent falls.

The Tribunal dismissed the claims for catastrophic impairment, non-earner benefits, and most medical and rehabilitation benefits.

However, the Tribunal awarded CN ¥159,705 yuan for incurred attendant care services and CN ¥612.32 yuan for specific prescription medications, finding the respondent had sufficient information to adjust those claims and the applicant had proven they were incurred.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the disputed treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's assessors, noting credibility issues and a lack of contemporaneous medical evidence supporting the applicant's assessors.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent held the applicant within the Minor Injury Guideline (MIG) and denied three treatment plans.

As a preliminary issue, the Tribunal found the applicant was not barred by the two-year limitation period for one of the plans, as O. Reg 73/20 extended the period by 183 days due to the COVID-19 pandemic.

On the substantive issues, the Tribunal found the applicant failed to demonstrate that his injuries warranted removal from the MIG, preferring the respondent's psychological assessment over the applicant's.

The applicant was entitled to the remaining balance of the $3,500 MIG limit for a disputed physiotherapy plan, but the two psychological treatment plans were denied as they proposed treatment outside the MIG.

The applicant was injured in a motor vehicle accident and received income replacement benefits from the insurer.

The insurer terminated benefits based on an orthopaedic surgeon's report that the applicant's ongoing disability was psychological and caused by a prior accident.

The applicant also received a temporary supplement from another insurer for the prior accident.

The arbitrator held that the insurer was entitled to deduct the temporary supplement from the income replacement benefits, as the applicant's inability to work was partly due to the prior accident.

However, the arbitrator also found that the insurer unreasonably delayed reinstating the income replacement benefits by relying on an orthopaedic surgeon's opinion regarding a psychological disability, and ordered the insurer to pay a special award of $2,060.67.

The applicant was injured in three motor vehicle accidents.

She applied for statutory accident benefits.

The insurer relied on section 21(9) of the Schedule to delay making a loss of earning capacity benefit (LECB) offer until two years after the second accident.

A RECDAC assessment concluded she could work full-time as a parking lot attendant.

The arbitrator found the applicant to be an unreliable historian due to her failure to disclose a significant pre-accident history of workplace injuries.

However, based on the medical evidence, the arbitrator found she suffered significant psychological and physical impairments.

The arbitrator concluded the RECDAC overestimated her functional abilities, finding she could only work part-time as a parking lot attendant.

Claims for acupuncture and a special award for delay were dismissed.

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

The applicant applied for arbitration, claiming ongoing benefits due to chronic pain and depression that rendered him unable to perform his pre-accident maintenance job.

The insurer argued the applicant was not disabled and that any impairment was due to pre-existing factors.

The arbitrator found the applicant's pain complaints genuine and supported by medical evidence, concluding he suffered from a chronic pain condition with a significant psychological component.

Applying the thin skull rule, the arbitrator held the accident materially contributed to the disability.

The applicant was awarded ongoing income replacement benefits, interest, and arbitration expenses, as well as partial chiropractic expenses, but the claim for a recliner chair was denied.

The insurer sought to compel the applicant to attend a psychiatric examination to determine his ongoing entitlement to income replacement benefits following a motor vehicle accident.

The applicant refused, arguing the insurer had already fully explored the psychological component of his claim through previous assessments and that the request was untimely.

The arbitrator found that because the applicant had recently obtained his own psychiatric report, which his counsel failed to disclose until the submissions on this motion, it was reasonably necessary for the insurer to obtain its own psychiatric opinion.

The insurer's request for the examination was granted.

The applicant was injured while a passenger on a bus and received statutory accident benefits.

The insurer terminated weekly income benefits and supplementary medical benefits in 1995.

The applicant sought reinstatement of weekly income benefits, and the insurer sought repayment of medical benefits paid for psychological treatment.

The arbitrator found that the applicant was physically and psychologically capable of returning to work by April 1995, dismissing the claim for ongoing weekly income benefits.

The arbitrator also dismissed the insurer's claim for repayment, finding the psychological treatment received prior to termination was reasonable and beneficial.