Selma Shreet v. RBC General Insurance Company, 2007 ONFSCDRS 194

Financial Services Commission des Commission services financiers of Ontario de l’Ontario

Neutral Citation: 2007 ONFSCDRS 194

FSCO A05-002602

BETWEEN:

SELMA SHREET

Applicant

and

RBC GENERAL INSURANCE COMPANY

Insurer

REASONS FOR DECISION

Before: Judith Killoran

Heard: July 16, 17, 18 and 19, 2007 at the Financial Services Commission of Ontario

Appearances: David Levy for Ms. Shreet Darrell March for RBC General Insurance Company

Issues:

The Applicant, Selma Shreet, was injured in a motor vehicle accident on May 27, 2004. She applied for and received statutory accident benefits from RBC General Insurance Company (“RBC”), payable under the Schedule.¹ The parties were unable to resolve their disputes through mediation, and Ms. Shreet applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended.

The issues in this hearing are:

Is Ms. Shreet entitled to receive weekly caregiver benefits at the rate of $250 per week from September 3, 2004 to April 10, 2005 and $250 weekly from July 22, 2005 to May 27, 2006, pursuant to section 13 of the Schedule?
Is Ms. Shreet entitled to payments for housekeeping and home maintenance services at the rate of $100 per week from September 3, 2004 to April 10, 2005 and $100 per week from July 22, 2005 to May 27, 2006, pursuant to section 22 of the Schedule?
Is Ms. Shreet entitled to receive a medical benefit in the amount of $3,498 for treatment provided by Downsview Health Recovery, pursuant to section 14 of the Schedule?

Result:

Ms. Shreet is not entitled to receive weekly caregiver benefits at the rate of $250 per week from September 3, 2004 to April 10, 2005 and $250 weekly from July 22, 2005 to May 27, 2006, pursuant to section 13 of the Schedule.
Ms. Shreet is not entitled to payments for housekeeping and home maintenance services at the rate of $100 per week from September 3, 2004 to April 10, 2005 and $100 per week from July 22, 2005 to May 27, 2006, pursuant to section 22 of the Schedule.
Ms. Shreet is not entitled to receive a medical benefit in the amount of $3,498 for treatment provided by Downsview Health Recovery, claimed pursuant to section 14 of the Schedule.

EVIDENCE AND ANALYSIS:

Background

The case before me turns on issues of causation and disability. Ms. Shreet was involved in 3 motor vehicle accidents: January 4, 2004, May 27, 2004 and November 27, 2006. My decision is restricted to the circumstances and claims related to the May 27, 2004 accident (the “second accident”). I heard no evidence with respect to the third accident. However, I heard evidence about the first accident, which has relevance when making determinations about the second accident.

Ms. Shreet was born in Damascus, Syria in 1966. She was educated as an electrical engineer and emigrated to Canada in 2000. She lives in Milton presently but lived in East York at the time of the accident. She is married with one daughter who is now 3 years old. Her daughter was born on February 6, 2004, before the second accident.

RBC challenged the credibility of Ms. Shreet. RBC paid to Ms. Shreet caregiver benefits of $2960, from May 27, 2004 to September 6, 2004. The termination was based on a medical opinion from a disability DAC assessment that there was no need for caregiver benefits. RBC also paid housekeeping benefits of $1,400 from May 27, 2004 to September 6, 2004. These benefits were terminated based upon an orthopedic surgeon’s finding that Ms. Shreet was capable of engaging in her post accident housekeeping duties. RBC paid $3,471 in medical benefits in accordance with treatment plans from Dr. Manish Patel, a chiropractor at Downsview Health Recovery (Downsview), which were deemed reasonable and necessary. The medical/ rehabilitation DAC assessment, conducted in September concluded that some of the treatment plans were not reasonable and necessary. Therefore, RBC paid the first treatment plan and part of the second treatment plan as recommended by the disability DAC assessment.

Ms. Shreet claimed that almost all her injuries from the second accident were new and unrelated to the first accident. Although her wrist injury was pre-existing, she claimed there was strong medical evidence that it was aggravated by the second motor vehicle accident. She conceded that she had received income replacement, housekeeping and medical/rehabilitation benefits from Cooperators from January 2004 to after the date of her second accident.

The First Accident

On January 4, 2004, Ms. Shreet’s husband was driving and applied his brakes suddenly. Ms. Shreet’s right wrist and both knees were injured in this accident. She had been working from Augsust 20, 2003 until December 10, 2003, full-time at Selectron, on the assembly line at its manufacturing plant for car parts. She was not working there at the time of the accident. She was also working part-time at Symcor Inc. stuffing envelopes, stamping and binding from October 2001 to the time of the accident. Ms. Shreet’s injuries prevented her from working after the first accident. She testified that she returned to work at Symcor for 1 week in May after her first accident and before her second accident.

Ms. Shreet’s disability certificate dated January 21, 2004, was signed by Dr. Patel. It stated that she had a wrist sprain/strain and a knee contusion.² After the first accident, Ms. Shreet began her maternity leave from Symcor on February 6, 2004. She never returned to work at Selectron. She testified that she had recovered substantially from the first accident at the time of the second accident. The swelling in her wrist had subsided, the redness was gone and there was less pain.

Ms. Shreet did not receive any x-rays or treatment for her wrist and knees until after her baby was born on February 6, 2004. She received treatment at Downsview for injuries from her first and second accidents. She also had a prior medical history of osteochondromas and benign cysts in her knees and shoulder, which required 4 surgeries to remove.

The invoices from Downsview for the first accident include treatment up to and continuing after the second accident.

The Second Accident

Ms. Shreet was involved in a motor vehicle accident on May 27, 2004 when her car was backed into by a vehicle in a parking lot. She was prepared to exit and was in a stationary position. Her infant daughter of 3 months was in a back car seat. Ms. Shreet’s daughter began crying because the car was shaking after being hit by the trailer hitch of the vehicle in front. Ms. Shreet testified that she was turning to see her daughter after she cried out. Ms. Shreet stated that she hit her hand on the passenger seat when she turned to check on her daughter. She described herself as nervous, dizzy light headed, with pain in the right hand afterward.³

Contrary to her testimony, however, in her Application for Accident Benefits dated June 25, 2004, Ms. Shreet stated that her injuries were to her neck, upper and lower back and head.⁴

Ms. Street claims that the second accident resulted in an aggravation of her right wrist injury and injury to her cervical, lumbar and thoracic spine and her shoulder. After the accident, Ms. Shreet had head and neck pain which caused problems with breastfeeding. Later, she experienced pain in her upper and lower back.

Downsview completed an initial examination report dated May 29, 2004.⁵ Ms. Shreet’s chief complaints were listed as: constant daily headaches and pain in the neck, upper/middle back and lower back. There is no mention of injuries to the right wrist. Although there is right wrist and arm tenderness documented by her family physician, Dr. Jenny Oda, clinical notes and records from May 28, 2004 and onward, appear to attribute these problems to Ms. Shreet’s first accident when she put her hand on the dashboard to protect her pregnancy.

MEDICAL EVIDENCE

The testimony of an expert witness, Dr. Dimitrios Lianos, a chiropractor at Downsview, was the only medical testimony before me at the hearing. Dr. Lianos was qualified as an expert in chiropractic rehabilitation. Dr. Lianos saw Ms. Shreet from October 12, 2004 to April 2005. He had a vivid recollection of his appointments with Ms. Shreet, which lasted for 30-60 minutes on average. He documented numerous objective signs of injury to Ms. Shreet which included her wrist, back, neck and shoulder.

Dr. Lianos examined Ms. Shreet for the first time on October 12, 2004, after having reviewed Dr. Patel’s records. Dr. Patel was Ms. Shreet’s treating chiropractor. Dr. Lianos testified that all treatment received by Ms. Shreet was reasonable and necessary. His diagnosis was that she had carpal tunnel syndrome, right wrist sprain/strain and wrist sprain. Dr. Lianos agreed that Dr. Patel’s May 29, 2004 examination of Ms. Shreet after the second accident did not mention wrist or knee pain. He did not know why. There had been a previous wrist and knee injury after the first accident. However, Dr. Lianos testified that the wrist injury had a different presentation than previously. In his opinion, tendonitis and carpal tunnel syndrome were additional to the sprain/strain injury to the wrist from the first accident. On July 17, 2004, his treatment plan was rejected by the Insurer. It was referred to a medical/rehabilitation DAC assessment.

Dr. Patel signed a Disability Certificate (dated July 17, 2004) which was forwarded to the Cooperators. He claimed Ms. Shreet continued to be entitled to income replacement and housekeeping benefits related to the first accident. There is no mention of the second accident. Cooperators confirmed on November 28, 2006 that it had paid to Ms. Shreet $4,159.18 in medical benefits, income replacement benefits of $17,192.31 and housekeeping of $4,000 related to the first accident.

On September 15, 2004, Dr. John Zeldin, an orthopedic surgeon, assessed Ms. Shreet and concluded that she had a temporary impairment due to neck and back strain from the second accident. He noted that Ms. Shreet had a pre-existing complaint with respect to a right wrist injury. However, he concluded that she did not suffer from a substantial inability to perform her housekeeping tasks as a result of the second accident.

On October 21, 2004, Dr. Rajwani, chiropractor, conducted a medical/rehabilitation DAC assessment. His history from Ms. Shreet was that she suffered neck and back pain from the second accident and wrist and knee pain from the first accident. He concluded that the treatment plan dated July 17, 2004 from Dr. Lianos was partially reasonable and necessary. He recommended an independent exercise program at home and alternative medical options with respect to the right wrist.

An in-home assessment report dated October 9, 2004 from Dr. Jeff Sole, chiropractor, concluded that Ms. Shreet needed housekeeping and caregiver assistance. A functional capacity assessment from Century Assessments contains recommendations for Ms. Shreet’s hand. On December 20, 2005, Dr. Oda recommended that Ms. Shreet attend physiotherapy because of right wrist pain and tendonitis and neck pain. Although Ms. Shreet’s hand hurt before the second accident, she testified that it was worse after the accident with more pain and more limitation of movement.

Dr. Lianos disagreed with Dr. Rajwani’s DAC assessment report dated October 26, 2004. Dr. Lianos testified that there were a number of objective signs of impairment contained in Dr. Rajwani’s report. For example, Dr. Lianos pointed to the position of the ortho joint and the de Quervain joint dysfunction, the neck pain and end range of motion restriction. Dr. Lianos recommended a number of treatments for Ms. Shreet, including chiropractic, massage, exercise and acupuncture.

In his notes and assessment, Dr. Lianos does not mention the first accident of January 4, 2004. His treatment plans restrict the onset of disability to May 27, 2004, the date of the second accident. RBC insisted that Dr. Lianos should be unable to render any opinion or comment on the ability of Ms. Shreet to engage in housekeeping and caregiving as he knew no details of her caregiver and housekeeping abilities prior to the second accident.

On October 21, 2004, Dr. Rajwani conducted another medical/rehabilitation DAC assessment. He concluded that the treatment plan proposed by Dr. Lianos, dated October 12, 2004, was not reasonable and necessary as the best form of intervention, in his opinion, would be a home-based exercise program. He commented on the de Quervain’s Syndrome in Ms. Shreet’s wrist which he believed was more related to the first accident. He did not recommend further physical rehabilitation.

On February 10, 2005, Dr. Rajwani conducted another medical/rehabilitation DAC assessment. He concluded that the treatment plan submitted by Dr. Lianos, dated December 28, 2004, was not reasonable or necessary. In his opinion, Ms. Shreet had reached maximum therapeutic benefit from intervention.

On April 29, 2005, Dr. Rajwani conducted another medical/rehabilitation DAC assessment. He concluded that the treatment plan submitted by Dr. Lianos, dated April 7, 2005, was not reasonable and necessary, as Ms. Shreet had received maximum therapeutic benefit from the treatment provided by Dr. Lianos and Downsview.

On July 5, 2004, Dr. Ramprashad, a radiologist, comments on the ultrasound of Ms. Shreet’s right wrist which may provide evidence of a tendonitis indicating carpal tunnel syndrome.⁶ There were differing diagnoses about the source of Ms. Shreet’s wrist pain. Dr. Dimitrios Anastakis, a plastic surgeon, recommended surgery on her wrist, which was done in April 2007.

Although Dr. English, an orthopedic surgeon, found Ms. Shreet not disabled from housekeeping and childcare, Dr. Lianos disagreed and described Ms. Shreet’s difficulties with breastfeeding due to problems with her wrist. He found she had a wrist injury compounded with a neck and back injury. However, a review of the treatment provided to Ms. Shreet from Downsview after the second accident shows no direct treatment for her knees and wrist. Dr. Lianos speculated that treatment for Ms. Shreet’s shoulders, neck and back might be related to nerve root complaints compromising the wrist.

A Disability DAC assessment was conducted on November 19 and 22, 2004 by Dr. J. Somerville, physiatrist, Barb Pinder, occupational therapist, and Amanda Cameron, physiotherapist. In their summary, they noted that Ms. Shreet had an injury to the right wrist as a result of her first accident. They believed that it was tendonitis with a weak grasp and a decreased range of wrist movement secondary to pain. Their understanding was that Ms. Shreet sustained cervical strain and back strain from the second accident. They encouraged further investigation of the underlying impairment of her right wrist but did not believe that Ms. Shreet was substantially disabled from performing the essential tasks of a caregiver or resuming her pre-accident housekeeping tasks.

On December 2, 2004, Dr. Wong, a physiatrist, examined Ms. Shreet. He ordered an EMG examination which revealed no sign of carpal tunnel syndrome. He believed that the numbness she was experiencing was due to tendonitis of the right elbow and bone damage. He recommended that she wear braces if needed, attend therapy and take medications when she stopped breast feeding.⁷ Dr. Wong’s report confirms that Ms. Shreet’s right wrist area was stiff and tender as was her right elbow. Her right side neck muscles were also stiff and tender as were her right upper back muscles.

Dr. Patel did not make any prognosis with respect to Ms. Shreet’s wrist/knee problems. He also did not diagnose wrist and knee problems from the second accident.

On August 10, 2004, Dr. Jose G. Guerra, an orthopedic surgeon, saw Ms. Shreet to assess her right wrist pain. He stated that the right wrist pain has steadily worsened since January 4, 2004. He states that the mechanics of the injury involved her placing her hand on the dashboard in front of her and sustaining a direct impact into her right hand.⁸ He does not discuss the possibility that the second accident exacerbated Ms. Shreet’s right wrist problems.

Housekeeping Claim

Ms. Shreet lived on O’Connor Drive in a 2-bedroom apartment on the 3rd floor of a low-rise building with no elevator. She had a large window in the living room, no dishwasher and did not use the laundry facility in the bottom floor. There was no garbage chute as the garbage bins were outside. Ms. Shreet had a kitchen, 1 bathroom, hall, 2 bedrooms, living room/dining room with hardwood, tiles in the bathroom and kitchen and a carpet in the living room and entrance. There were 5 windows with one big one in the living room.

Before the second accident, Ms. Shreet testified that she did dusting, arranging the apartment, sweeping the kitchen floor and the rest of the apartment, cleaning the bathroom, and washing the dishes. She travelled with her husband to do the laundry as they did not use the facility in the building. After the first accident, Ms. Shreet testified that she was doing some cooking, some dusting and receiving help from her husband and a friend. She slowly resumed some of her housekeeping duties. Before the accident, Ms. Shreet could do the grocery shopping but not after. Washing dishes was more difficult after the second accident. She testified that she performed about 10 to 20 hours of housekeeping a week with her friend coming only twice a week to assist.

A review of Ms. Shreet’s Activities of Normal Life form, dated June 25, 2004, advises RBC she could do everything before the second accident. This contradicts her testimony at the hearing. Ms. Shreet filled out the form to state that she could do the following before the second accident: meals, shopping for groceries, bed making, washing floors, cleaning the oven, washing dishes, ironing and sewing, but she did not do laundry.

Ms. Shreet testified that her injuries after the second accident were to her low back and knee. Her hand had more pain and limitation. She claimed that as of October 25, 2004, her husband starting doing the housekeeping because she could not afford to pay her friend. At the time of the second accident, her husband had 1 full-time and 1 part-time job. He averaged about 60 hours of work per week. On October 25, 2004, her husband left his full-time day job and started working full-time shift work during the night. The night shift that he worked was 10 p.m. to 6 a.m. at the University of Toronto. Then he would go to work at Symcor Inc. from 3 p.m. to 9 p.m.

Caregiving Claim

After the first accident, Ms. Shreet performed the caregiving for her daughter but received assistance from a friend. On July 13, 2004, Ms. Shreet elected caregiver benefits with respect to the second accident. Ms. Shreet testified that her friend, Fatima Momoni, helped with caregiving. She would arrive between 10 and 10:30 a.m. and leave at 3 or 4 p.m., and sometimes later in the evening. Fatima came to her home for 2 days a week. On average, she came to her home for 6 hours daily. She only came during the day when Ms. Shreet’s husband was at work.

Ms. Shreet testified that she was the primary caregiver at the time of the second accident. She changed diapers, breastfed her baby and did the majority of caregiving functions. After the second accident she was substantially disabled and relied on her friend to assist with caregiving. For the caregiver expense, she relies on reports that she needed assistance nursing her baby. Her disability certificate for Cooperators, from Dr. Patel, said she required caregiver assistance. On October 9, 2004, Dr. Sole recommended 10 hours per week of caregiving assistance.

With respect to the caregiver benefit, RBC relies on Dr. Zeldin’s s. 42 examination. He concluded that Ms. Shreet had reached a point where she could engage in the care of her daughter. Dr. English agreed with Dr. Zeldin that Ms. Shreet was physically capable of homemaking and child care. The disability DAC assessment report of November 2004 also came to this conclusion.

Medical Benefits

Five treatment plans for Ms. Shreet were submitted to RBC by Downsview. They are the following: a treatment plan dated May 29, 2004 from Dr. Patel for $2,582 which was approved and is not in dispute; a treatment plan dated July 17, 2004 from Dr. Patel for $1,762 which was denied, referred to a DAC assessment and partially approved for $889.50; a treatment plan dated October 12, 2004 from Dr. Lianos for $1,242 which was denied, referred to a DAC assessment and found not reasonable and necessary; a treatment plan dated December 28, 2004 from Dr. Lianos for $942 which was denied, referred to a DAC assessment and found not reasonable and necessary; and a treatment plan dated April 7, 2005 from Dr. Lianos for $822 which was denied, referred to a file review DAC assessment and found not reasonable and necessary. All the treatment was consumed by Ms. Shreet except that recommended in the April 7, 2005 treatment plan. The total outstanding account submitted by Downsview to RBC was $8,473, of which $3,471.50 was paid by RBC, with $4,548 remaining as $454 was paid by an unknown party. At the hearing, Ms. Shreet withdrew her claim for the transportation portion of the account, reducing her medical claim to $3,498.

In the Downsview Initial Exam Report after the second accident, there is no mention of wrist complaints although Ms. Shreet testified that she had pain in her upper and lower back, shoulder, knee, right wrist and hand. Dr. Patel documents thoracic and lumbar strain/sprain, shoulder area, and headaches. There was no explanation as to why Dr. Patel did not indicate a wrist injury in his assessment. Ms. Shreet was reevaluated by Dr. Patel on July 17, 2004. A treatment plan was issued and paid for by RBC. Problems noted were the following: cervical spine, thoracic spine, shoulder area, and headaches. Both of Dr. Patel’s reports do not mention knee and wrist problems.

Ms. Shreet testified about how the treatment at Downsview helped her deal with her pain and increased her ease of movement after the second accident. Although there was no mention of Ms. Shreet’s wrist complaint in Downsview’s records, she insisted that she had difficulties with her wrist. The Disability Certificate dated October 12, 2004 was the first time that a wrist problem attributable to carpal tunnel syndrome was mentioned.

On June 4, 2004, Dr. A. Tibbles, a chiropractor, examined Ms. Shreet for a medical/ rehabilitation DAC assessment. He assessed her with respect to the first accident and seemed to know nothing about the second accident. He commented that passive modalities would not assist with her right wrist complaint, whether there was a fracture which did not heal properly or a soft tissue injury.

Dr. Lianos testified that when he evaluated Ms. Shreet, she had the signs and symptoms of carpal tunnel syndrome with sprain/strain of the wrist. There was De Quervain’s inflammation and tendonitis in the forearm extending to the thumb. Dr. Lianos’ clinical notes document the following:

Grade II Whiplash Associated disorder – sprain and strain neck to back
Moderate lumbosacral strain
De Quervain’s syndrome – right wrist

Dr. Lianos testified about Ms. Shreet’s functional limitations which would restrict her caregiving abilities due to problems with her wrist, neck, back and knees. The most debilitating injury was to her wrist but her neck, back and knees compounded the wrist problem. In his opinion, this would prevent her from lifting, carrying, and changing her child’s diapers and clothes. When he saw her it was difficult to give a time frame for recovery for Ms. Shreet. He recommended 6 weeks of treatment and then follow-up to re-evaluate.

Dr. Lianos testified that treatment was anticipated to improve function, decrease pain and restore normal joint movement. Massage was designed to restore normal function of muscles and tissues. Functional exercises were designed to rehabilitate muscles and joints. The purpose of chiropractic treatment was to improve range of movement, deal with muscle tension, and strengthen/ improve coordination and balance. The purpose of acupuncture was to promote healing and restore normal tissue function.

Ms. Shreet testified that she received massage, heat, laser, acupuncture, hand waxing, physiotherapy and chiropractic services. She followed a prescribed exercise routine on the bicycle, board, extending her back and neck and balls for her hands to make them stronger. She stopped attending Downsview in April 2005. She attended for 3 times a week initially, then twice a week, and finally, once a week.

RBC claimed that the expenses on the Downsview account do not match the treatment plans.

Downsview offered no treatment for the wrist and knees. Rather, it was the head, neck, back and shoulders for which she received treatment.

For RBC, there were 5 treatment plans received and considered. There were medical/ rehabilitation DAC assessments on November 11, 2004, February 16, 2005, and April 29, 2005. RBC claims there is confusion about what exactly is being treated and why. The Downsview records document treatment for the back, shoulders, neck and head with no treatment for the wrist and knees. Dr. Patel’s records document wrist and knee injuries resulting from the first accident alone. He submitted 2 treatment plans to RBC after the second accident specifying treatment for the neck, back and shoulders, not the wrist and knees.

Dr. Lianos testified that his ultimate diagnosis was that Ms. Shreet’s wrist and knee problems were caused or exacerbated by the second accident. Dr. Lianos stated that the carpal tunnel syndrome he diagnosed was rooted in an elbow difficulty. However, Ms. Shreet did not testify about any elbow problems. The causation issue revolves around what is the cause of the right wrist problems. It may be a result of tendon problems or hereditary concerns. Ms. Shreet testified about her pre-existing condition of osteochondromas and the surgeries to remove benign tumours. The x-rays from Toronto Western Hospital on August 25, 2006 showed 3 views of her right wrist which were consistent with osteochondromas with Madelund’s deformity. Whatever it may be, RBC submitted that Ms. Shreet’s wrist problems cannot be linked to the second accident.

Dr. Lianos testified about the detailed conversation he had with Ms. Shreet at the examination on October 12, 2004. He was aware of both accidents: January 4, 2004 and October 12, 2004 before preparing the disability certificate. He documented the following injuries: wrist, hand, carpal tunnel syndrome, wrist/hand sprain/strain, cervical spine, lumbar spine and knee. In his opinion, the wrist presentation, plus signs and symptoms, were different from the first accident which resulted in wrist sprain/strain and knee contusion. He claimed the onset of disability for housekeeping and caregiving was on May 27, 2004. In hindsight, Dr. Lianos acknowledged he should have included the first accident in his report.

On October 12, 2004 and December 28, 2004, Dr. Lianos noted that Ms. Shreet suffered from right wrist tenderness on palpation. He claimed to have found objective signs of impairment to her wrist, neck, and back. He recommended 12 weeks of therapy with the same modalities as his previous treatment plan.

Ms. Shreet testified that she tried to return to work after the second accident. She returned on February 3 and March 3, 4, 5, 2005. She sought other medical advice and saw numerous specialists, including her family doctor. She finally had surgery performed on her wrist.

CONCLUSION

I find that Ms. Shreet is not entitled to caregiver, housekeeping and medical expenses as claimed. I have reached this conclusion for the following reasons.

First, I was not persuaded that Ms. Shreet’s wrist problems were caused or exacerbated by the second accident. While there were differences in the medical diagnoses about the nature of Ms. Shreet’s wrist pain and difficulties, there was no clear and convincing evidence that the second accident was the source of the wrist problems or exacerbated the wrist problems. Ms. Shreet’s Application for Accident Benefits after the second accident does not mention wrist pain or problems. Dr. Patel’s assessment after the second accident does not list wrist sprain/strain or pain as a presenting condition. While Dr. Oda does mention wrist pain and tenderness in her clinical notes and records, she appears to attribute its source as the first accident when Ms. Shreet protected herself by putting her hand on the dashboard.

Second, I am not persuaded that if I am wrong and the second accident exacerbated Ms. Shreet’s wrist problems, that Ms. Shreet was disabled from caregiving and housekeeping or that the continued treatment at Downsview was reasonable and necessary. In the disability DAC assessment report of September 17, 2004, Dr. E. English, an orthopedic surgeon, stated that he did not think that Ms. Shreet had been adequately assessed. He was not certain whether her wrist symptoms were related directly to the first accident or aggravated or accentuated by the second accident. In any case, Dr. English concluded that Ms. Shreet was not disabled from housework or child care activities.

I prefer the findings of the Disability DAC assessment conducted on November 19 and 22, 2004 to those of Dr. Lianos. The assessors encouraged further investigation of the underlying impairment of Ms. Shreet’s right wrist but did not believe that she was substantially disabled from performing the essential tasks of a caregiver or resuming her pre-accident housekeeping tasks.

I also prefer the conclusions of Dr. Rajwani’s DAC assessments which did not find the treatment plans submitted by Dr. Lianos to be reasonable or necessary.

Third, I did not find the caregiving and housekeeping claims submitted by Ms. Shreet to be credible. Ms. Shreet’s husband was working at 2 jobs for more than 60 hours a week. I did not find it believable that he was also performing 10 hours of housekeeping and 25 hours of caregiving over and above the hours he would have contributed to the household before the second accident.

Fourth, I was troubled by the duplication of housekeeping and medical receipts that were sent to the Cooperators and RBC for the same periods of time. Also troubling were the medical assessments conducted where the examiner appeared to be informed about only one of the accidents, sometimes the first accident and sometimes the second accident, whatever was most advantageous to Ms. Shreet. I did not always find that Ms. Shreet’s testimony was believable particularly when it contradicted some of the documentary evidence. For example, the Activities of Normal Life Form which Ms. Shreet filled out on June 25, 2004, claimed that she was able to perform almost all of the listed activities before the second accident, contrary to her testimony and despite the fact that she was continuing to receive housekeeping benefits resulting from the first accident.

EXPENSES:

The parties made no submissions with respect to expenses. I encourage the parties to resolve this issue. If they are unsuccessful, they may schedule an expense hearing pursuant to the Dispute Resolution Practice Code.

October 5, 2007

Judith Killoran Arbitrator

Date