Paul Wilkins

The applicant requested a reconsideration of a preliminary decision that suspended his right to dispute entitlement to attendant care and home modification benefits due to his failure to attend section 44 insurer examinations.

The applicant argued that his mental and physical impairments prevented him from attending non-therapeutic assessments and that the Tribunal failed to consider the Ontario Human Rights Code, section 55 of the Schedule, and the totality of his medical evidence.

The Vice Chair dismissed the request, finding that the Tribunal had properly considered the lack of medical evidence supporting accommodation, correctly balanced procedural fairness, and made no errors of law or fact.

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

The respondent requested further independent examinations (IEs) under s. 44 of the Statutory Accident Benefits Schedule to address attendant care and home modifications.

The applicant refused to attend, citing mental and physical health issues, and argued the respondent should rely on paper reviews of his experts' reports.

The Tribunal held that procedural fairness requires the respondent to have the opportunity to challenge the applicant's medical evidence with its own assessors.

The Tribunal suspended the applicant's right to proceed with all issues, except housekeeping expenses, until he attends the requested IEs.

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

The respondent denied payment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's psychological impairments, specifically Somatic Symptom Disorder and Posttraumatic Stress Disorder, took his injuries outside the MIG.

The Tribunal ordered the respondent to pay for a chronic pain assessment and two treatment plans for physiotherapy and chiropractic services, finding them reasonable and necessary.

Two other physiotherapy treatment plans were denied.

Interest was awarded on the overdue payments.