Dr. Stanley Debow

The applicant sought $19,097.00 for a multidisciplinary catastrophic impairment assessment following a 2012 motor vehicle accident.

The respondent insurer denied the treatment plan, arguing the applicant sustained only minor soft tissue injuries and had a significant pre-existing medical history.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide corroborating medical evidence to support the necessity of the assessments or justify their costs, particularly given the $2,000 cap per assessment under section 25(5)(a) of the Schedule.

The applicant sought ongoing income replacement benefits, a special award, interest, and costs following a motor vehicle accident.

The insurer had initially terminated the applicant's income replacement benefits based on Insurer Examinations placing her within the Minor Injury Guideline, but later reinstated them after receiving additional medical records.

The Tribunal held it lacked jurisdiction under section 281 of the Insurance Act to order ongoing benefits after reinstatement.

The Tribunal dismissed the claim for a special award under Regulation 664, finding the adjuster acted properly based on the medical evidence available at the time.

Claims for interest and costs were also dismissed.

The applicant sought statutory accident benefits for psychological services following a 2016 motor vehicle accident.

The insurer denied the treatment plan based on an insurer's examination which concluded the applicant suffered no accident-related psychiatric impairment.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting that the applicant's expert reports related to a previous 2012 accident, there was a lack of psychological complaints to his family doctor, and the applicant successfully completed a realtor program despite alleged concentration issues.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer denied claims for medical benefits, a psychological assessment, and income replacement benefits (IRBs), arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained psychological injuries, including major depressive disorder and PTSD, which removed him from the MIG.

The Tribunal ordered the respondent to pay for the disputed physiotherapy and psychological assessment.

The Tribunal also found the applicant eligible for IRBs due to a substantial inability to perform his pre-accident employment, awarding $134.62 per week.

The applicant's request for a special award under Regulation 664 was dismissed, as the insurer's conduct was not found to be unreasonable.

Interest was awarded on overdue payments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment, attendant care, caregiver, medical, and housekeeping benefits.

The arbitrator found that the applicant failed to prove her entitlement on a balance of probabilities, noting significant issues with her credibility, evidence of malingering, and a failure to disclose pre-existing medical conditions.

The arbitrator preferred the evidence of the insurer's medical experts, who concluded that the applicant had reached maximum medical recovery and did not meet the threshold for catastrophic impairment.

All claims for benefits were denied.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment, income replacement benefits, housekeeping benefits, and costs of examinations.

The arbitrator found that the applicant did not meet the 55% whole person impairment threshold for catastrophic impairment, as his psychological and chronic pain impairments were moderate rather than marked.

The claim for income replacement benefits was dismissed because the applicant continued to work and his income increased post-accident, failing to meet the substantial inability test.

The claim for housekeeping benefits was dismissed as he was not catastrophically impaired.

The arbitrator awarded $2,000 for a coordinator's assessment fees but denied other examination costs.

The defendant moved for an order requiring the plaintiff to attend a neuropsychological defence medical examination in a motor vehicle accident action.

The plaintiff argued that the defendant required leave under Rule 48.04(1) of the Rules of Civil Procedure because the matter had already been certified for trial.

The court granted leave, finding that defence counsel’s mistaken understanding regarding the plaintiff’s willingness to attend the examination constituted a substantial or unexpected change in circumstances.

Applying the principles governing additional defence medical examinations, the court held that the examination was necessary to allow the defence physiatrist to finalize his opinion regarding the cause of the plaintiff’s cognitive impairments, particularly in light of a prior head injury and the plaintiff’s expert report.

The motion was granted and the plaintiff was ordered to attend the examination.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits and medical/rehabilitation expenses.

The insurer terminated benefits, arguing the applicant's disability was due to a pre-existing schizoaffective disorder rather than the accident.

The arbitrator found that the trauma of the accident triggered an episode of the applicant's pre-existing psychiatric illness, entitling him to income replacement benefits for a limited period.

Claims for various assessments were largely dismissed, save for one functional capacity evaluation.

The claim for a special award was dismissed as the insurer's termination of benefits was not unreasonable given the complex medical evidence.

The applicant was injured in a rear-end motor vehicle accident and sought housekeeping and home maintenance benefits beyond the insurer's termination date of June 2, 2003.

The arbitrator found that the medical evidence, including the insurer's own multi-disciplinary assessment, supported that the accident materially contributed to a chronic pain condition limiting her ability to perform housekeeping.

However, the arbitrator drew an adverse inference from the applicant's failure to provide evidence regarding the outcome of a recommended 10-week psychotherapy treatment plan, concluding her entitlement ended on September 15, 2003.

Benefits were awarded at a rate of $30 per week based on in-home assessments, rather than the maximum $100 per week claimed.

The applicant, who suffered a catastrophic brain injury when struck by a car as a pedestrian, applied for ongoing income replacement benefits beyond the 104-week mark.

The insurer terminated benefits based on a DAC assessment concluding the applicant could work.

The arbitrator found the DAC assessment inherently flawed and preferred the evidence of the applicant's treating practitioners, which demonstrated that despite numerous attempts to work, the applicant's cognitive, behavioural, and physical deficits rendered him completely unable to engage in suitable employment.

The arbitrator ordered the insurer to pay ongoing income replacement benefits with interest, declined to reopen the hearing for new evidence, and gave notice that a special award for unreasonably withholding benefits was being considered.