Neutral Citation: 1994 ONICDRG 68

File No. A-004353

ONTARIO INSURANCE COMMISSION

BETWEEN:

ALDO DE LELLIS

Applicant

and

CO-OPERATORS GENERAL INSURANCE COMPANY

Insurer

DECISION

Issues:

The Applicant, Aldo De Lellis, was injured in a motor vehicle accident on August 9, 1991. He applied for and received statutory accident benefits from Co-operators General Insurance Company ("Co-operators"), payable under Ontario Regulation 672¹. Co-operators continues to pay some benefits, but has refused to pay others. The parties were unable to resolve their disputes through mediation, and Mr. De Lellis applied for arbitration under the Insurance Act R.S.O. 1990, c.I.8.

The issues in this hearing are:

1. Is Mr. De Lellis entitled to be reimbursed under section 6(1)(d) of the Schedule for his transportation costs from London, Ontario to the Toronto area to see his family doctor and three specialists?

2. Is Mr. De Lellis entitled to be reimbursed under section 6(1)(a) or (f) of the Schedule for $125 that he paid to Dr. A.N. Hanick?

3. Is Mr. De Lellis entitled to benefits for hydrotherapy expenses under section 6(1)(a) of the Schedule?

Mr. De Lellis also claims interest on any outstanding amounts owing, and his expenses incurred in the hearing.

Result:

1. Mr. De Lellis is entitled to the following transportation expenses:

• 400 kilometres for visits to Dr. Saeed (16 visits x 25 kilometres per visit)
• 800 kilometres for visits to Dr. Ogilvie-Harris (2 visits x 400 kilometres per visit)
• 400 kilometres for his visit to Dr. Weber (1 visit x 400 kilometres per visit)
• 175 kilometres for his visits to Dr. Hanick (7 visits x 25 kilometres per visit)

In calculating the amount owing, Co-operators is entitled to take into account the amount that it has already paid toward these transportation expenses. Mr. De Lellis is entitled to interest on the outstanding amounts, calculated according to section 24 of the Schedule.

2. Mr. De Lellis is not entitled to be reimbursed under section 6(1)(a) or (f) of the Schedule for $125 that he paid to Dr. Hanick.

3. Mr. De Lellis has not established that he requires hydrotherapy.

4. Mr. De Lellis is entitled to his expenses related to this arbitration.

Hearing:

The hearing was held in London, Ontario, on June 9, 1994, before me, David R. Draper, arbitrator.

Present at the Hearing:

Applicant:

Aldo De Lellis

Insurer's Representative:

Stephen Malach Barrister and Solicitor

Insurer's Officer:

Sharon Sharpe Claims Specialist

Also in attendance was Jason Francoz, clerk to Mr. Malach, and Leila Palerma, court reporter.

Witnesses:

1. Aldo De Lellis, Applicant
2. Dr. T. Saeed, Applicant's family doctor

Exhibits:

The exhibits introduced in this hearing and the other documents before the arbitrator are listed in Appendix A to this decision.

Cases considered:

Douglas R.G. Williams and Jevco Insurance Company, May 6, 1992, OIC File No. A-000112.

John Adusei and Royal Insurance Company of Canada, March 3, 1994, OIC File No. A-004404.

Reasons for Decision:

The issues in this hearing involve Co-operators' refusal to pay certain benefits under section 6 of the Schedule. The relevant provisions of section 6 state:

6.--(1) The insurer will pay with respect to each insured person who sustains physical, psychological or mental injury as a result of an accident all reasonable expenses resulting from the accident within the benefit period set out in subsection (3) for,

(a) medical, psychological, surgical, dental, hospital, chiropractic, nursing and ambulance services and the services of physio-therapists;

(d) transportation for the person to and from treatment, counselling and training sessions, including transportation for an assistant;

(f) other goods and services, whether medical or non-medical in nature, which the insured person requires because of the accident.

(4) Subject to subsections (5) and (6), the insurer, before making a payment for an expense under subsection (1), may require the insured person to submit a statement signed by the insured person's qualified medical practitioner or psychological advisor stating that the expense is necessary for the insured person's treatment or rehabilitation.

1. Transportation Expenses

a) The Issue

In February 1993, approximately 19 months after his motor vehicle accident, Mr. De Lellis moved from Mississauga, Ontario to London, Ontario. He continued to see a family doctor, an orthopaedic surgeon, a neurologist, and a psychiatrist, all in the Toronto area. Co-operators refused to pay the following transportation expenses on the basis that they were not reasonable:

DATE	DOCTORS VISITED	TOTAL KILOMETRES
April 19, 1993	Dr. Weber and Dr. Saeed	480
May 12, 1993	Dr. Saeed	360
June 3, 1993	Dr. Saeed	360
June 23, 1993	Dr. Saeed	360
July 14, 1993	Dr. Saeed	360
July 27, 1993	Dr. Hanick	400
August 4, 1993	Dr. Saeed	360
August 25, 1993	Dr. Saeed	360
September 15, 1993	Dr. Hanick and Dr. Saeed	440
September 29, 1993	Dr. Ogilvie-Harris and Dr Saeed	440
October 20, 1993	Dr. Saeed	360
November 25, 1993	Dr. Hanick and Dr. Saeed	440
December 15, 1993	Dr. Saeed	360
January 4, 1994	Dr. Hanick and Dr. Saeed	440
February 5, 1994	Dr. Hanick and Dr. Saeed	440
March 12, 1994	Dr. Hanick and Dr. Saeed	440
March 23, 1994	Dr. Ogilvie-Harris	400
April 16, 1994	Dr. Hanick and Dr. Saeed	440

For the purposes of the hearing, Co-operators conceded that Mr. De Lellis required treatment from a family doctor, an orthopaedic surgeon, a neurologist and a psychiatrist, but submitted that adequate services were available in the London area. Shortly before the hearing, Co-operators paid Mr. De Lellis on the basis of 25 kilometres for each visit (26 visits x 25 kilometres per visit), plus interest. It was submitted that this represented reasonable transportation expenses to see doctors in the London area.

b) The Facts

Mr. De Lellis has been involved in two accidents: a work-related accident on January 4, 1990, and a motor vehicle accident on August 9, 1991.

At the time of his first accident, Mr. De Lellis had been living in Mississauga for five or six years, working as a delivery truck driver. He was in the back of his truck, unloading it, when it was hit by another vehicle. Approximately one week later, he started seeing Dr. T. Saeed, a general practitioner with an office in Mississauga. His primary problem was back pain, but he also complained of numbness and pain in the left side from his hip down to his toes, and occasional mild headaches. Dr. Saeed monitored his condition, prescribed analgesics and referred him for physiotherapy. He also prepared a number of reports for the Workers' Compensation Board.

Dr. Saeed referred Mr. De Lellis to Dr. Dale, an orthopaedic surgeon whose office is in the Toronto area (Islington). Dr. Dale did an initial assessment on May 28, 1990, with follow-up examinations on August 16, 1990 and January 17, 1991. Dr. Dale did not find any evidence of nerve damage, and diagnosed Mr. Saeed as having a sprained back.

Mr. De Lellis continued to have problems related to his first accident, including headaches. In May 1991, he saw Dr. Weber, a neurologist whose office is in the Toronto area (Willowdale). It is not entirely clear who made the initial referral to Dr. Weber, although his reports, dated May 21 and 29, 1991, are directed to Dr. Saeed. Dr. Weber found evidence of a cerebral lesion which he felt might explain Mr. De Lellis's symptoms.

By the time of his motor vehicle accident on August 9, 1991, Mr. De Lellis had a family doctor (Dr. Saeed), and had been assessed by an orthopaedic surgeon (Dr. Dale), and a neurologist (Dr. Weber). Each of these doctors practised in the Toronto area, not too far from Mr. De Lellis's home in Mississauga. Between January 1990 and August 9, 1991, the date of the motor vehicle accident, Mr. De Lellis saw Dr. Saeed 35 times. This is an average of nearly twice a month.

After his motor vehicle accident, Mr. De Lellis continued to see Dr. Saeed once or twice a month for complaints of pain in his neck, shoulders, back and left leg, and headaches. Dr. Saeed monitored his condition and prescribed medication.

In September 1991, approximately one month after the motor vehicle accident, Mr. De Lellis started attending classes at Sheridan College in Oakville, Ontario. This had been arranged through the Workers' Compensation Board as re-training that he needed as a result of his first accident. As I understand it, the Sheridan program ran in four-month segments, alternating academic sessions and work placements, finishing in August 1993.

By December 1991, Mr. De Lellis had retained the law firm of Lofranco & Sabetti to represent him in a civil action arising out of the August 1991 motor vehicle accident, but apparently not with respect to his accident benefits under the Schedule. The law firm took an active role in referring Mr. De Lellis to medical specialists.

In December 1991, Mr. De Lellis saw Dr. Weber, the neurologist who he had seen previously. As I understood Dr. Saeed's testimony, he did not make a referral to Dr. Weber with respect to the motor vehicle accident. I also note that Dr. Weber's report, dated December 10, 1991, is to the law firm, with a copy to Dr. Saeed. Dr. Weber focused on Mr. De Lellis's headaches, and suggested medication and further testing.

The lawyers arranged for Mr. De Lellis to be assessed by Dr. Ogilvie-Harris, the Chief of Orthopaedics at the Toronto Hospital. Based on Dr. Saeed's clinical notes, I find that by September 29, 1992, approximately four months before Mr. De Lellis moved to London, an appointment with Dr. Ogilvie-Harris had already been scheduled. The assessment did not take place, however, until March 10, 1993, approximately two weeks after Mr. De Lellis moved.

The lawyers also arranged for Mr. De Lellis to be assessed by Dr. Adrian N. Hanick, a psychiatrist with an office in Toronto. Dr. Hanick's initial consultation took place on November 14, 1992, approximately three months before Mr. De Lellis moved to London.

Mr. De Lellis moved from Mississauga to London on February 25, 1993. At that time, he was still involved in the Sheridan College program, although it was not clarified when he was attending classes and when he was working, or the location of his work placements. My understanding is that during his school terms, Mr. De Lellis travelled from London to the Toronto area to attend classes. The Workers' Compensation Board paid for his transportation to school, but only from his previous address in Mississauga.

After his move to London, Mr. De Lellis:

• continued to see Dr. Saeed approximately once per month (16 visits);
• saw Dr. Weber on April 19, 1993 (1 visit);
• saw Dr. Ogilvie-Harris for follow-up assessments once every six months (2 visits); and,
• began to see Dr. Hanick for counselling (7 visits).

As can be seen from the table, above, Mr. De Lellis was able to see more than one doctor on almost half of his trips to Toronto.

c) Conclusions

Mr. De Lellis is entitled to see any doctor that he wants. The issue is whether Co-operators is required to pay his transportation expenses if he chooses to see doctors who are located a considerable distance from his home. Using the language of section 6 of the Schedule, are the transportation expenses that he has submitted "reasonable expenses" that are "necessary for the insured person's treatment or rehabilitation"?

I was referred to the arbitration decision in Douglas R.G. Williams and Jevco Insurance Company, May 6, 1992, OIC File No. A-000112. In that case, Mr. Williams submitted transportation expenses for visits to his chiropractor's office, a distance of approximately 17 kilometres (one way). The insurer paid transportation expenses for 3 miles (one way), representing the distance between Mr. Williams' home and the nearest chiropractor. Senior Arbitrator Rotter allowed Mr. Williams' claim in full, stating:

In my view, the Applicant has the right to attend at and seek treatment from the practitioner of his choice, so long as the resultant travel expenses are not clearly exorbitant or excessive. The Insurer cannot reasonably demand or require that an insured person attend at the treatment facility closest to his or her home.

There is no precise formula for determining what transportation expenses are reasonable. They must be evaluated based on the applicant's particular circumstances. Many factors may be relevant, including the existence of a doctor-patient relationship, the importance of that relationship to the applicant, the role that the doctor plays in the applicant's overall treatment, the availability of alternative care, and the distance and frequency of the trips to see the doctor.

(i) Dr. T. Saeed

By the time he moved to London, Mr. De Lellis had been seeing Dr. Saeed for just over three years. He testified that he was "comfortable" with his doctors, including Dr. Saeed, and wanted to continue seeing them.

Dr. Saeed provided Mr. De Lellis with a handwritten note, dated April 16, 1994, stating:

Due to Mr. Delellis [sic] complex history it is not in his best interest to change doctors. It is in his best interest to keep the same family doctor and specialists.

Dr. Saeed testified that each patient is unique, and must decide for himself or herself whether it makes sense to travel for medical appointments. In the case of Mr. De Lellis, he acknowledged that the trip to the Toronto area was "a little difficult", but stated that Mr. De Lellis was "comfortable with it".

Mr. De Lellis's existing relationship with Dr. Saeed is a significant factor. His desire to continue with the same family doctor is understandable. I must decide, however, whether Co-operators is obligated to pay his transportation expenses.

The transportation expenses that Mr. De Lellis is claiming are significant. He lives 180 kilometres from Dr. Saeed's office and sees him approximately once per month. The critical factor in this case is that, in my view, a review of Dr. Saeed's clinical notes indicate that his treatment of Mr. De Lellis was quite routine. He simply monitored Mr. De Lellis's condition, prescribed analgesics as required, and periodically prepared reports for the Workers' Compensation Board and Co-operators. Mr. De Lellis saw a number of specialists, but these referrals were made by his lawyers, not by Dr. Saeed.

Each patient is unique, and the family doctor must attempt to meet his or her clinical needs. I am not persuaded, however, that Mr. De Lellis's situation was particularly "complex", as suggested by Dr. Saeed. In the circumstances, I conclude that the role being played by Dr. Saeed was not sufficiently crucial or unique to make the transportation expenses reasonable.

Mr. De Lellis moved to London on February 25, 1993. He decided to continue seeing Dr. Saeed and did not attempt to locate a family doctor in the London area. The first expense that was denied by Co-operators was a trip to Toronto on April 19, 1993. In my view, he was given sufficient time to locate a family doctor of his choice in the London area.

I conclude, therefore, that Mr. De Lellis is not entitled to the transportation expenses that he has claimed to see Dr. Saeed. This does not mean that Mr. De Lellis cannot continue to see Dr. Saeed, but only if he chooses to do so, he will have to bear most of the transportation expenses.

Co-operators has paid transportation expenses based on 25 kilometres per visit. I heard no evidence to suggest that this does not represent a reasonable distance to see a doctor in the London area. I conclude, therefore, that Mr. De Lellis is entitled to transportation expenses based on 25 kilometres for each of the 16 visits to Dr. Saeed that he claimed.

(ii) Dr. Ogilvie-Harris

Co-operators conceded, for the purposes of this hearing, that Mr. De Lellis needed to see an orthopaedic surgeon. It was submitted, however, that it was unreasonable for him to travel to Toronto to see Dr. Ogilvie-Harris. I do not agree.

Mr. De Lellis had seen another orthopaedic surgeon, Dr. Dale, three times with respect to his first accident. His last visit, however, was January 17, 1991. Based on Dr. Saeed's clinical notes, I find that the referral to Dr. Ogilvie-Harris was made in August or September of 1992, over a year and a half after Mr. De Lellis last saw Dr. Dale. I find nothing inappropriate in his decision to see a different orthopaedic surgeon, particularly one with Dr. Ogilvie-Harris's qualifications. This is not a case in which a new doctor is consulted in order to conceal a pre-existing injury. It is clear from Dr. Ogilvie-Harris's report, dated April 12, 1994, that he was advised about Mr. De Lellis's first accident.

The referral to Dr. Ogilvie-Harris was made well before Mr. De Lellis moved to London, although the assessment did not take place until approximately two weeks after he moved. In my view, it was reasonable for Mr. De Lellis to proceed with the assessment by Dr. Ogilvie-Harris, despite his move. The distance involved was only 400 kilometres round trip, and it undoubtedly would have taken him some time to set up an assessment by a London area orthopaedic surgeon.

I also conclude that once he was assessed by Dr. Ogilvie-Harris, it was reasonable for Mr. De Lellis to continue with follow-up assessments with Dr. Ogilvie-Harris every six months. The transportation expenses involved are not particularly significant and, in my view, they are reasonable in order to maintain some consistency in the orthopaedic assessments.

I conclude, therefore, that Mr. De Lellis is entitled to the transportation expenses that he claimed to see Dr. Ogilvie-Harris:

September 29, 1993	400 kilometres
March 23, 1994	400 kilometres

(iii) Dr. M.B. Weber

Mr. De Lellis is claiming transportation expenses for only one visit to see Dr. Weber, the neurologist. Unfortunately, I was provided with little information about the purpose or outcome of this visit. Despite this lack of information, I am prepared to find that the expenses were reasonable based on Co-operator's concession that Mr. De Lellis needed to see a neurologist, the fact that Mr. De Lellis had previously been assessed by Dr. Weber with respect to both accidents, and that the follow-up assessment took place shortly after Mr. De Lellis's move to London.

Therefore, Mr. De Lellis is entitled to transportation expenses for his visit to see Dr. Weber on April 19, 1993 (400 kilometres).

(iv) Dr. Adrian N. Hanick

Dr. Hanick saw Mr. De Lellis on November 14, 1992, over three months prior to his move to London, for a psychiatric consultation. He provided Mr. De Lellis's lawyers with a lengthy report, dated November 15, 1992. As I understand Dr. Hanick's conclusion, he felt that although Mr. De Lellis was having some emotional problems, they were "appropriate to the problems that he has suffered", and did not indicate any psychiatric illness.

Dr. Hanick's role subsequently changed from consultant to clinician. He began to see Mr. De Lellis for counselling once or twice per month, starting on July 27, 1993, well after Mr. De Lellis moved to London. In a handwritten note, dated May 21, 1994, Dr. Hanick stated:

As a result of his motor vehicle accident, Mr. De Lellis has suffered physical, emotional, cognitive, and vocational problems, all of which have produced problems for Mr. De Lellis and all of which require treatment and rehabilitation. It is seen that he requires ongoing psychotherapy, in relation to other treatments, in order to facilitate his improvement and return to work and a productive lifestyle. It is hoped that Mr. De Lellis' continuing therapy with me can be facilitated.

At the time of his move to London, however, Mr. De Lellis had not established a clinical relationship with Dr. Hanick. Given the frequency of the sessions, the distance involved, and the lack of evidence that similar services are unavailable in the London area, I conclude that the transportation expenses associated with Dr. Hanick's counselling sessions are not reasonable.

Co-operators has paid Mr. De Lellis's transportation expenses based on 25 kilometres for each visit to Dr. Hanick. Again, I heard no evidence to suggest that this does not represent a reasonable distance to see a doctor in the London area. I conclude, therefore, that Mr. De Lellis is entitled to transportation expenses based on 25 kilometres for each of the seven visits to Dr. Hanick that he claimed.

2. Dr. Hanick's Fee

Mr. De Lellis testified that when he saw Dr. Hanick, he was asked to pay $25. He was not sure what the fee was for, but he paid it. After his fifth visit, he told Dr. Hanick that his insurance company would not reimburse him for this fee, and Dr. Hanick stopped charging him. Mr. De Lellis is seeking reimbursement for the $125 that he paid to Dr. Hanick (5 visits x $25 per visit).

The difficulty is that the nature of the fee is not clear. It cannot be a surcharge for medical services, as that would be illegal. Therefore, it cannot fall under section 6(1)(a) of the Schedule as medical services.

The question is whether it falls under section 6(1) (f) of the Schedule as "other goods and services, whether medical or non-medical in nature, which the insured person requires because of the accident." I was referred to the arbitration decision in John Adusei and Royal Insurance Company of Canada, March 3, 1994, OIC File No. A-004404. In my view, however, that decision is not of much assistance because it turned on its particular facts.

In the absence of any information about this fee, and in light of the fact that the fee was later waived, I am unable to conclude that it fits within section 6(1) (f) of the Schedule. Therefore, Mr. De Lellis is not entitled to be reimbursed for the fees that he paid to Dr. Hanick.

3. Hydrotherapy Treatment

This issue also suffers from a lack of information. Mr. De Lellis is claiming that as a result of his motor vehicle accident, he requires hydrotherapy. He initially testified that his family doctor, Dr. Saeed, recommended hydrotherapy. I find, however, that Mr. De Lellis suggested it to Dr. Saeed and the doctor agreed to recommend it. Dr. Saeed's clinical notes for April 19, 1993, indicate that Mr. De Lellis told him that Dr. Weber suggested hydrotherapy. Unfortunately, there is no report from Dr. Weber.

Dr. Saeed provided a handwritten note, dated June 3, 1993, stating that Mr. De Lellis should be having hydrotherapy due to problems related to his motor vehicle accident. It is not clear what happened with this request, but Mr. De Lellis did not receive hydrotherapy.

On March 12, 1994, Dr. Saeed recorded in his clinical notes that Mr. De Lellis "wants to get hydrotherapy". He provided a further handwritten note, dated April 16, 1994, stating that Mr. De Lellis "still needs further therapy such as hydrotherapy or next best". It was clear from Dr. Saeed's testimony, however, that he did not have a specific plan in mind when he recommended hydrotherapy. When asked what hydrotherapy involves, he was only able to say that he thought it included exercises in the pool and sauna. I also note, as submitted by Mr. Malach, that the specialists' reports do not mention the need for hydrotherapy.

Based on the information provided, I am unable to conclude that Mr. De Lellis required hydrotherapy as a result of injuries from his motor vehicle accident.

4. Expenses

An award for expenses may be made under section 282(11) of the Insurance Act, which provides as follows:

282 (11) The arbitrator may award to the insured person such expenses incurred in respect of an arbitration proceeding as may be prescribed in the regulations to the maximum set out in the regulations.

Mr. De Lellis was partially successful in this arbitration and, in my view, he should be awarded his expenses, calculated according to Schedule 1 of the Dispute Resolution Practice Code and in Ontario Regulation 664, R.R.O. 1990. The parties are encouraged to reach an agreement as to the expenses. However, if an agreement cannot be reached, I remain seized of this matter and either party may apply for an assessment of the expenses.

Order:

1. Mr. De Lellis is entitled to the following transportation expenses:

• 400 kilometres for visits to Dr. Saeed (16 visits x 25 kilometres per visit)
• 800 kilometres for visits to Dr. Ogilvie-Harris (2 visits x 400 kilometres per visit)
• 400 kilometres for his visit to Dr. Weber (1 visit x 400 kilometres per visit)
• 175 kilometres for his visits to Dr. Hanick (7 visits x 25 kilometres per visit)

In calculating the amount owing, Co-operators is entitled to take into account the amount that it has already paid toward these transportation expenses. Mr. De Lellis is entitled to interest on the outstanding amounts, calculated according to section 24 of the Schedule.

2. Mr. De Lellis is not entitled to be reimbursed under section 6(1)(a) or (f) of the Schedule for $125 that he paid to Dr. Hanick.

3. Mr. De Lellis has not established that he requires hydrotherapy.

4. Mr. De Lellis is entitled to his expenses related to this arbitration.

August 2, 1994

David R. Draper Arbitrator

Date

APPENDIX A

Exhibit 1 -

The medical brief prepared by Mr. Malach, counsel to the Co-operators, containing photocopies of the following documents:

Tab 1.

Medical form completed by Dr. Saeed on August 16, 1991.

Tab 2.

Medical form completed by Dr. Saeed on February 19, 1992.

Tab 3.

Handwritten note from Dr. Saeed to Mr. De Lellis, dated June 3, 1992.

Tab 4.

Medical form completed by Dr. Saeed on September 8, 1992.

Tab 5.

Handwritten note from Dr. Saeed to Mr. De Lellis, dated April 16, 1994.

Tab 6.

Report of Dr. J. Ogilvie Harris to Mr. R. Lofranco, dated April 12, 1994.

Tab 7.

Report of Dr. Adrian N. Hanick to Mr. Lofranco, dated November 15, 1992.

Tab 8.

Handwritten note from Dr. Adrian N. Hanick, dated May 21, 1994.

Tab 9.

Report of Mississauga Orthopaedic and Sports Injury Clinic to Co-operators, dated October 5, 1992.

Tab 10.

Report of Juhan Luik, registered physiotherapist, to Co-operators, dated December 22, 1992.

Exhibit 2 -

The clinical notes and records of Dr. T. Saeed, including photocopies of the following documents:

Tab 1.

The chart - January 12, 1990 to May 21, 1994.

Tab 2.

Handwritten note, dated February 26, 1991.

Tab 3.

Handwritten note, dated March 11, 1991.

Tab 4.

Forms completed for the Workers' Compensation Board from January 17, 1990 to September 29, 1993.

Tab 5.

Consultation note from Dr. Gordon G. Dale, dated May 28, 1990.

Tab 6.

Review note from Dr. Gordon Dale, dated August 16, 1990.

Tab 7.

Orthopaedic consultation note from Dr. Gordon Dale, dated January 17, 1991.

Tab 8.

Consultation note from Dr. M.B. Weber, dated May 21, 1991.

Tab 9.

EEG report from Dr. Weber, dated May 29, 1991.

Tab 10.

Report of Dr. Weber to the law firm of Lofranco, Longley & Vickar, dated December 10, 1991.

Tab 11.

Consultation note from Dr. Marvin Lester, dated March 25, 1992.

Tab 12.

Physiotherapy note from the Mississauga Hospital.

Tab 13.

Patient's Report from the Mississauga Orthopaedic and Sports Injury Centre, dated April 17, 1990.

Tab 14.

Discharge summary re physiotherapy from The Credit Valley Hospital, dated August 30, 1990.

Tab 15.

Form completed for Confederation Life, dated February 26, 1991.

Tab 16.

SPECT Scan report from North York General Hospital, dated January 8, 1992.

Tab 17.

X-ray and laboratory test results.

Exhibit 3 -

Two Applications for Additional Accident Benefits forms, completed by Mr. De Lellis.

In addition to the exhibits, the following documents were before the arbitrator from the Ontario Insurance Commission file:

• Reports of Mediator, dated April 20, 1993 and November 15, 1993.
• Application for Appointment of an Arbitrator, dated November 19, 1993.
• Response by Insurer, dated December 17, 1993.
• Letter, dated March 22, 1994, confirming the pre-hearing discussion held on March 3, 1994.

Cases referred to by the parties

• Douglas R.G. Williams and Jevco Insurance Company, May 6, 1992, OIC File No. A-000112.
• John Adusei and Royal Insurance Company of Canada, March 3, 1994, OIC File No. A-004404.
• Richard Mark Plows and Jevco Insurance Company, January 16, 1992, OIC File Nos. A-000175 and A-000588.

Footnotes

1. 1Prior to January 1, 1994, Ontario Regulation 672 was called the No-Fault Benefits Schedule. After that date it became the Statutory Accident Benefits Schedule - Accidents Before January 1, 1994. In this decision, the term "Schedule" will be used to refer to Regulation 672.