Sheila Don

The applicant sought entitlement to statutory accident benefits for an occupational therapy assessment and treatment plan following a 2018 motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary, noting that medical evidence and the applicant's own self-reports indicated she was independent in her activities of daily living, had resumed driving, and was working.

As no benefits were payable, the claims for interest and a special award were also dismissed.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including treatment plans for physiotherapy, occupational therapy, a chronic pain assessment, and catastrophic impairment assessments.

The respondent denied the benefits.

The Tribunal found that the respondent's notices of denial were compliant with the Statutory Accident Benefits Schedule.

On the merits, the Tribunal held that the applicant failed to prove the treatment plans were reasonable and necessary, noting that the applicant's cognitive impairments were pre-existing and that she had reached maximal medical recovery for her accident-related physical injuries.

The application was dismissed.

The Applicant was severely injured in a motorcycle accident and applied for statutory accident benefits.

The Insurer raised a preliminary issue that the Applicant was precluded from claiming benefits because he was driving without valid insurance.

The Arbitrator found that the Applicant, who had purchased what he believed to be a legitimate policy from a third party, reasonably believed he was insured.

On the substantive issues, the Arbitrator awarded pre-104 income replacement benefits, finding the Applicant suffered a substantial inability to perform his pre-accident employment tasks due to cognitive and physical impairments.

However, the claim for post-104 income replacement benefits was dismissed as the Applicant had returned to work and earned more than his pre-accident income.

The Arbitrator also awarded attendant care benefits, finding the Applicant's family members sustained an economic loss, and granted ongoing housekeeping and home maintenance benefits.