Krista M. Groen

The applicant was a pedestrian struck by a car, sustaining complex polytrauma.

He sought payment for the unapproved balance of a treatment plan for case management services provided by a registered social worker.

The respondent had partially approved the services at a lower hourly rate.

The Tribunal found that the proposed higher rate was appropriate based on the provider's education, training, and experience, and noted the respondent had recently approved the same provider at the higher rate for another client.

The Tribunal ordered the respondent to pay the unapproved balance.

The applicant sought medical benefits for chiropractic services and a psychological assessment following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500.

The Tribunal found that the applicant's physical injuries were predominantly soft tissue in nature and that she failed to provide compelling evidence of chronic pain, psychological impairment, or pre-existing conditions that would warrant removal from the MIG.

As the proposed treatment plans exceeded the MIG limit, the application for benefits was dismissed.

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

After the applicant's counsel was removed from the record due to an inability to communicate with the applicant, the applicant failed to attend the scheduled videoconference hearing despite receiving notice.

The Licence Appeal Tribunal found that the applicant had abandoned the application pursuant to Rule 3.4 of the Tribunal's Rules of Practice and Procedure and dismissed the claim.

The applicant sought entitlement to an income replacement benefit and a medical benefit for chiropractic treatment following a motor vehicle accident.

The adjudicator found the applicant was not entitled to the income replacement benefit because he failed to attend properly scheduled insurer's examinations and did not provide a reasonable explanation for his non-attendance.

The claim for chiropractic treatment was also dismissed, as the adjudicator preferred the respondent's expert reports over the applicant's family physician notes, concluding the treatment was not reasonable and necessary.

Claims for interest and an award were consequently dismissed.

An Ontario resident insured by the respondent was injured in a car accident in North Carolina caused by a driver insured by the appellant.

The respondent paid statutory accident benefits and demanded arbitration for loss transfer under s. 275 of the Insurance Act.

The appellant refused, arguing the scheme did not apply because the accident occurred outside Canada and the policy was issued in North Carolina.

The Court of Appeal dismissed the appeal, holding that because the appellant is an Ontario insurer, it is required to arbitrate the claim.