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Insurer ordered to pay one of two disputed physiotherapy plans; acupuncture claim dismissed for lacking treatment plan.
The applicant was injured in a motor vehicle accident when she fell from a transit bus.
She sought payment for physiotherapy and acupuncture treatments under the Statutory Accident Benefits Schedule after the insurer denied them.
The arbitrator found that the March 2002 physiotherapy treatment plan was reasonable and necessary, as the applicant was only partially recovered and a gradual reduction in treatment frequency was appropriate.
However, the April 2002 physiotherapy plan was denied because the passive treatments were no longer providing sustained relief.
The claim for acupuncture was dismissed because no treatment plan was ever submitted to the insurer.
Interest was awarded on the approved amount from the date of the decision, as the clinic had failed to advise the applicant of her personal liability or consider independent medical assessments.
Slip and fall on snow-covered island while avoiding oncoming bus constitutes a motor vehicle accident.
The applicant applied for statutory accident benefits after slipping and falling on a snow and ice-covered pedestrian island.
She claimed she was forced onto the island to avoid an oncoming bus that was blocking her path.
The insurer denied the claim, arguing the fall was caused by the snow and ice, not the use or operation of a motor vehicle.
The arbitrator found that the bus rolling towards the applicant was the dominant feature of the incident and directly caused her to step onto the island, resulting in her fall.
The arbitrator concluded the applicant was injured as a result of an 'accident' under subsection 2(1) of the Schedule.
