Serene Abraham

The applicant sought entitlement to a social work assessment and occupational therapy services following a motor vehicle accident.

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

The Tribunal preferred the respondent's psychological assessment over the applicant's physiatry report regarding the need for a social work assessment, and found insufficient evidence to support the disputed duration of occupational therapy sessions.

The applicant, an uninsured pedestrian injured in a hit-and-run, sought accident benefits from the Motor Vehicle Accident Claims Fund (MVACF).

MVACF denied a $1,950 in-home occupational therapy assessment and requested an insurer's examination (IE) by an occupational therapist, who deferred on causation.

MVACF then requested a second IE, which the applicant refused to attend.

The Tribunal found the proposed assessment was reasonable and necessary to address accident-related exacerbations of pre-existing injuries.

The Tribunal held the applicant was not barred from proceeding because MVACF's request for a second IE was not reasonably necessary, as the first IE improperly asked an occupational therapist to opine on medical causation.

The Tribunal also ordered a 40% special award against MVACF under O. Reg. 664, finding its conduct in adjusting the claim and maintaining the denial was unyielding and unreasonable given the applicant's vulnerability.

The applicant sought non-earner benefits following a motor vehicle accident, claiming a complete inability to carry on a normal life.

The applicant had a significant pre-accident medical history, including fibromyalgia, which had previously rendered her unable to work.

The Tribunal reviewed medical evidence, including insurer examinations and surveillance footage, which demonstrated that the applicant was able to engage in most of her pre-accident activities of daily living.

The Tribunal found that the applicant's ongoing impairments were largely attributable to her pre-existing conditions and dismissed the application for non-earner benefits.

The applicant was injured in a motor vehicle accident and subsequently determined to be catastrophically impaired due to chronic pain and depression.

She sought retroactive statutory accident benefits for housekeeping, attendant care, and medical marijuana.

The arbitrator held that the catastrophic impairment determination had retroactive effect, entitling the applicant to $17,800 for housekeeping benefits despite a lack of incurred expense receipts.

For attendant care, the arbitrator preferred the insurer's assessment of $864 per month, finding the applicant did not require 24/7 care.

The arbitrator also awarded $12,600 for medical marijuana purchases, noting that the applicant could not claim both growing equipment and purchasing costs.