Rod Hare

The appellant was injured in a motor vehicle accident and sought payment for two kinesiologist reports prepared by an assessment facility.

The insurer refused payment on the basis that the reports duplicated its own assessments and were not obtained for the purpose of the regulation.

The arbitrator dismissed the claim, finding no evidence that the referral was reasonable or that the reports were useful for the appellant's rehabilitation.

The arbitrator also ordered the appellant to pay the insurer's arbitration expenses.

On appeal, the Director's Delegate upheld the arbitrator's decisions, confirming that the insurer is not required to pay for stand-alone assessments initiated by service providers without reference to treatment needs, and finding no error in the expenses order.

The appellant appealed a preliminary arbitration order concerning the scope of the issue to be arbitrated.

The insurer had paid the base fee for an assessment but refused to pay a premium fee adjustment for travel time.

At arbitration, the insurer argued the appellant must prove the reasonableness of the entire account, which the arbitrator accepted.

On appeal, the Director's Delegate held that the insurer's prior payment and conduct put the reasonableness of the assessment itself beyond dispute.

The arbitrator exceeded her jurisdiction by expanding the issue.

The appeal was allowed and the matter remitted to determine only the entitlement to the premium fee adjustment.

The appellant appealed an arbitrator's decision denying payment for an in-home assessment following a motor vehicle accident.

The appellant argued that the insurer should be restricted to the reasons for denial set out in its initial notice, and alternatively, that there was sufficient evidence the assessment was for the purpose of the Statutory Accident Benefits Schedule.

The Director's Delegate dismissed the appeal, holding that an insurer is not strictly limited to its initial reasons for denial, provided there is fair disclosure and no undue prejudice.

Furthermore, the Director's Delegate upheld the arbitrator's finding that the appellant failed to provide sufficient evidence demonstrating that the assessment report was intended to be used for a treatment plan or other rehabilitation purpose under the Regulation.

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

She later signed a full and final release.

Over a year later, she underwent five health care assessments and sought reimbursement from the insurer.

The insurer denied the claims, initially relying on the release but later withdrawing that defence.

The arbitrator found that the applicant had recovered from her accident injuries at the time of the assessments and that her ongoing issues were due to pre-existing work-related hand injuries.

The assessments were deemed not reasonable expenses for the purpose of the Regulation.

The claim for a special award was also dismissed, as the insurer acted reasonably in relying on the release before the law changed.

The applicant was injured in a motor vehicle accident and sought payment of $800 for an in-home assessment conducted by a kinesiologist.

The insurer denied the expense, arguing it was not reasonable or necessary and did not meet the criteria of section 24 of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant failed to prove the assessment was obtained "for the purpose of the Regulation," as there was no evidence connecting the referral to the accident or showing the report was used for rehabilitation or benefit entitlement.

The application for payment was dismissed.