Charlia D. von Buchwald

The applicant, who suffered an acquired brain injury in a motor vehicle accident, disputed the quantum of attendant care benefits paid by the insurer.

During pre-hearing discussions, the insurer sought to have the applicant undergo an in-home occupational therapy assessment and a neuropsychological assessment in Toronto pursuant to section 42 of the Statutory Accident Benefits Schedule.

The applicant objected, arguing the insurer was out of time and attempting to buttress its case for arbitration, and objected to the location and assessor for the neuropsychological assessment.

The arbitrator held that the insurer was entitled to the assessments, as nearly two years had passed since its last assessment and the request was not primarily strategic.

The arbitrator also found the choice of a neuropsychologist with adolescent expertise in Toronto was not unreasonable.

The applicant, who was injured in a motor vehicle accident, sought a rehabilitation benefit under the Statutory Accident Benefits Schedule for the cost of two round-trip airline tickets to India for herself and her husband.

She argued the trip would provide a therapeutic environment.

The arbitrator dismissed the application, applying the ejusdem generis rule to find that airline tickets for visiting family and friends do not fall within the same class as the specific rehabilitation benefits contemplated by the Schedule.

The claims for interest and expenses were also dismissed or deferred.

The insurer brought a motion seeking production of a defence medical report prepared by a rehabilitation psychologist in the context of the insured's tort claim.

The insured opposed production, arguing the report was irrelevant, would unduly complicate the arbitration, and that the insurer already had sufficient medical reports.

The arbitrator ordered production of the report, finding it relevant to the insured's claim for a non-earner benefit and noting that the insurer's existing assessments were over a year old and lacked vocational rehabilitation expertise.

The arbitrator concluded that having the best evidence available outweighed the potential for lengthening the hearing.

Following a finding that the insurer unreasonably withheld and delayed payment of income replacement benefits, the arbitrator determined the quantum of a special award and arbitration expenses.

The arbitrator calculated the notional interest amount under section 282(10) of the Insurance Act and awarded $39,900, representing approximately half of the maximum allowable amount, citing the insurer's blameworthy conduct and intransigence.

The applicant was also awarded $16,118.80 in arbitration expenses due to the insurer's unreasonable positions that prolonged the hearing.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits.

The insurer paid a minimal income replacement benefit based on pre-accident income but failed to assess the applicant's post-accident self-employment business losses.

The arbitrator found that the insurer unreasonably delayed sending an accountant to review the applicant's business records, despite knowing the applicant's brain injury impaired his ability to maintain organized records.

The arbitrator awarded interest on the overdue income replacement benefits and held that the applicant was entitled to a special award under section 282(10) of the Insurance Act.

The applicant was injured in a motor vehicle accident and applied for attendant care benefits.

The insurer requested additional information beyond the Assessment of Attendant Care Needs (Form 1) to verify that the services were actually provided and expenses incurred.

The applicant argued that the Form 1 and the Schedule provided a complete code and no further information could be requested.

The arbitrator held that under section 33 of the Statutory Accident Benefits Schedule, the insurer is entitled to request reasonable information, including the identity of the service provider and the dates and approximate times of service, to satisfy itself that the attendant care services were provided and the expenses incurred before paying the benefit.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for massage therapy and a physiotherapy program.

The insurer denied the claims based on Designated Assessment Centre reports.

The arbitrator found the applicant credible and accepted evidence from her treating physician and physiotherapist that the treatments were reasonable and necessary for pain management and physical rehabilitation.

The insurer was ordered to pay $910 for massage therapy and $1,095 for the physiotherapy program.

The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought interim attendant care benefits for a period of hospitalization and interest on overdue attendant care benefits.

The arbitrator dismissed the claim for interim benefits, finding that the applicant failed to establish a prima facie case, urgency, or a blatant disregard for the Insurance Act by the insurer.

However, the arbitrator ordered the insurer to pay interest on previously agreed attendant care benefits, as the payment was overdue.

The applicants applied for statutory accident benefits following a motor vehicle accident.

The insurer requested that the applicants attend insurer examinations and produce certain documents, which the applicants refused.

On a preliminary issue, the arbitrator found that the insurer had a prima facie case for the requested examinations and that the applicants failed to make themselves reasonably available.

The arbitration hearings were adjourned until the applicants attend the examinations.

No production orders were made at this time, pending further submissions from the parties.