Lauren Grimaldi

The applicant requested a reconsideration of a Tribunal decision that denied entitlement to a chronic pain program and assistive devices following a motor vehicle accident.

The applicant argued the Tribunal made significant errors of law and fact, including misapprehending medical evidence regarding maximum medical recovery, misapplying the test for reasonable and necessary treatment, and ignoring relevant case law.

The adjudicator dismissed the request, finding that the original Tribunal decision was based on a reasonable interpretation of the medical evidence, applied the correct legal tests under the Statutory Accident Benefits Schedule, and properly exercised its discretion in weighing the evidence.

The original decision was confirmed.

The applicant sought statutory accident benefits for a chronic pain program and assistive devices (a lawn mower and snow blower) following a motor vehicle accident.

The Tribunal found that the chronic pain program was not reasonable and necessary, relying on insurer's examinations indicating the applicant had reached maximum medical recovery and was an adaptive pain coper.

The Tribunal also denied the assistive devices, noting the applicant's pre-accident inability to perform lawn care and snow removal tasks.

The application was dismissed.

The applicant was injured in two motor vehicle accidents and sought payment for six treatment plans for chiropractic services and massage therapy.

The respondent insurer denied the treatment plans, arguing the injuries were minor and did not require further facility-based treatment, relying on surveillance evidence and an independent medical examination.

The adjudicator found that the applicant suffered a chronic impairment to her thoracic spine and that the proposed treatments were reasonable and necessary to relieve pain and improve function.

The surveillance evidence did not undermine the applicant's credibility regarding her pain.

The insurer was ordered to pay for all six treatment plans.

The applicant was injured in a motor vehicle accident in 2005 and applied for statutory accident benefits, including income replacement, housekeeping, and rehabilitation benefits.

The insurer denied the claims.

At arbitration, the arbitrator dismissed the claims for income replacement and housekeeping benefits, finding the applicant's evidence regarding her pre-accident employment and hiring of a housekeeper to be inconsistent and not credible.

However, the arbitrator found the treatment plan for physiotherapy to be reasonable and necessary based on the medical evidence, and awarded $3,104.89 for rehabilitation benefits plus interest.

The respondent was injured in a motor vehicle accident but delayed notifying her insurer of her claim for statutory accident benefits for 29 months.

The insurer denied the claim based on the delay.

At arbitration, the arbitrator found the respondent had a reasonable explanation for the delay due to the severe psychological toll of caring for her brain-injured, abusive husband.

The insurer appealed, arguing the arbitrator made findings of fact without evidence and erred in applying the reasonable explanation test.

The Director's Delegate dismissed the appeal, finding the arbitrator's decision was supported by objective evidence and did not constitute an error of law.