Dr. Sol Goldenberg

The insurer appealed an arbitration order that reinstated the insured's caregiver benefits and imposed a special award at the maximum rate.

The insurer had suspended benefits after the insured refused to attend two sets of multi-disciplinary medical examinations.

The Director's Delegate dismissed the appeal, upholding the arbitrator's finding that the requested examinations were not reasonably necessary given the extensive medical information already available, including Designated Assessment Centre (DAC) reports supporting the insured's disability.

The Director's Delegate also confirmed the special award, finding that the insurer acted unreasonably in ignoring the medical evidence and the concerns of the insured's treating practitioners regarding the excessive assessments.

The appellant was injured in a motor vehicle accident and claimed weekly income benefits for a period of disability related to a shoulder injury.

The arbitrator awarded benefits for a portion of the claimed period but denied benefits from February 2, 1994 to July 21, 1994, finding the appellant was not disabled during that time.

On appeal, the Director's Delegate found that the arbitrator erred in his assessment of the evidence, including the appellant's work duties, his receipt of unemployment insurance benefits, and the medical reports from treating specialists.

The Director's Delegate substituted her own decision, finding the appellant was disabled during the disputed period and entitled to weekly income benefits.

The applicant, a 70-year-old pedestrian, was struck by a truck and sustained soft tissue injuries to her left shoulder and back.

The insurer terminated her statutory accident benefits in February 1997.

The applicant sought ongoing other disability benefits and rehabilitation benefits for case management services.

The arbitrator found that the applicant suffered a partial inability to carry on a normal life until March 1998, at which point her condition had stabilized such that she could perform most of her ordinary household tasks.

The arbitrator dismissed the claim for case management services, finding that the applicant's situation was not sufficiently complex to warrant a case manager given the support she already received from family, friends, and medical professionals.

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

The applicant brought a motion for interim weekly income benefits, and the insurer brought a cross-motion for the production of the clinical notes of the applicant's treating psychologist.

The arbitrator granted the motion for interim benefits, finding the applicant had established a prima facie case for entitlement and demonstrated financial need.

The arbitrator dismissed the insurer's motion for production of the clinical notes, finding the potential harm to the applicant's treatment outweighed the probative value of the notes, but ordered the production of raw testing data to the insurer's psychologist.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including weekly income and supplementary medical benefits, until April 1994.

She applied for arbitration to reinstate these benefits, claiming she suffered from chronic pain that prevented her from returning to her pre-accident job as a security guard.

The arbitrator reviewed medical evidence and video surveillance showing the applicant performing various physical activities, including shopping and shoveling snow.

The arbitrator preferred the evidence of the insurer's rehabilitation specialist and concluded the applicant no longer suffered a substantial inability to perform the essential tasks of her employment.

The claims for ongoing benefits were dismissed, though the applicant was awarded her arbitration expenses.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for university residence fees, arguing her injuries prevented her from commuting from home as originally planned.

The insurer paid for the first two years but disputed entitlement for subsequent years, alternatively arguing for a deduction of hypothetical commuting and meal costs.

The arbitrator found that the applicant's physical and psychological injuries, including whiplash and post-traumatic stress disorder, rendered her unable to commute daily.

The residence fees were deemed a reasonable rehabilitation expense under section 6 of the Statutory Accident Benefits Schedule.

The arbitrator also rejected the insurer's request to deduct hypothetical commuting costs, finding them speculative.

The applicant sought ongoing weekly income benefits following a motor vehicle accident, claiming he was substantially unable to perform the essential tasks of his employment.

The insurer terminated benefits on the basis that the applicant was no longer disabled.

At arbitration, the evidence revealed that the applicant had been involved in two prior motor vehicle accidents which he had concealed from several assessing and treating physicians.

Furthermore, surveillance video demonstrated the applicant performing physical movements that contradicted the severe restrictions he reported during medical examinations.

The arbitrator found the applicant's testimony and subjective reports to medical professionals to be unreliable.

Consequently, the claim for ongoing weekly income benefits and a special award was dismissed.

However, the arbitrator exercised discretion to award the applicant his arbitration expenses.