Financial Services Commission of Ontario

Commission des services financiers de l’Ontario

Neutral Citation: 2007 ONFSCDRS 246

FSCO A06-000387

BETWEEN:

NAGALINGAM PUSPANATHAN

Applicant

and

RBC GENERAL INSURANCE COMPANY

Insurer

Before: Arbitrator, Denise Ashby

Heard: September 25 September 26 and September 27, 2007, at the offices of the Financial Services Commission of Ontario in Toronto.

Appearances: Adam Ezer, Student-at-law, for Mr. Puspanathan

Darrell March for RBC General Insurance Company

Issues:

The Applicant, Nagalingam Puspanathan, was injured in a motor vehicle accident on December 21, 2004. He applied for and received statutory accident benefits from RBC General Insurance Company (“RBC”), payable under the Schedule.¹ RBC terminated weekly child care and housekeeping benefits and denied certain medical benefits. The parties were unable to resolve their disputes through mediation, and Mr. Puspanathan 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 Mr. Puspanathan entitled to a weekly caregiver benefit from December 21, 2004 to November 20, 2005, pursuant to section 13 of the Schedule?
Is Mr. Puspanathan entitled to a medical benefit for treatment provided by Downsview Health Recovery Centre, pursuant to section 14 of the Schedule?
Is Mr. Puspanathan entitled to a weekly housekeeping benefit, from December 21, 2004 to November 20, 2005, pursuant to section 22 of the Schedule?
Is Mr. Puspanathan entitled to an examination expense, pursuant to section 24 of the Schedule?
Is RBC liable to pay Mr. Puspanathan’s expenses in respect of the arbitration pursuant to subsection 282(11) of the Insurance Act, R.S.O. 1990, c. I.8?
Is Mr. Puspanathan liable to pay RBC’s expenses in respect of the arbitration pursuant to subsection 282(11) of the Insurance Act, R.S.O. 1990, c. I.8?
Is Mr. Puspanathan entitled to interest for the overdue payment of benefits, pursuant to section 46(2) of the Schedule?

Result:

Mr. Puspanathan is not entitled to a weekly caregiver benefit.
Mr. Puspanathan is entitled to a medical benefit, for treatment provided by Downsview Health Recovery Centre, in the amount of $2,509.00.
Mr. Puspanathan is not entitled to a weekly housekeeping benefit.
Mr. Puspanathan is not entitled to an examination expense.
The issue of expenses remains outstanding.
Mr. Puspanathan is entitled to interest on overdue medical benefits.

EVIDENCE AND ANALYSIS:

Mr. Puspanathan was involved in a single car accident. His car hit an abutment and the vehicle’s air bag deployed. Although an ambulance attended at the scene, Mr. Puspanathan declined to be taken to hospital. At the time of the accident, Mr. Puspanathan was living with his wife and two daughters aged 11 and 3 years. He held two jobs: one at a factory which constructs doors and the other as a short order cook in a restaurant. He testified that he was on modified duties at both jobs for 7 to 8 months.

Mr. Puspanathan returned to work at the factory on December 23, 2004. On December 24, 2004, the plant closed for three weeks. When he returned to work in January, he was placed on light duties. The particulars of those duties were not provided. Mr. Puspanathan returned to work at the restaurant on modified duties, described as salad preparation, within days of the accident.

Mr. Puspanathan and Dr. D. Lianos, a chiropractor employed by Downsview Health Recovery Centre (Downsview) were the only witnesses to testify at the hearing. Dr. Lianos was qualified as an expert in chiropractic treatment on the consent of the parties. He testified that he knew that Mr. Puspanathan built doors at a factory but was unaware of his second job as a short order cook. Dr. Lianos was able to recall seeing Mr. Puspanathan regularly over the six month period he was treated at Downsview. I accept that Dr. Lianos recalled Mr. Puspanathan and the treatment he provided to him.

Medical Expenses:

Mr. Puspanathan claims a medical benefit for the cost of treatment provided by Downsview in the amount of $2,509.00 pursuant to section 14 of the Schedule. He submits that all treatment provided to him was reasonably necessary to rehabilitate him and manage his post-accident pain. This permitted him to return to work and maintain his employment on modified duties.

Mr. Puspanathan testified that he ceased attending treatment when the pain from his injuries sustained in the accident had significantly resolved.

RBC submits that it paid for all reasonably necessary treatment totaling $6,601.42.

Section 14 requires that Mr. Puspanathan prove that the treatment he received from Downsview was reasonable and necessary. Dr. Lianos testified that from his first examination of

Mr. Puspanathan on December 23, 2004 to his last on June 30, 2005 he found objective signs of injury.

Dr. Lianos examined Mr. Puspanathan on December 23, 2004. He was the first health professional to examine Mr. Puspanathan post-accident. I accept his initial opinion that

Mr. Puspanathan suffered acute traumatic strain/sprain of the cervical, thoracic and lumbar paraspinal muscles, ligaments and joints; sprain/strain of both shoulders and legs and posttraumatic cervical headaches as described in his “Initial Examination Report.”²

Dr. Lianos’ Treatment Plan, dated December 23, 2004, recommended 6-weeks of treatment for sprain or strain of the joints and ligaments of the lumbar spine, thorax, right and left shoulders, cervical spine, lower leg muscle strain and headaches. The Treatment Plan, dated February 2, 2005, recommended a further 6-weeks of treatment of sprain and strain of the lumbar spine, thorax, right shoulder, cervical spine and headaches. In his testimony, Dr.Lianos explained that

the symptoms in the left shoulder and legs had resolved.

The Treatment Plan, dated March 23, 2005, recommended a 6-week course of treatment for sprain and strain of the lumbar spine, thorax, right shoulder, cervical spine. By this date the cervical headaches had resolved.

The Treatment Plan, dated May 16, 2005, recommended 6-weeks of treatment for cervical and thoracic joint dysfunction and right shoulder rotator cuff syndrome. The corresponding follow-up report indicates that Dr. Lianos had reduced the visits from the initial regime of three times per week to once weekly.

The final Treatment Plan and follow-up report dated June 30, 2005 recommended a further

6-weeks of treatment for the impairments noted in May. Downsview’s attendance records, submitted as part of Exhibit 5, indicate that Mr. Puspanathan last attended for treatment on June 30, 2005.

From the outset RBC denied the Treatment Plans submitted on behalf of Mr. Puspanathan. The first was referred to a Fast Track DAC on the basis that: “the OCF-18 dated December 23, 2004 belongs in the PAF.”³ The DAC report dated February 3, 2005 and signed by Julie Grossman, Clinical Coordinator, states:

There is very little documentation in the file to base Dr. Pringle’s opinion; however, he has reviewed all the documents provided in the file and as listed on the OCF-11. Based on the guidelines as noted above and his review of the contents of the file it is his opinion that Mr. Puspanathan’s impairments likely meet the PAF WAD II guidelines and therefore it is his opinion that the pre-approved framework for WAD II would apply.⁴

Downsview treated Mr. Puspanathan, notwithstanding the opinion set out in this DAC report.

On April 27, 2005, Dr. Pringle assessed Mr. Puspanathan in relation to a Treatment Plan dated March 23, 2005. This assessment led Dr. Pringle to conclude that the recommended treatment was partially reasonable and necessary. Dr. Pringle states: “My examination today revealed some inconsistencies and no significant objective muscoskeletal evidence of impairment.” ⁵ He did not amplify and explain the inconsistencies or what relevance or impact the inconsistencies might have on his opinion with respect to either Mr. Puspanathan’s impairment or the treatment.

On June 1, 2005, Dr. Pringle conducted a further paper review of the Treatment Plan dated May 16, 2005. He concluded that this Treatment Plan was “neither nor necessary.” This report was signed by Dr. Pringle.⁶

It is very troubling that RBC would prefer the equivocating report of February 3, 2005, to that of Mr. Puspanathan’s treating chiropractor, Dr. Lianos. The DAC report is unsigned by Dr. Pringle. It cannot reasonably be held to be Dr. Pringle’s opinion. Rather, it is a clinical coordinator’s impression of Dr. Pringle’s opinion. It is not reasonable to deny treatment based on a report which concludes that it is “likely” the PAF guidelines would apply in the face of a contrary opinion of a treating health professional.

I prefer Dr. Lianos’ opinion expressed in his Treatment Plans and reports and confirmed in his testimony to those of Dr. Pringle. Dr. Lianos had the benefit of regularly seeing

Mr. Puspanathan. He observed his progress and altered treatment recommendations to reflect the change in his condition. As well, Dr. Lianos described in his testimony the diagnostic process and how he came to recommend the treatment for the relevant impairment. I accept that

Dr. Lianos, in forming his opinion, listened to Mr. Puspanathan’s description of his restrictions and symptoms, compared them with his observations, while physically assessing

Mr. Puspanathan and then recommended the treatment, which in his opinion would affect healing while managing Mr. Puspanathan’s pain.

Following the accident, Mr. Puspanathan quickly returned to work. I find that his work at both the factory and restaurant were not sedentary, notwithstanding he was accommodated by both employers with modified duties. I accept his evidence that the treatment he received at Downsview helped him to continue to work by reducing the pain. I also accept his evidence and find that he ceased attending treatment when the pain had resolved sufficiently to make it unnecessary.

The evidence of Mr. Puspanathan and Dr. Lianos establishes that Mr. Puspanathan made significant progress between December 23, 2004 and May 16, 2005. I find that all treatment received by Mr. Puspanathan during this period to be reasonable and necessary.

The oral and documentary evidence also reflects that, by May, Mr. Puspanathan’s progress appeared to have plateaued, in respect of the injuries to his right shoulder and thorax and cervical joint dysfunction. Dr. Lianos’ recommendations for treatment of these impairments remained essentially unchanged between May and June. Mr. Puspanathan did not avail himself of the treatment recommended by Dr. Lianos in his Treatment Plan of June 30. Dr. Lianos’ evidence and reports did not assist in determining why he chose to recommend the same therapy in June as he had in May for those treatment resistant impairments. However, I find that the treatment provided between May 16 and June 30, 2005 was reasonable and necessary to confirm that continuing treatment was unlikely to produce significant change for Mr. Puspanathan’s condition or provide effective pain management.

Therefore, on the basis of the combined evidence of Mr. Puspanathan and Dr. Lianos, I find that all treatment incurred from December 23, 2004 to June 30, 2005 was reasonable and necessary. Further, I find that the treatment recommended in Dr. Lianos’ Treatment Plan dated June 30, 2005 was not reasonable and necessary.

Downsview’s records indicate there were 5 Treatment Plans submitted to RBC on behalf of

Mr. Puspanathan from December 23, 2004 to June 30, 2005, the estimated cost of treatment was $7,661.00 of which RBC paid $5,152.00 leaving a balance owing of $2,509.00.⁷

RBC has submitted various OCF-9s in which it provides explanations of its denial or payment of various Treatment Plans. It submitted that it paid $6,601.42 for treatment provided by Downsview to Mr. Puspanathan.

The evidence provided by Mr. Puspanathan references payments to the submitted Treatment Plans. RBC did not provide a similar record of its payments cross referenced to the invoices submitted on Mr. Puspanathan’s behalf. Such a record would have been helpful in establishing the basis for RBC’s figure of payment of $6,601.42. I prefer Mr. Puspanathan’s evidence and find that he is entitled to a Medical Benefit of $2,509.00 for treatment provided by Downsview from December 23, 2005 to June 30, 2005.

CAREGIVING AND HOUSEKEEPING BENEFITS:

Mr. Puspanathan testified that his wife suffered post-partum medical problems, following the birth of their second child. Due to his wife’s condition, he assumed both primarycare of the children and the housekeeping. Mr. Puspanathan’s description of his wife’s difficulties and how they prevented her from participating in caregiving and housekeeping activities was vague. He provided no supporting medical evidence in respect of his wife’s medical condition and his wife did not testify.

Dr. Lianos testified that, based on his examination of Mr. Puspanathan and his description of his post-accident restrictions, he formed the opinion that Mr. Puspanathan would have been substantially disabled from engaging in either pre-accident caregiving or housekeeping activities. Dr. Lianos also testified that he had no specific knowledge of the date upon which

Mr. Puspanathan returned to work, that he had two jobs and what pre-accident caregiving or housekeeping tasks Mr. Puspanathan engaged in.

On December 23, 2004, Dr. Lianos issued a Disability Certificate in which he indicated that

Mr. Puspanathan was “substantially unable to perform the essential tasks of his employment at the time of the accident.” Dr. Lianos stated that Mr. Puspanathan could not return to work as there were no modified duties available. Dr. Lianos was also of the opinion that Mr. Puspanathan was suffering “a substantial inability to perform the housekeeping and home maintenance services that he performed before the accident.” Dr. Lianos noted that caregiver benefits were non-applicable.⁸

Dr. Lianos’ initial assessment notes, dated December 23, 2005, reflect his diagnosis in the Disability Certificate. Dr. Lianos checked off a box which asked: “As the Primary Caregiver, does the applicant suffer a substantial inability to engage in the care giving activities which he/she engaged at the time of the accident?” These notes describe Mr. Puspanathan as the primary caregiver for two children aged 12 and 3. Dr. Lianos has also checked off a box which enumerates examples of activities as follows: bending, lifting, feeding, dressing, laundry and cleaning up. Similar boxes were crossed off for a substantial inability to perform housekeeping and home maintenance chores. The activities noted were cleaning, laundry, tidying up, vacuuming, shopping, cooking and general household chores.⁹

On February 2, 2005, Dr. Lianos issued another Disability Certificate. The Certificate indicated that Dr. Lianos continued to be of the opinion that Mr. Puspanathan was substantially disabled from performing the essential tasks of his pre-accident employment. He opined that

Mr. Puspanathan was unable to engage in “repetitive bending, lifting, pushing and pulling without aggravation.” As well, Dr. Lianos continued to be of the opinion that “prolonged sitting, standing and walking are provocative.” The Certificate also indicates that Dr. Lianos was of the opinion that Mr. Puspanathan continued to be substantially disabled from performing his housekeeping and home maintenance services. Dr. Lianos used the same wording to describe the reasons for Mr. Puspanathan’s inability to engage in the essential tasks of his employment and housekeeping as found in the December Disability Certificate. The February Certificate reflects Dr. Lianos’ opinion that Mr. Puspanathan was substantially disabled from engaging in his pre-accident caregiving activities from the date of the accident. The explanation is: “See the above limitations.” Those limitations noted that Mr. Puspanathan had returned to work, on modified duties, notwithstanding his inability to perform activities of repetitive bending, lifting, pushing and pulling without aggravation.¹⁰

Dr. Lianos also completed forms entitled “Chiropractic Re-Evaluation.” The boxes, describing caregiving and housekeeping restrictions, contain the same wording as the initial evaluation form described above. In the form dated February 4, 2005, both caregiving and housekeeping tasks are checked off.¹¹ In the re-evaluation, of March 23, 2005, Dr. Lianos has not checked any boxes with respect to income replacement, caregiving or housekeeping. Similarly, there are no further notations in the re-evaluations conducted on May 16 and June 30, 2005.¹²

In light of Dr. Lianos’ testimony, that he had no specific information regarding the caregiving and housekeeping activities in which Mr. Pupanathan engaged pre-accident, the Assessment and Re-evaluation forms have little value. The forms merely list activities which may be relevant to a claim for caregiving or housekeeping and home maintenance benefits. It does not provide evidence that Dr. Lianos informed himself of the specific tasks that Mr. Puspanathan performed prior to the accident and how the impairment he diagnosed might prevent Mr. Puspanathan from engaging in those activities. For example: one box suggests that Mr. Puspanathan could not engage in feeding activities. However, he did not feed either of his daughters prior to the accident, although he prepared meals. Checking a box beside a list of activities, of which

Dr. Lianos had no knowledge of their relevance to Mr. Puspanathan’s pre-accident activities, undermines the reliability of any opinion expressed by Dr. Lianos regarding Mr. Puspanathan’s post-accident restrictions. An arbitrator cannot infer that a task, within the list, was not intended to be considered. As well, an arbitrator cannot reach any conclusion as to which of the remaining tasks might have contributed to Dr. Lianos’ opinion in respect of functional capacity for caregiving and housekeeping. On the basis of the foregoing, I place little weight on Dr. Lianos’ opinion in respect of Mr. Puspanathan’s ability to engage in his pre-accident caregiving and housekeeping activities.

On February 5, 2005, Dr. J. Sole, DC, conducted an In-home Assessment.¹³ A further In-home Assessment was conducted on February 17, 2005, by Dr. M. Patel, DC.¹⁴ Both Dr. Sole and

Dr. Patel were retained by Century Assessment and Diagnostic Centre on behalf of

Mr. Puspanathan. Their reports indicate that they were both aware that Mr. Puspanathan had returned to work at the door factory and was assigned to light duties. Their reports did not mention either Mr. Puspanathan’s second job as a short order cook or his wife’s post-partum difficulties that required him to assume the primary care of the children and the housekeeping.

Dr. Sole concluded that Mr. Puspanathan required 23 hours weekly of caregiving assistance and 10 hours weekly of housekeeping assistance. This conclusion is inconsistent with his notation of Mr. Puspanathan’s reported pre-accident caregiving responsibilities of 9 hours. In assessing

Mr. Puspanathan’s functional abilities, Dr. Sole found that Mr. Puspanathan had partial difficulty with the following child care tasks: bathing and dressing and car seat transfers. Dr. Patel concluded that Mr. Puspanathan required 5 hours of child care assistance weekly and 10 hours of housekeeping assistance.

Dr. Patel’s analysis of Mr. Puspanathan’s functional abilities relied on a level 4 scale that descended from independent to unable. The level next to independent was “with difficulty.”

Dr. Patel indicated that Mr. Puspanathan was able to do the following tasks with difficulty: change linens, clean bathtub, remove garbage, bend to low cupboards, reach high cupboards, wash dishes, carry laundry, enter and exit a bus or streetcar. Dr. Patel rated Mr. Puspanathan as independent with respect to all other tasks relating to household cleaning, meal preparation and laundry. Dr. Patel’s report included methods by which Mr. Puspanathan might complete those tasks which were rated with difficulty and recommended assistive devices which would further facilitate Mr. Puspanathan being independent in completing the tasks albeit with difficulty.

Dr. Patel concluded that Mr. Puspanathan suffered from physical impairments which restricted him from conducting the essential tasks of his pre-accident housekeeping and caregiving activities as follows:

Restricted neck, upper back and bilateral shoulder range of motion.
Decreased tolerance to activities involving reaching, lifting, pushing and pulling.
Functional restrictions and impairments in homecare tasks.
These limitations disable the claimant from completing his pre-accident level of activities.¹⁵

Dr. Patel’s assessment and report is much more detailed than that of Dr. Sole. As well,

Dr. Patel’s conclusion with respect to the amount of time required for both caregiving and housekeeping activities reflected Mr. Puspanathan’s description of the time he spent engaging in those activities pre-accident. I found the inconsistencies in Dr. Sole’s assessment and report rendered his observations and conclusions unreliable, except where they are consistent with

Dr. Patel’s findings.

Caregiver Benefit:

The provisions of section 13 of the Schedule require that Mr. Puspanathan establish, on a balance of probabilities, that he was the primary caregiver of his two children who resided with him. He must also prove that as a result of the accident he suffered a substantial inability or a significant and important impairment of his ability, to perform the essential or major tasks of his pre-accident care giving tasks.

Was Mr. Puspanathan the Primary Caregiver?

Mr. Puspanathan testified that prior to the accident; he left for work at the factory at approximately 6:00 in the morning, before his children were awake, and returned at approximately 6:00 in the evening depending on traffic. On weekends he worked 20 hours at the restaurant. Quite frequently he would be called into work at the restaurant during weekday evenings to fill in for absent staff.

He testified that during the day his wife would care for the youngest daughter when she was not in nursery school. As well, his wife would walk their eldest daughter to and from school in the morning and at lunch. His wife prepared the majority of the family’s meals. His daughters were usually in bed by 9:00 in the evening. During the day and early evening his wife took sewing and English courses. He testified that the sewing class was at 4:00 in the afternoon for two to three hours.

When Mr. Puspanathan was at home in the evenings, he would prepare meals for his daughters’, clean their room, wash their clothes and help his youngest bath. As well, he took his eldest daughter to tutoring. He also assisted her with homework.

I accept that prior to the accident Mr. Puspanathan was an extremely hard working husband and father. He worked long hours at two physically demanding jobs. I also accept that during the evenings he was at home, Mr. Puspanathan spent time caring for his children. This conclusion is supported by the assessments of Dr. Sole and Dr. Patel. However, the care described in those reports and his evidence do not equate with being the primary caregiver.

At most Mr. Puspanathan was with his children for three hours a day from Monday to Friday. Quite frequently he spent less time with them because he was called into work at the restaurant. On the weekend, Mr. Puspanathan worked twenty hours at the restaurant. This work left little time to care for his children. I find that his wife cared for the children for substantially all of their waking hours. His wife insured that the children were dressed in the morning, had their meals during the day and escorted them to and from school and daycare. I find the time his wife spent taking sewing and English courses did not diminish her role as primary caregiver to their children.

On the basis of the foregoing, I find that Mr. Puspanathan is not the primary caregiver and is therefore not entitled to a caregiver benefit.

Although I have concluded that Mr. Puspanathan does not meet the definition of primary caregiver to his two daughters, I will deal with the issues of his eligibility pursuant to the substantially disabled test and the duration of any eligibility.

Substantial Inability:

Mr. Puspanathan must prove that on a balance of probabilities he suffered a substantial inability or a significant and important impairment of his ability, to perform the essential or major tasks of his pre-accident care giving tasks. He does not dispute that RBC paid him $1,230.00 for caregiving benefits incurred from December 21, 2004 to January 23, 2005.

Mr. Puspanathan testified that he was unable to engage in his pre-accident caregiving tasks described above because of accident related pain. As well, because he continued to work, the pain was exacerbated and prevented him from completing his pre-accident caregiving tasks.

While I accept that Dr. Patel conducted a reliable assessment which documents

Mr. Puspanathan’s functional abilities on February 17, 2005, I do not agree with his conclusion that Mr. Puspanathan was substantially disabled. Dr. Patel describes Mr. Puspanathan as being able to do the majority of his caregiving activities with difficulty. This is one level down from independent on the scale he used to assess caregiving restrictions. I find that difficulties in completing caregiving do not equate with a substantial disablility.

The report of Dr. Sole found a similar level of functionality to that described by Dr. Patel. Therefore, I find that he was not substantially disabled from providing caregiving to his two daughters on February 5, 2005, when Dr. Sole conducted his assessment. Dr. Patel’s February 17, 2005, assessment does not suggest that the functional abilities described in his report were recently acquired. There is no evidence to suggest that there was a substantial improvement in Mr. Puspanathan’s condition in late January. Therefore, I infer that there was no significant change from January 23, 2005, the date RBC ceased to pay a caregiving benefit and the date upon which Dr. Sole assessed Mr. Puspanathan. I find that any period of substantial inability had resolved by January 23, 2005. Therefore, no caregiving benefit is outstanding.

Housekeeping:

Mr. Puspanathan claimed a housekeeping benefit pursuant to section 22 of the Schedule for the period from December 21, 2004 to November 20, 2005, at the rate of $100.00 less amounts paid by RBC.

On April 28, 2005, RBC issued an OCF-9 setting out the housekeeping benefits paid. The period from December 21, 2004 to January 23, 2005 was paid at the rate of $100.00 weekly as claimed by Mr. Puspanathan. RBC denied housekeeping benefits for the period from January 24 to April 7, 2005, because he failed to attend an in-home assessment scheduled by RBC. However, RBC paid an additional two days, April 8 and 9, 2005, at the rate of $14.29 and issued a further cheque for $28.58.¹⁶ Mr. Puspanathan did not dispute that RBC had paid him $528.58 in housekeeping benefits.

I accept that Mr. Puspanathan believed his wife was unable to do the heavy housekeeping due to his wife’s post-natal medical condition. As a consequence of this belief, Mr. Puspanathan assumed those duties following the birth of their second daughter. On the basis of the reports of Dr. Sole and Dr. Patel I find that Mr. Puspanathan provided 10 hours of housekeeping services weekly. I find that an hourly rate of $10.00 is reasonable.

Using the same reasoning set out above with respect to caregiving expenses, I find that any post-accident substantial inability to perform his pre-accident housekeeping activities experienced by Mr. Puspanathan had resolved by January 23, 2005. Therefore, no housekeeping benefit is outstanding.

Examination Expense:

Mr. Puspanathan claims an examination expense, for a follow-up In-home assessment recommended by Dr. K. Bar, chiropractor, in his Application for Approval of an Assessment or Examination (OCF-22) dated June 10, 2005, pursuant to section 24 of the Schedule.¹⁷

Dr. Bar is a chiropractor with the Century Diagnostic and Assessment Centre (Century.) It was Century who conducted the two previous In-home Assessments by Dr. Sole and Dr. Patel in February 2005. I found on the basis of those assessments that Mr. Puspanathan no longer required either caregiving or housekeeping assistance at the time they were conducted. Therefore, the follow-up assessment recommended by Dr. Bar is unreasonable and unnecessary.

Interest:

Mr. Puspanathan is entitled to interest on outstanding medical benefits in the amount of $2,509.00, commencing 30 days following receipt of the relevant invoice, pursuant to section 46(2) of the Schedule.

EXPENSES:

The parties made no submissions with respect to expenses. I encourage them to resolve the issue, failing which they may request an expense hearing before me in accordance with the Dispute Resolution Practice Code.

December 11, 2007

Denise Ashby Arbitrator

Date