Dr. Simard

The applicant sought payment for various medical and rehabilitation benefits following a motor vehicle accident.

The Licence Appeal Tribunal denied several out-of-pocket expenses because the applicant failed to submit a Treatment and Assessment Plan prior to incurring them, as required by section 38(2) of the Statutory Accident Benefits Schedule.

However, the Tribunal awarded $14,266.59 for prescription medications, finding they fell under the exception in section 38(2)(c)(i) and were reasonable and necessary to treat accident-related physical and psychological impairments.

The Tribunal also approved a chiropractic treatment plan aimed at pain reduction, while denying a physiotherapy plan that had previously shown no improvement.

Interest was awarded on the payable benefits.

The applicant, a self-employed pedorthist, was injured in a motor vehicle accident and claimed statutory accident benefits.

The insurer disputed her entitlement to income replacement benefits, arguing she was not substantially disabled and disputing the calculation of her post-accident business expenses.

The arbitrator found the applicant suffered a mild traumatic brain injury and was substantially disabled until October 1995.

The arbitrator allowed most of the applicant's post-accident business expenses, finding they were reasonably incurred to prevent a loss of revenue in her expanded business, but denied her claim for loss of profits.

The arbitrator also awarded various medical and rehabilitation benefits, including psychological counselling and a treadmill.

A special award of 35% was imposed against the insurer for unreasonably delaying and withholding benefits, particularly psychological counselling, despite recommendations from multiple assessors.

The applicant sought statutory accident benefits, including weekly income benefits and housekeeping expenses, following a 1991 motor vehicle accident.

The insurer terminated benefits in 1994.

The arbitrator found the applicant lacked credibility due to contradictory statements made to the Workers' Compensation Board, the insurer, and her doctors regarding the cause of her disability.

The arbitrator concluded that the applicant failed to establish she was disabled as a result of chronic pain caused by the accident, and that her cognitive impairment was more likely due to prescription drug dependency than a traumatic brain injury.

The claims for benefits were dismissed, but the applicant was awarded 75% of her reasonable legal fees and all disbursements.