Carlos Ortiz

The applicant requested a reconsideration of a decision finding she suffered predominantly minor injuries and was not entitled to a physiotherapy treatment plan.

She argued the Tribunal violated procedural fairness and erred in law by requiring expert evidence for chronic pain and by concluding she could engage in daily activities despite her pain.

The adjudicator dismissed the request, finding no violation of procedural fairness or significant error of law or fact, as the applicant failed to provide objective evidence of chronic pain or functional impairment.

The applicant was injured in a motor vehicle accident and sought approval for psychological and physiatry assessments.

The insurer denied the treatment plans on the basis that they were not reasonable and necessary, noting that it had already approved nine other assessments related to a catastrophic impairment determination.

The Tribunal found that the requested assessments were duplicative and not reasonable and necessary given the comprehensive slate of assessments already approved.

The claims for the costs of examination and interest were dismissed.

The insurer's request for costs was also dismissed.

The respondent insurer filed a request for reconsideration of a preliminary decision that allowed the applicant insured to proceed with her application for income replacement benefits despite failing to attend seven scheduled insurer examinations.

The insurer argued the applicant should be completely barred from proceeding due to prejudice.

The Tribunal dismissed the request for reconsideration, finding no error of law or fact in the preliminary decision.

The Tribunal upheld the original order requiring the applicant to attend rescheduled insurer examinations as a condition of proceeding with her application, noting the applicant had provided reasonable explanations for missing some of the appointments.