Dr. Richard M. Gladstone

The applicant was injured in a rear-end motor vehicle accident and sought payment for a multi-disciplinary catastrophic impairment assessment under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plan on the basis that it was not reasonable and necessary.

The applicant argued that the insurer was required to pay for any reasonable fee charged for a catastrophic impairment assessment, regardless of necessity.

The Tribunal rejected this argument, holding that each constituent assessment making up the multi-disciplinary assessment must be proven to be reasonable and necessary.

Upon reviewing the medical evidence, the Tribunal found that the applicant failed to prove on a balance of probabilities that any of the proposed assessments were reasonable and necessary.

The application was dismissed.

The applicant sought weekly caregiver benefits following a 2009 motor vehicle accident.

The insurer terminated benefits without requesting a Disability Certificate under s. 37(1) of the Schedule.

The arbitrator applied the Court of Appeal's decision in Stranges, holding that the insurer's procedural failure did not relieve the applicant of her burden to prove entitlement.

The arbitrator found the applicant's evidence lacked credibility, noting she had submitted fraudulent expense reports bearing a forged signature of her cousin, and gave inconsistent testimony regarding her living arrangements, education, and work experience.

The applicant's medical reports were outweighed by the credible testimony of her cousin, who observed the applicant functioning normally shortly after the accident.

The application was dismissed, and the applicant was ordered to pay the insurer's arbitration expenses.