R.S. Miller

The applicant was injured in a motor vehicle accident and sought $2,103.34 for a physiotherapy treatment plan under the Statutory Accident Benefits Schedule.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the treatment was reasonable and necessary, noting that previous treatments had not achieved their goals and the applicant had reached maximum medical improvement.

The application was dismissed, and no interest was awarded.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the insurer, including income replacement benefits (IRBs) and medical benefits.

The insurer denied the benefits based on its assessors' reports, which concluded the applicant could return to his pre-accident employment as a heavy labourer.

The arbitrator found the applicant's evidence and his experts' reports more credible, noting the insurer's assessors lacked complete information and ignored the applicant's chronic pain.

The arbitrator held that the applicant met the test for IRBs both before and after the 104-week mark, as he suffered a complete inability to engage in suitable employment.

The requested medical benefits were also found to be reasonable and necessary.

However, the arbitrator dismissed the claim for a special award, finding the insurer did not act unreasonably in relying on its medical assessors, despite the flaws in their reports.

Arbitration under the Statutory Accident Benefits Schedule concerning ongoing income replacement benefits after a motor vehicle accident.

The arbitrator found that the applicant met the own-occupation disability test up to the two-year anniversary of the accident, largely on the strength of two functional capacity evaluations that were not effectively undermined by the insurer.

The insurer's orthopaedic expert was given little weight because his analysis focused unduly on objective findings and failed to address the functional demands of the pre-accident job.

The applicant failed, however, to prove the stricter post-104 week any-occupation test.

Issues of prejudgment interest, special award, and legal expenses were left for further submissions.

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The Insurer terminated income replacement and housekeeping benefits based on insurer's examinations.

The arbitrator found the Applicant's evidence and her medical assessors' opinions credible, establishing that her physical and psychological impairments substantially prevented her from performing her pre-accident employment and housekeeping tasks.

The arbitrator rejected the Insurer's assessors' evidence as flawed and unpersuasive.

The Applicant was awarded income replacement and housekeeping benefits for the 104-week period, with interest.

Claims for post-104 week benefits were dismissed on a technical basis without prejudice.

The claim for a special award was dismissed as the Insurer's reliance on its assessors, though ultimately unsuccessful, was not unreasonable.

The insurer applied to vary an earlier order that awarded the applicant interim income replacement and housekeeping benefits, arguing the benefits should terminate at the 104-week mark.

The applicant opposed the variation and brought a motion for continued interim income replacement benefits.

The arbitrator found that the change in the disability test after 104 weeks constituted a material change in circumstances, justifying a variation of the original order to terminate benefits as of January 9, 2004.

However, based on the applicant's demonstrated financial need and strong medical evidence of ongoing physical and psychological disability, the arbitrator issued a fresh order granting continued interim income replacement benefits pending the final arbitration hearing.

The applicant was injured in a motor vehicle accident and sought interim income replacement and housekeeping and home maintenance benefits after the insurer terminated them.

The arbitrator found that the applicant established financial need, having exhausted his savings and borrowed money to meet living expenses.

The arbitrator also found that the applicant established a prima facie case for entitlement to the benefits based on medical evidence of his inability to perform his pre-accident job as a janitor and his housekeeping duties.

The motion for interim benefits was granted.

The applicant was injured in a motor vehicle accident and received statutory accident benefits from the insurer until they were terminated.

She applied for arbitration claiming ongoing weekly income benefits, medical expenses, and a special award.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of her employment as a dispatcher/cashier due to ongoing physical and psychological injuries, including right arm weakness, anxiety, and depression caused by the accident.

The arbitrator awarded weekly income benefits for the disputed two-year period.

Claims for nutritional counselling, meal replacements, and a special award were dismissed due to insufficient evidence.

The arbitrator also ruled that the new expense provisions under the Automobile Insurance Rate Stability Act did not apply retroactively, denying the insurer's claim for expenses and awarding the applicant her expenses of the proceeding.