Neutral Citation: 1996 ONICDRG 60

File No. A-003815

ONTARIO INSURANCE COMMISSION

BETWEEN:

RADHA RAMBALLY

Applicant

And

MARKEL INSURANCE COMPANY OF CANADA (TTC)

Insurer

DECISION

Issues:

The Applicant, Radha Rambally, was a passenger on a TTC bus which struck a car on May 26, 1992. She applied for and received statutory accident benefits from the Insurer, payable under Ontario Regulation 672.¹ The Insurer paid Ms. Rambally weekly benefits under the Schedule for a period of one week, and some supplementary medical and rehabilitation expenses. Ms. Rambally claimed ongoing entitlement to weekly benefits and additional supplementary medical and rehabilitation benefits. The parties were unable to resolve their disputes through mediation and the Applicant applied for arbitration under the Insurance Act, R.S.O. 1990, c.I.8, as amended.

The issues in this hearing are:

1. Is Ms. Rambally entitled to receive further weekly benefits under section 13 of the Schedule?

2. Is Ms. Rambally entitled to housekeeping expenses under section 6(1)(f) of the Schedule?

3. Is Ms. Rambally entitled to marriage counselling under section 6(1)(f) of the Schedule?

4. Is Ms. Rambally entitled to a special award under section 282(10) of the Insurance Act?

5. Is Markel Insurance Company of Canada entitled to an award under section 282(11.2) of the Insurance Act, in respect of its expenses?

The Applicant claims interest on overdue benefits and her expenses in respect of the arbitration.

Result:

1. Ms. Rambally is not entitled to further weekly benefits.

2. Ms. Rambally is not entitled to housekeeping expenses.

3. Ms. Rambally withdrew her claim for marriage counselling.

4. Ms. Rambally is not entitled to a special award.

5. Ms. Rambally is not entitled to her expenses.

6. Markel Insurance Company of Canada is entitled to an award in the amount of $1,000 in respect of its expenses.

Hearing:

The hearing was held in North York, Ontario, on September 19, 20 and 21, 1994, and February 3, 4, 5 and 16, 1995, before me, Suesan Alves, arbitrator.

Present at the Hearing:

Applicant:

Radha Rambally

Applicant's Representative:

Alfred Kwinter Barrister and Solicitor

Insurer's Representative:

Brian Leck Barrister and Solicitor

Insurer's Officer:

Wendell Pilgrim

Witnesses:

Radha Rambally

Rafeek Maxfaults

Vanda Bisneth

Nazra Mohammed

Dr. Beharry

Dr. Becker

Dr. White

Dr. Arndt

Dr. Hall

Dave Burt

Bernadette Philip

Carol Mohamed

James Tuck

Albert Li

Wendell Pilgrim.

Exhibits:

40 exhibits were filed at the hearing. They are detailed in Appendix A.

The proceedings were recorded in part by Legal Transcript Services

Evidence and Findings:

On May 26, 1992, the Applicant, Radha Rambally, was a passenger on a TTC bus. The bus pulled out from a bus stop, and travelled about 200 feet. The driver applied his brakes and swerved to the left in an attempt to avoid hitting a car which had stopped in front of him. Unfortunately, the bus struck the car.

Ms. Rambally claimed that at the time of the collision, she was thrown off her seat on the bus and sustained injuries to her wrist, neck and low back. Ms. Rambally was taken to Toronto Western Hospital where she was examined and x-rays were taken. She was provided with medication for pain, asked to follow up with her family physician and discharged.

At the time of the accident, Ms. Rambally was 36 years of age. She was a homemaker, mother and caregiver of two children aged 4 and 10. She claimed weekly benefits under section 13 of the Schedule, at the rate of $285 per week, housekeeping expenses, interest on overdue expenses and a special award. At the outset of the hearing Ms. Rambally withdrew her claim for marriage counselling.

The Insurer paid weekly benefits for one week and also paid some supplementary medical and rehabilitation expenses. Counsel for the Insurer submitted that beyond a possible injury to her wrist, Ms. Rambally's claim was fraudulent. The Insurer claimed an award in respect of its expenses. No claim was made for a repayment of benefits.

1. Claim for Weekly Benefits

A) Ms. Rambally's evidence:

In order to succeed in her claim for weekly benefits under section 13 of the Schedule, Ms. Rambally must establish on a balance of probabilities, that the injuries she sustained on May 26, 1992, caused or significantly contributed to a substantial inability to perform the essential tasks in which she normally engaged.

Ms. Rambally testified that prior to the accident she would vacuum, iron, make beds, wash the floor and do "heavy cooking", i.e prepare lasagne, macaroni pie, meat and spaghetti, oven roasts, pot roasts, roti and Indian food. Her habit was to prepare several meals in one day, which she and her family consumed over the course of two or three days.

Ms. Rambally testified that she would play frisbee, baseball and cricket with her children and jog with them. She also helped her older son with his homework and her younger son with his art. Ms. Rambally testified that she enjoyed shopping. Prior to the accident she would leave the house at 9:00 a.m. and spend the entire day shopping with her children. Ms. Rambally testified that prior to the accident she was responsible for all of the household tasks. In her testimony, she seldom indicated how often she performed her pre-accident tasks.

Ms. Rambally testified that for the two months following the accident, she did no housework. She spent eight out of 12 hours during the day lying on the couch. Ms. Rambally testified that Susan Maharaj, the sister-in-law of her spouse, did the cooking, got the children up, dressed them and took them to school. In terms of her personal care, Ms. Rambally testified that she was unable to wash her hair or her back for the first two months after the accident.

Ms. Rambally testified that after two months she could get up and make a cup of tea. She could not go to the washroom by herself or "clean herself." Ms. Rambally testified that by November, six months after the accident, her wrist was no longer sore. She could do light cooking i.e. eggs, cheese dinners and sandwiches. She could go shopping for between one and one and a half hours. Ms. Rambally stated that she could read to the children and help them with school work.

In November 1992, Ms. Rambally was deported. She returned to Canada in November 1993. Ms. Rambally testified that between 1992 and 1993, she lived in her father's home where her sisters relieved her of all household and child care responsibilities.

Between March 29, 1994 and July 11, 1994, Ms. Rambally completed a rehabilitation program at Columbia Health Centre. Ms. Rambally stated that after she completed this program she was "60% towards recovery", and that she has remained at that level.

Ms. Rambally testified that she can do some dishes, some light cooking, and light dusting. She stated that she cares for her children a little more now, for example, she can dress them, and can sometimes walk them across the road to school. She can shop for a short time. She cannot wash the floors. She can do a few pieces of laundry at a time in the washing machine and remove them. However she cannot do a full load. Ms. Rambally's position was that she was disabled as of the date of the hearing.

Even if I accepted that all of Ms. Rambally's pre-accident tasks were essential, I am not prepared to conclude that she has met the test for receiving weekly benefits under section 13 of the Schedule. I did not find Ms. Rambally's testimony reliable or credible. The following are some of the factors which led me to this conclusion.

According to her testimony Ms. Rambally was still unable to do much of her personal care two months after the accident. However, on June 15, 1992, approximately three weeks after the accident, Ms. Rambally completed a form at the request of the Insurer.² In that form Ms. Rambally indicated that she was able to perform her personal care normally. In cross-examination Ms. Rambally agreed that the form was correct when she signed it. She stated that she felt that she could have done these things, however, she had not actually done them. I do not accept this as a satisfactory explanation of the discrepancy between Ms. Rambally's testimony and her written statement.

In her testimony, Ms. Rambally indicated a limited ability to perform her household tasks even after completing the program at Columbia Health Care Centre. She was discharged from the program on July 11, 1994. The follow up report done by that facility four weeks after the program states "She appeared to be managing most household activities with the exception of carrying out the garbage, vacuuming and grocery shopping." According to a checklist completed by Ms. Rambally at Columbia Health Centre, she did not take out the garbage prior to the accident. The surveillance videotape shows her shopping in a grocery store with her sons on June 9, 1994.

Ms. Rambally denied portions of her pre-accident medical history as outlined in the clinical notes and records of her family physician, Dr. Beharry. This included denials of a surgical procedure, of medication, and of two episodes of low back pain. During his testimony, Dr. Beharry reviewed and confirmed Ms. Rambally's pre-accident history as contained in his clinical notes and records. There was no explanation or clarification as to how the discrepancies arose.

Counsel for the Applicant relied on Ms. Rambally's oral statement made on May 29, 1992, which had been reduced to writing by Mr. Pilgrim, the TTC adjuster, and signed by Ms. Rambally. Ms. Rambally agreed that she signed the statement after reading it.

During cross-examination Ms. Rambally was presented with inconsistencies between the statement and her testimony. In re-examination, Ms. Rambally explained the inconsistencies by stating that she made certain statements to Mr. Pilgrim, that Mr. Pilgrim suggested certain facts to her, that she was sick and lying down, and that she had only read parts of the statement. This explanation caused me to question the reliability of Ms. Rambally's evidence.

One of the issues in this arbitration was whether Ms. Rambally was disabled as a result of chronic pain syndrome and, if so, whether this was caused by the accident, or by other stresses in Ms. Rambally's life. Ms. Rambally alleged that her problems were the result of the accident. The Insurer alleged that her stresses had nothing to do with the accident, but related to her precarious immigration status and domestic affairs.

Ms. Rambally's position was that she had cleared up all of the problems related to her immigration status. Ms. Rambally testified that when she returned to Canada in November 1993, she was a landed immigrant. She appeared to be as calm and self-assured during this portion of her testimony as she appeared during most of her testimony. Ms. Rambally produced no documentation at the hearing to support her claim that she was a landed immigrant.

The Insurer summonsed Mr. Li, a program analyst at Employment and Immigration Canada. Mr. Li testified from his review of a computer print out of Ms. Rambally's immigration status, that Ms. Rambally was not a landed immigrant and that the processing of her application for landed immigrant status had been stopped.

I accept the evidence of Mr. Li where it conflicts with that of the Applicant. He relied on a business record. He had no interest in the outcome of this proceeding. His evidence was neither challenged on cross-examination nor refuted by documentary evidence to the contrary.

I find that in the circumstances of this case, this evidence was relevant to the issues raised in relation to Ms. Rambally's claim for weekly benefits. On the basis of this misrepresentation and the other difficulties with her evidence I am not prepared to accept any of the Applicant's testimony given during the course of the hearing.

B) Other lay witnesses on behalf of the Applicant:

Mr. Maxfaults, the Applicant's brother, testified at the hearing. In general his evidence supported Ms. Rambally's position. Two friends of the Applicant, Ms. Bisneth and Ms. Mohamed, gave evidence at the hearing. Their evidence provided a contrast between the cleanliness of Ms. Rambally's home and her activity level before and after the accident. However, I did not find their evidence to be sufficiently specific to assist me in assessing Ms. Rambally's ability to perform her essential tasks

C) The medical evidence:

Ms. Rambally presented evidence that she was substantially unable to perform the essential tasks in which she normally engaged due to back pain, a bulging and or herniated disc, chronic pain syndrome and a near psychotic episode.

(i) Back pain

The Applicant's medical evidence:

Dr. Beharry, Ms. Rambally's family physician at the time of the accident, testified at the hearing. He supported Ms. Rambally's position that she continued to be disabled as a result of her pain. Dr. Beharry testified that following the accident, he saw Ms. Rambally on some 25 occasions for between 10 to 20 minutes. He concluded that her complaints of pain were consistent with the accident, his examination, and evaluation. He testified that he had no reason to doubt Ms. Rambally's claims of pain. In his opinion, Ms. Rambally remained disabled as a result of her injuries as of the date of the hearing.

In July 1992, Dr. Beharry certified that Ms. Rambally was totally disabled. This conflicts with Ms. Rambally's written statement of June 15, 1992³ in which she indicated that she could perform her personal care normally, 25% of the child care and 50% of the cooking.

Dr. Beharry was clearly concerned about his patient and did his best to shed a positive light on her situation. During cross-examination, Dr. Beharry was visibly disturbed that he had no information concerning Ms. Rambally's marriage, pregnancy and miscarriage, all of which Ms. Rambally testified occurred in July 1992, within months of the accident, while she was under Dr. Beharry's care. It appears that Ms. Rambally withheld information from Dr. Beharry which may have affected his opinion on the relationship between her disability and the accident.

In these circumstances, I am not prepared to give much weight to Dr. Beharry's opinion that Ms. Rambally remained substantially disabled as a result of the injuries she sustained in the accident on May 26, 1992.

Ms. Rambally relied on some objective medical evidence of a bulging and a herniated disc to support her claims of disability. As early as June 24, 1992, Ms. Rambally's claims of radiating pain in her right leg and in her right great toe were considered to be suggestive of L4-5 disc herniation.⁴ Three CT-scans were performed. In the first scan, a bulging disc was seen at the L4-5 level on the left side which could be compressing the left L5 root.

Ms. Rambally saw Dr. R. Wong, an orthopaedic surgeon. Dr. Wong recommended that Ms. Rambally should not sit for more than twenty minutes at a time while travelling or working.

Dr. Wong placed no other restrictions on Ms. Rambally's activities.

Dr. Wong's reports appear to be directed to the issue of whether Ms. Rambally was able to travel so that she could be deported. The reports were not helpful with respect to the issue before me-- the Applicant's ability to perform her essential tasks. There was no evidence which suggested that Ms. Rambally's essential tasks as a homemaker and mother of two children required her to sit for extended periods of time.

In August 1992, Dr. G. Lloyd, an orthopaedic surgeon, saw Ms. Rambally in relation to her ongoing complaints of pain. Dr. Lloyd noted that Ms. Rambally "continues to complain of almost total body pain to the point that a meaningful physical examination is almost prohibited."⁵ Within the limits of the examination, there were no objective physical findings. Dr. Lloyd noted that Ms. Rambally's complaints were on the right side; if the reported disc bulge were the cause of the problem, the symptoms would be expected to show up on her left side.

In the second CT-scan, performed one year later, the L4-5 disc is reported to be normal. However, the disc immediately below the L4-5 disc, L5-S1, is reported as showing a central posterior bulge, consistent with a small central protrusion. The report of the third CT-Scan, performed in 1994, states that a bulging disc with slight left sided accentuation is noted at the L5-S1 level.

Dr. Becker, a family physician whose practice mainly involves persons who have been injured in motor vehicle accidents, treated Ms. Rambally. He testified that the herniated disc shown in the 1993 report, was the cause of Ms. Rambally's problems -- it simply took time for the fluid to leak out. However, Dr. Becker also stated that the usual problem reported by patients with a disc protrusion at that site were bowel and bladder complaints. These were not Ms. Rambally's complaints. Dr. Becker was not asked to comment on this, nor was he asked to comment on the third CT-scan report.

Ms. Rambally testified that she had been deported in November 1992. She testified that she lived outside of Canada between November 1992 and November 1993. No explanation was provided as to how the second CT-Scan could have been performed on Ms. Rambally in Toronto, in July 1993. If I assume that all of the CT-scans were indeed taken of Ms. Rambally, then the reports, when read together, raise questions such as the poor correlation between Ms. Rambally's complaints and the reported findings, and the probable cause(s) of the reported findings.

The Insurer's medical evidence:

Dr. White, an orthopaedic surgeon, examined Ms. Rambally at the request of the Insurer in July 1992. He, too, was unable to conduct an orthopaedic examination of Ms. Rambally. Dr. White felt that he could not assess her exaggerated limp and the increased lurch to her gait. He found no involuntary muscle spasm. He did not believe that Ms. Rambally was as disabled as she portrayed.

Dr. White stated that, giving Ms. Rambally the benefit of the doubt, she would have to be considered unfit to perform at least the more demanding and heavier duties such as vacuuming and lifting and activities that required repetitive bending. He stated that unless there was more definite evidence of pathology, such as a positive CT-Scan for disc protrusion, Ms. Rambally could be expected to make a full and complete recovery. Although Dr. White testified at the hearing, none of the CT-Scan reports were put to him for his comments.

Dr. Hall, an orthopaedic surgeon, examined Ms. Rambally at the request of the Insurer in June 1994. Dr. Hall testified at the hearing. He concluded that Ms. Rambally was not believable, and that she was not disabled. He commented on the first CT-Scan report, only.

Conclusion

None of the doctors commented on all of the CT-Scan reports. In the result, I am left with a number of unanswered questions with respect to the medical evidence. Having reviewed and considered the CT-Scan reports in light of the other evidence, I conclude that the Applicant has failed to discharge the onus on her to establish that she injured a disc in the accident and that this injury caused a substantial inability to perform the essential tasks in which she would normally engage.

ii) Chronic pain syndrome

Dr. Becker testified that Ms. Rambally's suffered from chronic pain syndrome. Dr. Becker is of the opinion that Ms. Rambally was more susceptible to developing chronic pain syndrome because of certain features of her personality.

Dr. Becker stated that he felt that Ms. Rambally had always been straightforward with him. He noted that she got better, participated in treatment and responded to the advice of the staff at the Columbia Health Centre. Dr. Becker concluded that Ms. Rambally was not malingering and was totally disabled up to the time of her discharge from the Columbia Health Centre in August 1994. Again, this conflicts with Ms. Rambally's written statement to the Insurer as to the extent of her disability on June 15, 1992.

It was evident that Dr. Becker spends a great deal of time with his patients. I find, however, that Ms. Rambally did not always keep Dr. Becker abreast of facts which could have a significant impact on his opinion.The following are three examples.

Dr. Becker testified that bed rest had not as yet been tried as a treatment for Ms. Rambally. This conflicts with Ms. Rambally's testimony that for the first two months following the accident, she spent eight out of 12 hours during the day, lying on the couch. In addition, Ms. Rambally testified that she was relieved of all household and child care responsibilities by her sisters between November 1992 and November 1993.

Dr. Becker stated that he had asked Ms. Rambally about her pre-accident history and that Ms. Rambally denied any prior back problems. Dr. Becker acknowledged that he "effectively did not know" Ms. Rambally's previous history and he would have liked to have known about her previous episodes of back pain.

Dr. Becker recommended marriage counselling as reasonable and necessary treatment for Ms. Rambally following the motor vehicle accident. Dr. Becker testified that there was some confusion on his part as to whether Ms. Rambally's partner was Mr. Maharaj, her spouse of approximately 10 years, or Mr. Gomes, her present husband. In order to clarify who he was referring for counselling, Dr. Becker arranged for Ms. Rambally to return to his office. Dr. Becker testified that he was able to clarify that it was to be Mr. Maharaj. At the hearing, Ms. Rambally testified that it was to be Mr. Gomes. As noted earlier, Ms. Rambally withdrew her claim for marriage counselling at the hearing.

For all of these reasons I am not prepared to give much weight to Dr. Becker's opinion that Ms. Rambally suffered from chronic pain syndrome.

The Insurer's medical evidence:

Dr. Arndt, a psychiatrist with expertise in personal injury sequelae, examined Ms. Rambally at the request of the Insurer in August 1994.

Dr. Arndt acknowledged that there may have been a medical basis for Ms. Rambally's claim in the early stages; however he felt that Ms. Rambally was malingering i.e. consciously and deliberately magnifying her symptoms in order to support her claim. Dr. Arndt testified that Dr. Becker is able to diagnose chronic pain syndrome. However, in his opinion, Ms. Rambally misled Dr. Becker about significant facts.

For example, she provided Dr. Becker with a partner who was "a composite man" who had the combined history and characteristics of her spouse of 10 years and of her present husband.

Dr. Arndt noted that Ms. Rambally displayed no pain behaviour before him. He concluded that she did not suffer from chronic pain syndrome or any other psychiatric illness as a result of the accident on May 26, 1992.

I prefer the evidence of Dr. Arndt where it conflicts with that of Dr. Becker. In my view, Dr. Arndt had a better grasp of the facts on which he based his opinion than did Dr. Becker. I am not persuaded by the evidence before me that Ms. Rambally suffered from chronic pain syndrome as a result of the accident on May 26, 1992.

(iii) The near psychotic episode

The hearing was adjourned on September 21, 1994 and resumed on February 3, 1995. Dr. Becker testified that during the course of the adjournment, Ms. Rambally saw him on an emergency basis, complaining that she had been hearing voices. Dr. Becker testified that Ms. Rambally was hallucinating and close to a psychotic episode because of "the lack of belief she was encountering at the arbitration hearing." He referred Ms. Rambally to a psychiatrist. Dr. Becker testified that in his opinion, during this time, Ms. Rambally was substantially disabled from performing her essential tasks on psychiatric grounds.

Dr. Becker's opinion would have been based, at least in part, on Ms. Rambally's presentation and complaints. Given the extent to which Ms. Rambally was prepared to mislead Dr. Becker in the past, I am not satisfied that Ms. Rambally was any more truthful with Dr. Becker than she had been previously. I am therefore not persuaded by Dr. Becker's evidence that there was a further period of disability on psychiatric grounds.

Conclusion

Ms. Rambally has not persuaded me on the basis of back pain, a disc problem, chronic pain syndrome or a psychotic episode that she was substantially unable to perform the essential tasks in which she normally engaged prior to the accident. I find therefore that Ms. Rambally is not entitled to further weekly benefits under section 13 of the Schedule.

2. The claim for housekeeping expenses:

Ms. Rambally's claimed housekeeping expenses under section 6(1)(f) of the Schedule. Section 6 of the Schedule provides for the payment by an Insurer of all reasonable expenses for "other goods and services" incurred within the benefit period and required as a result of the accident. Ms. Rambally testified that her spouse paid the amount of $250 per week for housekeeping services to his sister-in-law, Susan Maharaj.

Ms. Rambally testified that Ms. Maharaj moved into her home to provide housekeeping and childcare services for two months. Since the accident occurred on May 26, 1992, I conclude that Ms. Maharaj was in her home until approximately July 26, 1992. Ms. Rambally testified that following this Ms. Maharaj performed housekeeping and child care services during the day and returned to her own home at night. Ms. Rambally also testified that Mr. Gomes took over the housekeeping responsibilities after she married him on July 6, 1992.

For the reasons given earlier, I am not prepared to accept Ms. Rambally's testimony. I was presented with no reliable evidence with respect to this claim, such as receipts or cancelled cheques. Neither Ms. Maharaj, who is alleged to have provided the services, nor Mr. Maharaj who is alleged to have paid for the services, testified at the hearing.

I conclude therefore that Ms. Rambally has not established her claim for housekeeping expenses.

3. The claim for a special award:

The Applicant claimed a special award on the basis that the Insurer had unreasonably withheld benefits or delayed their payment. I have found that the Applicant failed to establish on a balance of probabilities that she was entitled to weekly benefits or to housekeeping expenses as a result of the accident. I therefore find that no benefits have been unreasonably withheld or delayed.

4. The Applicant's claim for expenses:

The Applicant seeks an award of her expenses. An arbitrator has a discretion to award these expenses pursuant to section 282(11) of the Insurance Act.

In exercising my discretion I have considered the intent and purpose of the legislative scheme, the need to facilitate applicants' access to the informal adjudication of disputes, the submissions of counsel and the circumstances of this case.

Although there was some possible objective medical basis to her claim, in my view, this consideration is outweighed by Ms. Rambally's misrepresentations to doctors and the misrepresentations in her testimony, which contributed to a prolonging of the hearing. I exercise my discretion to deny the Applicant her expenses in respect of the arbitration.

5. The Insurer's claim for an award:

The Insurer sought an order requiring Ms. Rambally to pay its expenses in an amount of $1,000. Section 282(11.2) of the Insurance Act provides as follows:

If an insured person commences an arbitration that, in the opinion of the arbitrator is frivolous, vexatious or an abuse of process, the arbitrator may award an amount to be paid by the insured person to the insurer that does not exceed the amount assessed against the insurer in respect of the arbitration under section 14.

The Insurer alleged that the claim was fraudulent. In this case I have accepted the opinion evidence of Dr. Arndt that Ms. Rambally consciously and deliberately misrepresented her case in order to further her claim. Ms. Rambally commenced the arbitration process in support of that claim. At the arbitration she gave testimony which was demonstrably untrue. In my view this was an abuse of the arbitration process. I award the amount of $1,000, the amount assessed against the Insurer in respect of this arbitration, to be paid by Ms. Rambally.

Order

1. Ms. Rambally is not entitled to further weekly benefits under section 13 of the Schedule.

2. Ms. Rambally is not entitled to housekeeping expenses.

3. Ms. Rambally's claim for marriage counselling was withdrawn.

4. Ms. Rambally is not entitled to her expenses in respect of the arbitration.

5. Ms. Rambally shall pay to the Insurer the amount of $1,000 award in respect of its expenses in this arbitration.

April 25, 1996

Suesan Alves Arbitrator

Date

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.
2. 2Exhibit 13
3. 3Exhibit 13
4. 4Note from Dr. Gayah, chiropractor June 24, 1992 indicating need for CT Scan
5. 5Report to Dr. Beharry dated August 6, 1992