Kelly Siegner

Following an appeal decision that upheld an award of medical benefits to the insured person, the Director's Delegate assessed the insured's arbitration and appeal expenses.

The Delegate allowed an increased hourly rate for the insured's counsel but denied the insured's claim for lost wages, finding that lost wages do not qualify as disbursements under the Expense Schedule.

Claims for meal allowances were also denied as there was no overnight stay, but mileage was allowed for each separate hearing attendance.

Total expenses were assessed at $12,461.95.

The insurer appealed an arbitration decision allowing the insured's claim for medical benefits for the period between June 1998 and October 2001.

The insurer argued that the claim was barred by issue estoppel because a previous arbitration had dismissed the insured's claim for medical benefits for the period between January 1997 and June 1998.

The Director's Delegate dismissed the appeal, finding that the previous decision was limited to the specific benefits claimed for that specific period and did not decide the underlying issues of impairment or causation.

The Delegate also held that issue estoppel is an awkward fit for accident benefits adjudication, which contemplates multiple claims over time, and that the second arbitration was not an abuse of process.

The applicant was injured in a motor vehicle accident and sought medical rehabilitation benefits for treatments received between June 1998 and October 2001.

The insurer argued the claim was barred by res judicata due to a prior arbitration decision that denied benefits for an earlier period.

The arbitrator rejected the res judicata argument, finding that entitlement to medical benefits can arise at any time and the issues were not identical.

On the merits, the arbitrator found the applicant's ongoing chiropractic, acupuncture, osteopathic, and massage treatments were reasonable and necessary to manage his symptoms and allow him to work.

The claim for prescription expenses was denied due to lack of evidence.