Dr. V. Kekosz

The applicant sought payment for two physiotherapy treatment plans following a 2015 motor vehicle accident.

The respondent denied the plans, arguing that they included treatment for a right rotator cuff injury that occurred in 2023 due to moving and heavy lifting, not the accident.

The Tribunal agreed, finding that medical evidence, including ultrasound and physiatry reports, confirmed the rotator cuff tear was an intervening, non-accident-related injury.

Because the treatment plans did not differentiate between accident-related and non-accident-related injuries, the applicant failed to prove the plans were reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits for five chiropractic treatment plans following a 2015 motor vehicle accident.

The respondent denied the plans, arguing the applicant's symptoms were a continuation of pre-existing injuries from a 2011 accident.

The adjudicator found that the applicant had returned to her pre-accident health status shortly after the 2015 accident and that her ongoing difficulties at work were primarily cognitive, not related to the subject accident.

The adjudicator concluded the proposed treatment plans were not reasonable and necessary, and dismissed the claims for benefits, interest, and an award.

The applicant was injured in a motor vehicle accident and received weekly income replacement benefits until the insurer terminated them at the 156-week mark.

The insurer argued the applicant could return to work in a suitable occupation, such as a millwright foreman.

The arbitrator found that the applicant had developed a chronic pain syndrome as a result of the accident, which caused fluctuating symptoms, fatigue, and poor endurance.

Applying the post-156 week test, the arbitrator concluded that the applicant's condition continuously prevented him from engaging in any occupation or employment for which he was reasonably suited, including part-time sedentary work.

The insurer was ordered to pay ongoing weekly income replacement benefits and interest.

The applicant was injured in a motor vehicle accident and received statutory accident benefits.

The insurer terminated weekly income benefits, and the applicant sought ongoing income benefits, supplementary medical and rehabilitation benefits, care benefits, and a special award.

The insurer claimed a repayment of overpaid benefits due to an alleged calculation error and the applicant's receipt of CPP disability benefits.

The arbitrator found that the applicant failed to establish that her ongoing back problems were caused by the accident, given her pre-existing degenerative disc disease and prior injuries.

Consequently, claims for ongoing income, medical, and care benefits were dismissed.

The arbitrator determined the correct weekly income benefit rate and ordered the applicant to repay $16,540.54 for overlapping CPP benefits, but denied the insurer's claim for repayment based on 'error,' finding the insurer had deliberately chosen its calculation method.

The applicant's claims for a special award and arbitration expenses were dismissed.