Robert W. Vitols

The applicant, who was catastrophically impaired in a 2010 motor vehicle accident, sought a rehabilitation benefit of $2,388.93 for occupational therapy.

The respondent insurer denied the benefit, arguing the treatment plan lacked measurable goals and timelines.

The Tribunal found the occupational therapy was reasonable and necessary to help reduce the effects of the applicant's physical and psychological disabilities and facilitate his reintegration into his family.

The Tribunal ordered the respondent to pay the benefit with interest, but denied the applicant's request for costs, finding the respondent's conduct during the proceeding was not unreasonable.

The applicant, who suffered catastrophic mental impairments following a 2010 motor vehicle accident, sought a rehabilitation benefit of $2,363.23 for occupational therapy services.

The respondent insurer denied the benefit, relying on an insurer's examination that found no clear rationale for continued therapy.

The Licence Appeal Tribunal found the treatment plan was reasonable and necessary to help the applicant cope with her psychological injuries and reintegrate into her family.

The Tribunal ordered the respondent to pay the benefit with interest, but denied the applicant's request for costs, finding the respondent had not acted unreasonably, frivolously, vexatiously, or in bad faith during the proceeding.

The plaintiff brought an action for damages arising from a motor vehicle accident.

Following a jury trial where the defendant was found 100% at fault and the jury awarded $1,053 for general damages and $38,500 for past wage loss, the defendants brought a threshold motion arguing the plaintiff did not suffer a permanent serious impairment.

The trial judge granted the threshold motion, finding the plaintiff's evidence lacked credibility and was undermined by surveillance footage and medical records showing significant pre-existing chronic pain and narcotic use.

The court concluded the low-impact collision did not materially contribute to a diminution in her function.

The applicant was injured in a motor vehicle accident and claimed post-104 week income replacement benefits.

The insurer suspended benefits after the applicant failed to attend scheduled insurer examinations, and later formally refused benefits after the examinations were completed.

The insurer argued the arbitration application was time-barred under section 281.1 of the Insurance Act, relying on the initial suspension as the trigger for the limitation period.

The arbitrator held that the initial suspension was a temporary procedural stoppage, not a clear and unequivocal refusal, and lacked required information about the dispute resolution process.

Therefore, the limitation period was not triggered until the later formal refusal, making the applicant's mediation and arbitration applications timely.

The insurer appealed a pre-hearing arbitrator's order requiring it to produce its first-party adjusting file up to the date of the application for mediation, including reserve information.

The Director's Delegate allowed the appeal in part, finding that reserve information is generally irrelevant to the adjusting of a file and is protected by a zone of privacy, and therefore need not be produced.

However, the Director's Delegate upheld the order requiring production of the file up to the date of the application for mediation, as the insurer failed to establish that the dominant purpose of the documents created before that date was litigation.

The Appellant insurer sought a stay of the accrual of interest and of the Arbitrator's order awarding interest on $57,078.50 for massage therapy benefits pending its appeal.

The Director's Delegate denied the stay request, finding that the Appellant failed to meet the criteria for a stay.

The Delegate noted questions regarding the bona fides of the appeal, as the Appellant had not raised the interest issue during the eight-day arbitration hearing, and found that staying the order would prejudice the Respondent by further delaying payment for treatment received over several years.

The applicant was injured in motor vehicle accidents in 1997 and 2003, developing chronic pain.

She sought payment for massage therapy incurred between 2002 and 2008, which the insurer denied on the basis that ongoing passive therapy was not reasonable and necessary.

The arbitrator found that the massage therapy was reasonable and necessary as supportive care to manage the applicant's chronic pain and allow her to maintain her function and participate in active therapies.

The insurer was ordered to pay $57,078.50 for the incurred massage therapy, plus interest.

The insurer sought to appeal an arbitrator's preliminary order excluding an expert medical report that was served only seven days prior to the start of the arbitration hearing, contrary to the 30-day requirement in Rule 39.1 of the Dispute Resolution Practice Code.

The Director's Delegate rejected the appeal, finding no extraordinary circumstances to justify an exception to the rule against appealing preliminary or interim orders before the arbitration is finally decided.

The Delegate emphasized the legislative deference given to arbitrators' discretionary procedural decisions and the importance of timely disclosure to ensure fairness and efficiency.

The applicant sought production of the insurer's complete adjusting file, including reserve information, in a dispute over statutory accident benefits.

The insurer objected, claiming litigation privilege over documents created after it denied benefits.

The arbitrator ordered the insurer to produce all documents in its first-party adjusting file created on or before the commencement of mediation, finding that the insurer failed to establish that the dominant purpose of the documents created after the denial was for litigation rather than ongoing claims assessment.

The applicant was injured in a motorcycle accident and received weekly income benefits until the insurer terminated them in December 1996.

The applicant sought ongoing benefits under the post-104 week test, arguing he was continuously prevented from engaging in any suitable occupation.

Following the accident, the applicant started a small business selling garlic spread.

The arbitrator found that while the applicant could not return to his pre-accident employment, he had developed transferable skills through his new business that made sedentary sales work a suitable occupation.

However, because these skills were only developed after running the business for some time, the arbitrator awarded an additional 52 weeks of benefits, concluding the applicant was capable of working full-time by December 1997.

The claim for a special award was dismissed.