Financial Services Commission of Ontario

Neutral Citation: 2009 ONFSCDRS 129

FSCO A08-000036 FSCO A08-000037

BETWEEN:

SHEILA RAMBALL Applicant

and

WAWANESA MUTUAL INSURANCE COMPANY Insurer

AND BETWEEN:

SAMUEL RAMBALL Applicant

and

WAWANESA MUTUAL INSURANCE COMPANY Insurer

REASONS FOR DECISION

Before: Arbitrator Denise Ashby

Heard: May 4, 5, 6, June 1 and 3, 2009, at the offices of the Financial Services Commission of Ontario in Toronto.

Appearances: Michelle Whiteman, Student-at-law, for Mrs. Ramball and Mr. Ramball Seth Kornblum, Counsel for Wawanesa Mutual Insurance Company

Issues:

The Applicants, Sheila and Samuel Ramball, were injured in a motor vehicle accident on November 12, 2004. They applied for and received statutory accident benefits from Wawanesa Mutual Insurance Company (“Wawanesa”), payable under the Schedule.¹ Wawanesa stopped certain benefits and denied others. The parties were unable to resolve their disputes through mediation, and Mrs. and Mr. Ramball 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:

In respect of Sheila Ramball:

1. Is Mrs. Ramball entitled to receive the following medical benefits:

(a) $3,094.32 for treatment by Dr. Awenus, as set out in treatment plans dated August 30, 2006 and May 30, 2008; and

(b) $4,956.16 for psychological services provided by Beverley Tingling Counselling Services, as set out in treatment plans dated September 21, 2006, January 16, 2007 and May 13, 2008;

pursuant to section 14 of the Schedule?

2. Is Mrs. Ramball entitled to attendant care benefits of $55.70 per month, less amounts paid, from November 12, 2004 to November 11, 2006, pursuant to section 16 of the Schedule?

3. Is Mrs. Ramball entitled to payment of housekeeping and home maintenance benefits at the weekly rate of $100, from November 22, 2004 to November 11, 2006, pursuant to section 22 of the Schedule?

4. Is Wawanesa liable to pay Mrs. Ramball’s expenses in respect of the arbitration under section 282(11) of the Insurance Act?

5. Is Mrs. Ramball liable to pay Wawanesa’s expenses in respect of the arbitration under section 282(11) of the Insurance Act?

6. Is Mrs. Ramball entitled to interest for the overdue payment of benefits pursuant to section 46(2) of the Schedule?

In respect of Samuel Ramball:

1. Is Mr. Ramball entitled to receive the following medical benefits:

(a) $3,044.32 for treatment by Dr. Awenus, as set out in treatment plans dated September 6, 2006 and May 30, 2008; and

(b) $5,911.16 for treatment by Beverley Tingling Counselling Services, as set out in treatment plans dated September 25, 2006, January 16, 2007 and May 14, 2008;

pursuant to section 14 of the Schedule?

2. Is Mr. Ramball entitled to payment of housekeeping and home maintenance benefits at the weekly rate of $100 from November 12, 2004 to November 11, 2006, pursuant to section 22 of the Schedule?

3. Is Wawanesa liable to pay Mr. Ramball’s expenses in respect of the arbitration under section 282(11) of the Insurance Act?

4. Is Mr. Ramball liable to pay Wawanesa’s expenses in respect of the arbitration under section 282(11) of the Insurance Act?

5. Is Mr. Ramball entitled to interest for the overdue payment of benefits pursuant to section 46(2) of the Schedule?

Result:

In respect of Sheila Ramball:

1. Mrs. Ramball:

(a) Is entitled to receive $1,388.02 in respect of Dr. Awenus’ Treatment Plan dated August 30, 2006 and $2,332.76 in respect of his Treatment Plan dated May 30, 2008.

(b) Is not entitled to payment for outstanding accounts relating to treatment provided by Beverley Tingling Counselling Services, in respect of treatment plans dated September 21, 2006, June 2, 2006, January 16, 2007 and May 14, 2008.

2. Mrs. Ramball is entitled to an attendant care benefit of $55.70 per month, less amounts paid, for services provided from November 12, 2004 to January 23, 2005 and at the rate of $10.85 per month, less amounts paid, from January 24, 2005 to April 11, 2005.

3. Mrs. Ramball is entitled to housekeeping and home maintenance benefits at the weekly rate of $100.00, less amounts paid, from November 14, 2004 to January 6, 2005 and at the weekly rate of $54.25, less amounts paid, from January 7, 2005 to November 13, 2006.

4. In the event the parties are unable to resolve the issue of expenses of this hearing between themselves an expense hearing may be requested before me pursuant to the Dispute Resolution Practice Code.

5. Mrs. Ramball is entitled to interest for the overdue payment of benefits set out above. In the event the parties are unable to agree about the quantum of interest a hearing may be requested before me pursuant to the Dispute Resolution Practice Code.

In Respect of Samuel Ramball:

1. Mr. Ramball:

(a) Is entitled to payment of $996.12 in respect of Dr. Awenus’ Treatment Plan dated September 6, 2006 and $2,221.76 in respect of his Treatment Plan dated May 30, 2008.

(b) Is not entitled to payment in respect of treatment provided by Beverley Tingling Counselling Services.

2. Mr. Ramball is not entitled to a housekeeping and home maintenance benefits.

3. In the event the parties are unable to resolve the issue of expenses of this hearing between themselves an expense hearing may be requested before me pursuant to the Dispute Resolution Practice Code.

4. Mr. Ramball is entitled to interest for the overdue payment of benefits set out above. In the event the parties are unable to agree about the quantum of interest a hearing may be requested before me pursuant to the Dispute Resolution Practice Code.

PROCEDURAL RULINGS:

Combining the Proceedings:

Prior to commencing the hearing, I ordered that the claims of Sheila and Samuel Ramball be heard by me at the same time pursuant to Rule 30 of the Dispute Resolution Practice Code (DRPC) to produce the most just, quickest and least expensive resolution of the issues in dispute.

Disclosure of Ontario Disability Support Program File:

Wawanesa sought disclosure of Sheila Ramball’s Ontario Disability Support Program (O.D.S.P.) file. Although Wawanesa was aware the file existed at the time Sheila Ramball applied for accident benefits it did not seek its disclosure until the hearing.

On April 9, 2009, the pre-hearing Arbitrator ordered that Sheila Ramball’s claim for attendant care benefits be added as an issue. He also ruled that this was without prejudice to Wawanesa’s right to receive full particulars of the claim and production of relevant documents.²

Sheila Ramball had received disability benefits for a period for which she was claiming attendant care. Therefore, I found that the medical records and reports supporting a disability claim were prima facie relevant to her claim for attendant care and should be disclosed to Wawanesa.

I ordered a third-party production motion to be heard, on short notice, on May 14, 2009 and required that Mrs. Ramball provide O.D.S.P. with a release which would permit it to produce all materials in respect of her medical or psychological impairment to her representative. As well, in the event it was determined that the materials were admissible as evidence at the hearing, I ordered that Mrs. Ramball re-attend to be examined in respect of the materials on the O.D.S.P. file. The O.D.S.P. file was released to Mrs. Ramball’s representative and disclosed to Wawanesa without the necessity of the motion. Mrs. Ramball re-attended on June 1, 2009.

EVIDENCE AND ANALYSIS:

On November 12, 2004, Sheila and Samuel Ramball were stopped at an intersection when their car was rear-ended. Following the accident they attended a walk-in clinic. Subsequently, their family physician referred them to a chiropractic clinic for treatment.

Mrs. and Mr. Ramball bear the burden of proving their claims for benefits on a balance of probability. They testified in support of their claim, as did their daughter, Vandana Brown and their daughter-in-law, Mary Lee Ramball. Dr. G. Awenus, a chiropractor who treated the Applicants, also testified on behalf of the Applicants. Dr. P. Se-Young Kim, chiropractor, and Lyndy Goldlust, Occupational Therapist, testified on behalf of Wawanesa.

Credibility of the Lay Witnesses:

I found the evidence of Vandana Brown and Mary Lee Ramball to have been given in a straight forward manner and therefore found them to be credible. However, the Applicants’ credibility was cast in doubt by their testimony in respect of the preparation of the invoices they submitted as evidence supporting their claims for housekeeping and Mrs. Ramball’s claim for attendant care³ and their pre-accident social activities in their home.

Both Samuel Ramball and Sheila Ramball testified that the housekeeping and attendant care invoices they submitted to Wawanesa were prepared and signed by the service provider. Mrs. Ramball testified that they were kept in the home office and were all signed in her presence. Mr. Ramball testified that either he or his wife were present when the invoices were prepared and signed by the service provider. Neither of the Applicants had a clear memory of when they began using the forms.

Vandana Brown testified that the invoices were signed years after the services were provided. She and her sister-in-law worked together to create the invoices from memory based on their recollection and Ms. Brown’s work diaries and the Applicants’ medical appointments. Mary Lee Ramball testified that the invoices were filled out months after the services were provided. She recalled that the duties she had performed had been itemized on the invoices prior to her signature. She would review the invoice for accuracy and sign. Ms. Ramball believed that Samuel Ramball had prepared the documents because Sheila Ramball was unable to prepare them due to her physical restrictions.

There are two Explanations of Benefits (OCF-9s) dated January 16, 2007 issued by Wawanesa which relate to the invoices. The first relates to Sheila Ramball’s claim for housekeeping in the amount of $12,118.00 and attendant care benefits in the amount of $15,773.00.⁴ The second relates to Samuel Ramball’s claim for housekeeping benefits in the amount of $10,094.00 and attendant care benefits.⁵ Wawanesa stamped Samuel Ramball’s attendant care invoices received on December 18, 2006.⁶ I conclude that the OCF-9s dated January 16, 2007 relate to invoices in respect of the Applicants’ claims for housekeeping and home maintenance and attendant care which were submitted to and received by Wawanesa on or about December 18, 2006. I find that they were prepared by Vandana Brown at a time proximate to that date.

Both Applicants attested to the fact that the invoices were prepared at times relatively contemporaneous to the provision of the services and they were present at their signing. This was inaccurate. I do not accept that their testimony was a mere lapse of memory.

Although I accept that Ms. Brown made an honest attempt to reconstruct what services might have been provided on a particular date or in a particular week, they are no more than an estimate. Therefore, I place no weight on the invoices as evidence of what housekeeping and home maintenance and attendant care services were provided.

Both Applicants testified that before the accident they were very active people. They frequently entertained groups of 30 to 40 people in their 3,500 square foot home which they shared with their eldest child, Vandana. Mrs. Ramball would cook traditional meals and Mr. Ramball helped ready the house by moving heavy furniture and assisting with food preparation.

Ms. Goldlust noted in her report dated December 16, 2004, Mr. Ramball was living with his son and his family at their farm at the time of the accident. Samuel Ramball returned to the home his wife and daughter shared following the accident to be close to treatment. Ms. Goldlust reported that prior to the accident Mr. Ramball helped with household tasks, feeding the animals and general repairs.⁷ This is supported by the O.D.S.P. file report, dated September 7, 2005, which described Mrs. Ramball as being separated and living at her daughter, Vandana Ramball’s, home.⁸

Sheila Ramball testified that her husband had moved to their son’s farm to help with construction and it was necessary to report this change in status to the Ministry of Community and Social Services. She also testified that title to the home she lived in with Vandana was held by Vandana and her brother.

The Applicants failed to explain the logistics of hosting large community gatherings while they were not living together. I find it unlikely that at a time proximate to the accident they were entertaining in the manner they described.

The failure of Mrs. and Mr. Ramball to testify candidly about the preparation of the invoices and their living arrangements at the time of the accident casts doubt on their credibility. However, while their credibility may be in doubt such doubt is not fatal to their receiving benefits to which they are in law entitled. Therefore, reliance on their testimony will be restricted to that which is corroborated by other credible evidence.

Pre-Accident and Post- Accident Activities of Daily Living:

In July 2008, the couple moved from the house they shared with Ms. Brown to their son’s house. They presently live with him, his wife, Mary Lee Ramball and their 3 small children. The Applicants, Vandana Brown and Mary Lee Ramball testified that neither Sheila Ramball nor Samuel Ramball have returned to their pre-accident level of activity due to the impairments sustained as a result of the accident.

Sheila Ramball:

The Applicants, Vandana Brown and Mary Lee Ramball testified that prior to the accident Sheila Ramball was an avid gardener. As well, she provided translation services for a television program from English to Hindi for foreign broadcasts. She was independent in all aspects of her personal care. Since the accident, Sheila Ramball has been depressed, confined to her home and continues to require assistance with her personal care, food preparation and other housekeeping tasks. She has returned to a few of her pre-accident household activities but does very little socializing. I accept that Sheila Ramball has not yet returned to her pre-accident activities of daily living.

Samuel Ramball:

The Applicants, Vandana Brown and Mary Lee Ramball testified that prior to the accident Samual Ramball was both physically and socially active. He was a member of a gun club, hunted and rode horses. He helped with the mowing of the grass, groceries, occasional cleaning and simple food preparation tasks. As well, he worked at Home Depot as a consultant in the flooring department. They testified that he has not yet returned to his pre-accident activities but has helped with his wife’s personal care and some minor housekeeping tasks. He returned to work at Home Depot on modified duties but stopped working in 2005. I accept that prior to the accident Samuel Ramball was a socially and physically active person who has not yet returned to all of his pre-accident activities of daily living.

Medical Benefits:

Section 14 provides for the payment of a medical benefit for all expenses incurred for described medical treatment and other goods or services of a medical nature which are reasonable and necessary to deal with the impairment sustained as a result of the accident.

Chiropractic Treatment:

Sheila Ramball claims entitlement to $3,094.32 for treatment provided by Dr. Garey Awenus, as set out in treatment plans dated August 30, 2006⁹ and May 30, 2008.¹⁰ Samuel Ramball claims $3,044.32 for treatment provided by Dr. Garey Awenus pursuant to Treatment Plans dated September 6, 2006¹¹ and May 30, 2008.¹²

Sheila Ramball:

On August 30, 2006, Dr. Awenus recommended 6 sessions of manipulation, exercise and education at an estimated cost of $598.68. The remainder of the $996.12 plan was for filling out forms and conducting an initial evaluation.

In Dr. Awenus’ opinion, Mrs. Ramball’s impairments were beyond the PAF time line provisions and therefore no longer qualified as such.¹³ Dr. Awenus testified that it had been a year since Sheila Ramball’s last treatment session and she was experiencing increased pain. Dr. Awenus opined that as Mrs. Ramball is an older woman with a pre-existing problem with osteoarthritis in her knee the accident aggravated her condition. As well, she reported pain and reduced range of motion in her neck and low back. The pain was limiting her activities of daily living. Dr. Awenus testified that in examining Mrs. Ramball he noted objective signs of impairment which supported Mrs. Ramball’s reports of increased pain and reduced range of motion.

In Dr. Awenus’ opinion, the premature termination of treatment had contributed to the need for a graduated return to more active treatment modalities. Therefore, he had recommended ultrasound, interferental [sic] current with some manipulation. This combined with the educational component regarding the use of the recommended therabands would lead to Mrs. Ramball being able to engage in a self-directed home exercise program. Dr. Awenus was satisfied that Mrs. Ramball was motivated to participate in his recommended treatment and was very cooperative. Dr. Awenus testified that as part of the educational component he would be teaching “hurt versus harm” while helping Mrs. Ramball to do the recommended exercises. In Dr. Awenus’ opinion, the chronic nature of Mrs. Ramball’s impairments and her psychological fragility would necessitate a lengthier treatment program.

Dr. Kim testified that he examined Mrs. Ramball on October 26, 2006. This was two to three months after treatment, in respect of Dr. Awenus’ Treatment Plan of August 30, had begun. Dr. Kim noted little improvement from the reports of the chiropractor who had treated her the previous year. In his opinion, this treatment should have resulted in objective and significant change. However, in his report Dr. Kim noted that Mrs. Ramball was not able to tolerate pressure on the spine. This led him to conclude that she could not tolerate any meaningful passive manual therapies.¹⁴ Notwithstanding this he concluded that Mrs. Ramball may have reached maximal therapeutic response with the treatment provided a year earlier, therefore further treatment was neither reasonable nor necessary. As well, Dr. Kim was of the opinion that the recommended home exercise program failed to challenge the affected areas sufficiently to increase mobility. In his report dated November 2, 2006, he wrote:

…In any event, at this time, a greater focus and emphasis should be on a self-directed program to further rehabilitate her condition. As she is already receiving psychological counselling, it would be helpful, if some of the sessions could be used to discuss the concept of “hurt versus harm” so that she can better understand her condition and engage in a more appropriate program. As this is outside of my scope of practice, further comments will not be made at this time.¹⁵

The invoices issued by Dr. Awenus indicate that by November 4, 2006, nine treatment sessions had been provided.¹⁶ Therefore, the majority of the treatment recommended in the August 30 Treatment Plan had been provided by the time Dr. Kim assessed Sheila Ramball. Dr. Kim concluded that Mrs. Ramball required educational sessions relating to the theory of hurt versus harm which he recommended be provided by Mrs. Ramball’s psychotherapist.

I prefer the evidence of Dr. Awenus. It is reasonable that the therapist assisting with the physical impairments provide education with respect to hurt versus harm. As well, I accept his evidence that he observed objective indicators of continuing impairment. I find that the chronic nature of the symptoms and the lapse of one year between Sheila Ramball’s previous treatment and that recommended by Dr. Awenus were a reasonable basis for providing a further course of treatment. Therefore, I find that the Treatment Plan dated August 30, 2006 was reasonable and necessary.

Dr. Awenus’ invoice indicates that of the $1,715.48 billed $327.44 was paid. The outstanding amount was $1,388.02. Dr. Awenus provided 3 more treatment sessions than were set out in the Treatment Plan. He claimed $450.00 for a rebuttal report in response to Dr. Kim’s assessment. The three extra sessions were reasonable given the chronic nature of the impairments he observed. Therefore, I find that the outstanding amount of $1,388.02 is payable in respect of the Treatment Plan dated August 30, 2006 pursuant to the Schedule.

Samuel Ramball:

Dr. Awenus recommended 6 treatment sessions over 6 weeks of treatment. The treatment was to include manipulation, other modalities, exercise and education. As well, he recommended Mr. Ramball be provided with therabands. The estimated cost of the treatment plan was $996.12.¹⁷ On November 11, 2006, Wawanesa issued an Explanation of Benefits denying the August 30, 2006 Treatment Plan.¹⁸ Mr. Ramball does not dispute the validity of this denial.

Dr. Awenus testified that he observed objective indicators that Mr. Ramball was suffering from accident-related impairments although it was nearly two years post-accident. He used a cane and Dr. Awenus noted reduced range of motion in the cervical and lumbar regions of the spine and the left elbow was quite stiff. Mr. Ramball had advised Dr. Awenus that he did home exercise but it was irregular. Dr. Awenus’ treatment objectives were to ameliorate pain and increase Mr. Ramball’s range of motion to assist him to regularly engage in a self-directed program at home. The educational component would include a discussion of hurt versus harm while having Mr. Ramball engage in physical activity.

Dr. Kim testified that Mr. Ramball walked with a cane but did not use it and otherwise had a normal gait. In his report, he noted the cane and observed that Mr. Ramball did not appear to use it for support.¹⁹ He was of the opinion that Mr. Ramball exaggerated the pain he was experiencing because he estimated it as 8 out of 10 which would be crippling. In his opinion, this was inconsistent with someone employed at Home Depot. Dr. Kim was of the opinion that the passive treatments recommended did not challenge the affected areas sufficiently to improve their range of motion or increase their functionality. In his report dated November 2, 2006, he concluded that Mr. Ramball had good functional mobility and his current limitations were associated with weakness and the focus of treatment should be on self-directed exercise.²⁰ As with Mrs. Ramball, Dr. Kim recommended that Mr. Ramball be educated by his psychotherapist regarding hurt versus harm.

Although, Dr. Kim believed that Mr. Ramball exaggerated his symptoms he did not dismiss that he was experiencing pain, stiffness and weakness. Dr. Kim’s evidence that Mr. Ramball was carrying a cane but did not use it is inconsistent with exaggerating symptoms. I accept that the chronic nature of the symptoms and the lapse of one year between Samuel Ramball’s previous treatment were a reasonable basis for attempting to obtain further therapeutic gains by attempting another course of treatment. It was reasonable to provide further treatment, to assuage pain, improve Mr. Ramball’s strength and flexibility while providing him with guidance on a self-directed exercise program. As a consequence, I prefer the evidence of Dr. Awenus in respect of the September 6, 2006 treatment plan. I find that the recommended treatment was both reasonable and necessary including the cost of the therabands. However, the invoice dated November 17, 2008, indicates that Dr. Awenus commenced treatment on September 6 and continued treatment to March 28, 2007. During this period Dr. Awenus provided 18 treatment sessions. I find that providing 3 times the number of treatment sessions set out in the Treatment Plan is not reasonable. Therefore, Mr. Ramball is only entitled to the amount specified in the Treatment Plan dated September 6, 2006 in the amount of $996.12.

Sheila Ramball and Samuel Ramball

On May 30, 2008, Dr. Awenus recommended that Sheila Ramball receive 12 treatment sessions over a 6 week period. He also recommended x-rays be taken of her cervical spine and left knee. Further, he recommended a knee support. The Treatment Plan estimated the cost of treatment at $2,332.76 inclusive of examinations and preparation of the plan.²¹ Dr. Awenus also issued a Treatment Plan in respect of Samuel Ramball in which he recommended 12 treatment sessions over a 6 week period, an x-ray of the cervical spine and therabands. The Treatment Plan estimated the cost of treatment at $2,221.76 inclusive of examinations and preparation of the plan.²²

Wawanesa responded to the receipt of the Treatment Plans in letters to each of the Applicants dated June 16, 2008 and enclosed an OCF-25, Notice of Examination. The letters advised that they were sent in fulfillment of the requirements of subsection 38(8) of the Schedule and indicated that Wawanesa did not agree to pay for the goods and services set out in the Treatment Plans.²³ The Notice of Examination provided the following reasons:

We question the necessity of the proposed OCF-18 Treatment Plan dated May 30, 2008. Based on the medical documentation on file, no further facility based treatment is necessary. As such we require the decision of an Independent Medical Assessment to determine if the suggested OCF-18 Treatment Plan is reasonable and necessary.²⁴

The assessments were scheduled to take place on June 25, 2008. They were rescheduled to occur on July 17, 2008.²⁵ The Applicants did not attend these assessments.

The Applicants testified that they did not attend because they were moving to their son’s home. Vandana Brown testified that she was married on July 12, 2008 and has not lived with her parents since.

On July 31, 2008, Mrs. Ramball’s representative wrote to Wawanesa advising of her change of address.²⁶ A more detailed letter was sent in respect of Samuel Ramball’s non-attendance on the same date. It explained that Mr. Ramball did not receive the Notice until July 16, 2008. The letter also advised that he was willing to attend a rescheduled examination and provided some dates when he would be available.²⁷ Wawanesa’s counsel responded on August 26, 2008, indicating that Wawanesa had been advised that the Applicants did not attend the examinations on July 17 because of a move and family functions.²⁸

Subsection 38(15) provides:

If an insured person fails or refuses to comply with subsection 42(10), the insurer may make a determination that the insured person is not entitled to the goods and services contemplated by the treatment plan.

Subsection 38(16) provides:

If an insured person subsequently complies with subsection 42(10), the insurer shall reconsider the insured person’s claim and make a determination under this section.

Subsection 42(10)(b) provides:

If the attendance of the insured person is required at the examination, the insured person shall attend the examination and submit to all reasonable physical, psychological, mental and functional examinations requested by the person or persons conducting the examination.

Pursuant to subsection 42(9)1, the insurer “shall make reasonable efforts to schedule the examination for a day and time that are convenient for the insured person.”

Wawanesa submitted that as the Applicants had failed to attend the examinations they were in non-compliance with subsection 42(10) and therefore the benefits were not payable pursuant to subsection 38(15). The Applicants submitted that they had a reasonable explanation for their non-attendance. Further, Wawanesa had failed to reschedule the examinations within a reasonable period and had failed to properly deny the benefits and therefore Samuel Ramball and Sheila Ramball were each entitled to the benefits.

There is no evidence that either Samuel Ramball or Sheila Ramball were consulted in respect of the rescheduled date of July 17, 2008. I am satisfied that the preponderance of the evidence is that the Ramball household was in transition in July 2008. The couple moved from the home they had previously shared with their daughter at a time proximate to her daughter’s wedding on July 12, 2008.

I find that the move provides a reasonable explanation for their non-attendance and Wawanesa was aware of the reasons for the non-attendance by August 26, 2008.

Wawanesa did not attempt to reschedule the examinations. The letters and Notices of Examination of June 16, 2008 lead me to conclude that the claims adjuster was unaware that it was her obligation to consider the available medical information and determine whether Wawanesa would pay the benefits. She states clearly that the examinations were scheduled to obtain “the decision of an Independent Medical Assessment” if the recommended treatment was reasonable and necessary. This statement is not a denial as it clearly indicates a decision has not yet been made. As the benefits were not properly denied, Sheila Ramball is entitled to $2,332.76 and Samuel Ramball is entitled to $2,221.76 of medical goods and services as set out in the Treatment Plans dated May 30, 2008.

Pyschological Services:

Both Sheila Ramball and Samuel Ramball claim entitlement to a medical benefit in respect of counselling provided by Beverley Tingling Counselling Services. Ms. Tingling is a registered social worker.

The Applicants testified that the counselling provided by Ms. Tingling helped them deal with fears and emotional distress related to the accident. As they were continuing to experience distress they wanted to continue treatment. Neither Ms. Brown nor Mary Lee Ramball attributed changes in the Applicants’ moods or functioning to the counselling sessions.

On March 26, 2009, Dr. T. Kulbatski, a psychologist, released a report in which she concluded that Mrs. Ramball requires 20 weekly sessions to assist in dealing with a chronic pain disorder, a major depressive disorder and post-traumatic stress disorder. She did not discuss how the counselling provided by Ms. Tingling would ameliorate or treat the disorders diagnosed by Dr. Kulbatski. Therefore, I place no weight on this report in respect of the disputed Treatment Plans.²⁹

Sheila Ramball:

Sheila Ramball seeks $4,956.16 for the outstanding treatment and administrative services in respect of the Treatment Plans dated September 21, 2006,³⁰ January 16, 2007³¹ and May 14, 2008.³²

An initial Treatment Plan dated June 12, 2006 was approved following a paper review by a Social Worker who was of the opinion that the 12 treatment sessions and associated costs were reasonable and necessary.³³

In the Treatment Plan dated September 21, 2006, Ms. Tingling describes the injuries or symptoms as follows: sleeping difficulties, nightmares, depression, fearful of driving, increased stress in relationships, memory and concentration difficulties, feeling tense, worried, nervous irritability, frustration, low energy, difficulty coping with pain.³⁴ To treat these complaints she recommends 12 further counselling sessions, documentation of $63.72, planning and preparation costs of $300.00, travel and transportation of $50.00, progress report of $400.00, inter-professional consultation of $130.00, documentation review of $130.00 and a reassessment of $130.00 for a total cost of $2,763.72. The Treatment Plan dated January 16, 2007 describes the same symptoms and recommends 10 sessions and $260.00 in planning and preparation for a cost of $1,943.72. The Treatment Plan dated May 14, 2008 refers to the same complaints or symptoms as set out above and recommends 12 sessions with the associated administrative costs for a total cost of $2,763.72.

Ms. Tingling submitted six reports to Wawanesa in respect of her treatment of Mrs. Ramball on May 24, 2006, December 30, 2006, March 29, a rebuttal report dated March 31, 2007, June 30, 2008 and a further rebuttal report of August 28, 2008.³⁵

Ms. Tingling’s report dated March 29, 2007 indicates that she saw Mrs. Ramball for 30 sessions. Mrs. Ramball reported a 15% to 20% improvement in her anxiety relating to being driven in a car. As well, her personal hygiene had improved 60%. Ms. Tingling concluded that notwithstanding she was of the opinion that Mrs. Ramball was suffering a psychological impairment which was directly related to the accident she was no longer in need of counselling.³⁶

On November 2, 2006, Dr. R. Lubbers, a registered psychologist, conducted a paper review of the September 2006 Treatment Plan. He concluded that the recommended 12 additional sessions at the hourly rate of $130.00 and preparation of the OCF-18 in the amount of $63.72 were reasonable and necessary. However, Dr. Lubbers concluded that the fees proposed for planning and preparation, documentation review, progress reporting, inter-professional consultation and reassessment totalling $1,750.00 were neither reasonable nor necessary.³⁷

On February 28, 2007, Dr. Lubbers released a report following an in-person psychological assessment of Mrs. Ramball in respect of the January 16, 2007 Treatment Plan. He enumerated various complaints that Mrs. Ramball reported were current and attributed to the accident including: daily pain, re-experiencing the events of the accident visually during the day and auditory intrusions at night. Dr. Lubbers noted that there was a significant pre-accident history with respect to pain and other health problems. Further, Ms. Tingling had addressed the enumerated complaints in two previous Treatment Plans and there was no clear indication that Mrs. Ramball’s current complaints were accident related. Therefore, in Dr. Lubbers opinion further treatment for these complaints was neither reasonable nor necessary.³⁸

Ms. Tingling’s report dated March 31, 2007 is a rebuttal of Dr. Lubber’s examination. She acknowledges his finding that the administration fees were not reasonable and necessary but provides no information explaining their importance to treatment. She questioned the reliability of the psychometric testing that Dr. Lubbers conducted.³⁹

Although, Mrs. Ramball testified that her sessions with Ms. Tingling were helpful she provided no detail regarding the manner in which they assisted her. The evidence of the other lay witnesses did not support a significant post-accident change in mood or reduction in symptoms as a consequence of the two approved Treatment Plans.

Ms. Tingling did not give evidence. Her reports are vague regarding the counselling she provided to Mrs. Ramball and contain no objective support for its efficacy. Ms. Tingling’s report of March 29, 2007 attributed various reported improvements to the previous 6 sessions. There was no indication that Mrs. Ramball had experienced a therapeutic breakthrough in those 6 sessions for which the previous 24 were a necessary prologue. In her rebuttal report of March 31, 2007, Ms. Tingling failed to explain how the administrative costs were necessary components of the treatment she was providing. Therefore, I find that the administrative costs associated with the Treatment Plans dated September 21, 2006 and January 17, 2007 are not reasonably necessary elements of the treatment and Sheila Ramball is not entitled to payment of those benefits.

In respect of the January 17, 2007 Treatment Plan, I do not accept Dr. Lubber’s conclusion that Mrs. Ramball had pre-existing psychological problems relating to her pre-accident health problems. There is no reliable evidence before me that she had a pre-existing psychological disorder. The O.D.S.P. file indicates that her disability benefits were related to physical issues. There was no evidence of pre-accident psychiatric or psychological assessments or notes of treatment of such problems. However, Ms. Tingling relied on the self-report of Mrs. Ramball that the six sessions prior to her discharge from treatment resulted in positive change. There is no supporting evidence that the 24 approved sessions produced significant improvement. I find that 24 sessions is a reasonable course of treatment to determine whether the modalities being employed were of assistance. As there was no objective evidence of positive change, I find that the treatment recommended by Ms. Tingling in the Treatment Plans dated January 16, 2007 and May 14, 2008 were not reasonable. Therefore, Mrs. Ramball is not entitled to payment for treatment pursuant to those Plans.

Samuel Ramball:

Samuel Ramball seeks payment of $5,911.16 in respect of counselling services he received from Ms. Tingling. He seeks payment of outstanding administrative costs in respect of the Treatment Plan dated September 25, 2006.⁴⁰ Mr. Ramball claims payment of both the treatment and administrative costs in respect of the Treatment Plans dated January 16, 2007⁴¹ and May 14, 2008.⁴²

An initial treatment plan dated June 6, 2006 was approved following a paper review by a Social Worker who determined the Plan, recommending 12 sessions and associated administrative costs to be reasonable and necessary.⁴³

In the Treatment Plan of September 25, 2006, Ms. Tingling describes the injuries or symptoms as follows: sleeping difficulties, nightmares, depression, fearful of driving, increased stress in relationships, memory and concentration difficulties, feeling tense, worried, nervous irritability, frustration, low energy, difficulty coping with pain. To treat these complaints Ms. Tingling recommends 12 further counselling sessions, documentation of $63.72, planning and preparation costs of $300.00, travel and transportation of $50.00, progress report of $400.00, inter-professional consultation of $130.00, documentation review of $130.00 and a reassessment of $130.00 for a total cost of $2,763.72.⁴⁴

The Treatment Plan dated January 16, 2007 describes the same symptoms and recommends 10 sessions and $260.00 in planning and preparation in the amount of $1,943.72.⁴⁵

The Treatment Plan dated May 14, 2008 also refers to the same symptoms set out above and recommends a further 12 counselling sessions plus the administrative expenses in the amount of $2,763.72.⁴⁶

In her report dated March 28, 2007, Ms. Tingling states she saw Mr. Ramball for 36 sessions. She concluded that notwithstanding Mr. Ramball was suffering a psychological impairment he did not require any further counselling and she discharged him from treatment. At the time, Mr. Ramball reported a 60 to 65% improvement in his socializing and had returned to 50% of his domestic tasks. As well, his comfort with driving had improved somewhat. He attributed this improvement to the previous 6 sessions.

Dr. Lubbers conducted a paper review of the Treatment Plan dated September 25, 2006.⁴⁷ As well, he assessed Mr. Ramball on March 14, 2007.⁴⁸ As with Mrs. Ramball, Dr. Lubbers concluded that the treatment and documentation charges recommended by Ms. Tingling in September 2006 were reasonable and necessary but the additional administrative costs were not.

Mr. Ramball was provided with approximately 24 counselling sessions. Twelve under the first Treatment Plan and a further twelve in respect of the Treatment Plan dated September 25, 2006. This represents approximately 6 months of counselling. Ms. Tingling did not give evidence. Her report of March 28, 2007 is vague. It provides no detail as to what was done during the 36 sessions she saw Mr. Ramball. She reports that Mr. Ramball attributed improvement to the 6 sessions which preceded her report.

The descriptions of Mr. Ramball’s symptoms are essentially the same in each of the Treatment Plans. As well, they are very similar to Ms. Tingling’s descriptions of Mrs. Ramball’s symtoms. In addition to the hourly cost of the counselling sessions, Ms. Tingling charges planning and preparation costs of $300.00, travel and transportation of $50.00, progress report of $400.00, inter-professional consultation of $130.00, documentation review of $130.00 and a reassessment of $130.00. Ms. Tingling relied on the self-report of Mr. Ramball that the six sessions prior to his discharge from treatment resulted in positive change. There is no supporting evidence that the 24 approved sessions produced substantial change. On the basis of the foregoing, I find that the treatment recommended in the Treatment Plans dated January 16, 2007 and May 14, 2008 is not reasonable and therefore Samuel Ramball is not entitled to payment of a medical benefit in respect of those Plans.

Attendant Care Benefits:

Mrs. Ramball seeks payment of attendant care benefits at the monthly rate of $55.70, less amounts paid, from November 12, 2004 to November 11, 2006.

In 1993, Sheila Ramball applied for and was granted disability benefits. At the time of her application, she was diagnosed with a deep vein thrombosis and severe anaemia. As well, severe back pain was noted. The Medical Adjudicator’s (Adjudicator) report describes Sheila Ramball as requiring someone with her at all times because of the dizziness she was experiencing.⁴⁹ The Adjudicator determined that Mrs. Ramball was permanently unemployable. As a consequence, she began to receive disability benefits under the then Family Benefits Act. Her benefits were “grandfathered” into the provisions of the Ontario Disability Support Program Act.⁵⁰ In September 2005, the Ministry of Community and Social Services (the Ministry) which administers O.D.S.P. payments, requested and obtained information relating to her continuing eligibility for benefits under the Act. These benefits were terminated in August 2006.

There is no indication that the Ministry conducted updated medical assessments on Sheila Ramball subsequent to the 1993 Adjudicator’s report. The Termination Letter dated August 1, 2006 states that Mrs. Ramball’s benefits are suspended because information was missing. There is no description of what information is missing.⁵¹ I find that the Ministry’s information, in respect of Mrs. Ramball’s physical and psychological health, was obtained in 1993 and was not updated. The relevance of this information to her health on the date of the accident is remote. Therefore, I have assigned it no weight in respect of Mrs. Ramball’s claim for an attendant care benefit.

Both Vandana Brown and Mary Lee Ramball testified that they provided attendant care assistance to Sheila Ramball from shortly following the accident to present. There has been a reduction in respect of the amount of time spent providing these services. Initially, Mrs. Ramball required a great deal of assistance with her personal hygiene, preparing her meals and attending medical appointments. As time went on these services were less necessary and the focus was on taking care of Mrs. Ramball’s hair.

On November 26, 2004, Ms. Goldlust conducted an in-home assessment⁵² and prepared an Assessment of Attendant Care Needs (Form 1). She determined that 73.5 minutes of attendant care were required for Level 1 dressing and grooming at the monthly rate of $55.70.⁵³ She prepared subsequent Form 1s on January 15, 2005 and March 4, 2005. In January, Ms. Goldlust reduced the Level 1 care to 14.5 minutes per week or 1.03 hours per month for braiding and colouring her hair. The In-home Assessment report of January 6, 2005 indicates that Ms. Goldlust determined that Mrs. Ramball demonstrated an ability to resume her personal care except for the braiding and colouring of her hair.⁵⁴ This resulted in a monthly rate of $10.85.⁵⁵ In March, Ms. Goldlust determined that there was no longer any need for attendant care.⁵⁶ In a letter report dated March 11, 2005, Ms. Goldlust reported that Mrs. Ramball advised her that she had not coloured her hair since the January visit because her daughter was not available to assist. She was putting her hair in a bun rather than braiding it but was physically able to braid her hair.⁵⁷

On March 5, 2008, Dr. Awenus completed a Form 1 in which he concluded that Mrs. Ramball required attendant care in the amount of $1,270.73 per month.⁵⁸ Dr. Awenus did not attend at her home and based his findings on his examination. His Form 1 was completed beyond the two year period for which Mrs. Ramball claims a benefit. Therefore, I give no weight to Dr. Awenus’ Form 1.

Subsection 16(4) provides:

The monthly amount payable by the attendant care benefit shall be determined in accordance with Form 1.

Subsection 39(4) provides:

The insurer shall begin payment of attendant care benefits within 10 business days after receiving the assessment of attendant care needs and, pending receipt by the insurer of the report of any examination under section 42 required by the insurer, shall calculate the amount of the benefits based on the assessment of attendant care needs.

I rely on the Assessments of Attendant Care Needs prepared by Ms. Goldlust and find that Sheila Ramball is entitled to receive a monthly attendant care benefit in the amount of $55.70 from November 2004 to January 5, 2005 and at the rate of $10.85 from January 5, 2005 until March 11, 2005. Thereafter, the attendant care benefit is reduced to zero pursuant to the Assessment of Attendant Care Needs dated March 11, 2005. I have not been provided with any reliable evidence regarding the attendant care benefits paid to Mrs. Ramball pursuant to the assessments conducted by Ms. Goldlust.

Housekeeping and Home Maintenance Benefits:

Subsection 22(1) provides for the payment of a housekeeping and home maintenance benefit for all reasonable and necessary additional expenses incurred as a result of an insured person being substantially disabled from performing his or her pre-accident tasks as a result of the accident.

Wawanesa retained Ms. Lyndy Goldlust to conduct an In-home Assessment and two reassessments. There were no other In-home assessments of either Mrs. Ramball or Mr. Ramball.

Both of the Applicants have claimed housekeeping and home maintenance benefits at the weekly rate of $100.00 for the period from November 14, 2004 to November 13, 2006 for services provided by Vansenth David and others. Sheila Ramball and Samuel Ramball testified that Mr. David was a friend who came to the home to do both housekeeping and home maintenance. Mr. David was not called as a witness. Neither Vandana Brown nor Mary Lee Ramball referred to the services he provided. The In-home Assessments conducted by Ms. Goldlust do not refer to Mr. David’s services but make note of the daughter’s assistance in respect of both of the Applicants. There is no evidence supporting the Applicants’ testimony that Mr. David provided housekeeping or home maintenance assistance. Therefore, any claims in respect of Mr. David’s services are not payable.

Sheila Ramball:

In her In-home Assessment report dated November 26, 2004, Ms. Goldlust concludes that Sheila Ramball was entitled to 17 hours of housekeeping assistance per week.⁵⁹ Her follow-up assessment report dated January 6, 2005, reduced the assistance to 1.5 hours of assistance weekly.⁶⁰ Her re-evaluation dated April 29, 2005 recommended that the 1.5 hours of assistance be continued until Mrs. Ramball was reassessed. Ms. Goldlust noted she was unable to conduct a re-evaluation because Mrs. Ramball reported being in pain and was recovering from the flu.⁶¹ There was no subsequent attendance.

Wawanesa’s Explanation of Benefits dated January 16, 2007 sets out the following payment schedule based on those assessments and its receipt of invoices from Mrs. Ramball in December 2006:

Your housekeeping expenses will be reimbursed as per the section 42 in home reports & as follow: Feb 8/05 – Jun 25/05 (1.5hrs/week x 20 weeks x$7.45/hr), June 26/05 - Jan 30/06 (5hrs/week x 31 weeks x $7.45/hr), Jan 31/06 to Nov 12/06 (5 hrs/week x 41 weeks x $7.75/hour). As per section 22(3) of the SABS: No payment is required under this section for expenses incurred more than 104 weeks after the onset of the disability”. As such, no further expenses will be considered…⁶²

Ms. Goldlust assessed Mrs. Ramball’s post-accident housekeeping abilities by observing her in her home and by conducting testing to determine her range of motion and grip strength. I accept her finding that Mrs. Ramball required 17 hours of housekeeping assistance in January 2005. I find that Mrs. Ramball required those services from the date of the accident.

Based on the testimony of Vandana Brown and Mary Lee Ramball regarding the services they provided, I accept Wawanesa’s determination that 5 hours of housekeeping was payable for the period from June 26, 2005 to November 12, 2006.

The Assessment of Attendant Care Needs hourly rate for Level 1 assistance is $10.85. Level 1 assistance is similar to housekeeping tasks and therefore I find the hourly rate of $10.85 to be a reasonable amount to be applied to housekeeping and home maintenance services.

On the basis of the foregoing, I find that Mrs. Ramball is entitled to housekeeping and home maintenance benefits at the weekly rate of $100.00 from November 14, 2004 to January 6, 2005 and at the weekly rate of $54.25 from January 7, 2005 to November 13, 2006.

Samuel Ramball:

Both Vandana Brown and Mary Lee Ramball testified that Mr. Ramball does not engage in heavy housekeeping and home maintenance tasks. However, he is self-sufficient and assists Sheila Ramball with light housekeeping.

On December 16, 2004, Ms. Goldlust conducted an In-home Assessment in respect of Mr. Ramball’s claim for housekeeping and home maintenance benefits. She noted that following the accident Mr. Ramball moved to live with his wife and daughter from his son’s home to be closer to therapy. Ms. Goldlust described Mr. Ramball’s pre-accident tasks as assisting with household tasks, feeding the animals and general repairs.⁶³ She conducted static grip strength testing which indicated that Mr. Ramball’s grip strength was extremely low for his age and gender. However, Ms. Goldlust noted that the classic bell curve expected with this testing was not present which suggested maximal effort was not given. She concluded that Mr. Ramball was capable of completing his pre-accident housekeeping and home maintenance tasks and was therefore not substantially disabled.⁶⁴

On September 6, 2006, Dr. Awenus issued a Disability Certificate. In his opinion, Mr. Ramball was substantially disabled from engaging in his housekeeping and home maintenance activities because he was unable to engage in repetitive bending or lifting above the shoulder. He recommended that lighter loads and more frequent trips would permit Mr. Ramball to resume and engage in some of his tasks.⁶⁵

As Ms. Goldlust observed Mr. Ramball functioning in the home, I prefer her evidence to Dr. Awenus’. In her report, Ms. Goldlust assesses Mr. Ramball’s active range of motion and strength. She found Mr. Ramball to be within normal limits for many of the indicators and not more than mildly restricted in the remainder. Ms. Goldlust’s observations led her to conclude that Mr. Ramball was not substantially disabled from engaging in his pre-accident housekeeping and home maintenance activities. I accept Ms. Goldlust’s assessment and find that Mr. Ramball was not substantially disabled from engaging in his pre-accident tasks and is therefore not entitled to a housekeeping and home maintenance benefit.

INTEREST:

I find that the Applicants are entitled to interest pursuant to subsection 46(2) of the Schedule. I encourage the parties to agree to the amount of interest owed to Sheila Ramball and Samuel Ramball pursuant to my findings set out above, failing which they may request a hearing before me in accordance with the Dispute Resolution Practice Code.

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.

September 25, 2009

Denise Ashby Arbitrator

Date

ARBITRATION ORDER

Under section 282 of the Insurance Act, R.S.O. 1990, c.I.8, as amended, it is ordered that:

1. Wawanesa shall pay Sheila Ramball a medical benefit of $1,388.02 in respect of Dr. Awenus’ Treatment Plan dated August 30, 2006 and $2,332.76 in respect of his Treatment Plan dated May 30, 2008.

2. Wawanesa shall pay Sheila Ramball an attendant care benefit at the monthly rate of $55.70, less amounts paid, for services provided from November 12, 2004 to January 23, 2005 and at the monthly rate of $10.85, less amounts paid, from January 24, 2005 to April 11, 2005.

3. Wawanesa shall pay Sheila Ramball a housekeeping and home maintenance benefit at the weekly rate of $100.00, less amounts paid, from November 14, 2004 to January 6, 2005 and at the weekly rate of $54.25, less amounts paid, from January 7, 2005 to November 13, 2006.

4. Wawanesa shall pay Samuel Ramball a medical benefit of $996.12 in respect of Dr. Awenus’ Treatment Plan dated September 6, 2006 and $2,221.76 in respect of his Treatment Plan dated May 30, 2008.

5. Wawanesa shall pay Sheila Ramball and Samuel Ramball interest on overdue benefits.

September 25, 2009

Denise Ashby Arbitrator

Date

Footnotes

1. 1The Statutory Accident Benefits Schedule - Accidents on or after November 1, 1996, Ontario Regulation 403/96, as amended.
2. 2Commission letter dated April 9, 2009, page 2
3. 3Exhibit 1, Arbitration Brief of Applicant, Sheila Ramball, Volume II, Tab 4, Exhibit 9, Attendant Care Invoices and Exhibit 2, Arbitration Brief of Applicant, Samuel Ramball, Volume II, Tab 4, pages 1 to 24
4. 4Exhibit 6, Arbitration Brief, Tab 13, page 2
5. 5Exhibit 7, Arbitration Brief, Tab 13, page 2
6. 6Exhibit 8, Supplementary Arbitration Brief of the Respondent, Tab 4
7. 7Exhibit 7, Arbitration Brief, Tab 22, page 2
8. 8Exhibit 10, page 119
9. 9Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume I, Tab 3, pages 83 to 88
10. 10Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume I, Tab 3, pages 93 to 97
11. 11Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume II, Tab 3, pages 159 to 164
12. 12Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume II, Tab 3, pages 90 to 95
13. 13Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume I, Tab 3, page 85
14. 14Ibid, page 3
15. 15Exhibit 6, Arbitration Brief, Tab 34, page 4
16. 16Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume II, Tab 4, page 28
17. 17Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume I, Tab 3, pages 159 to 164
18. 18Exhibit 7, Tab 12, page 2
19. 19Exhibit 7, Arbitration Brief, Tab 27, page 6
20. 20Exhibit 7, Arbitration Brief, Tab 27, page 3
21. 21Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume I, Tab 3, page 97
22. 22Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume I, Tab 3, page 94
23. 23Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume II, Tab 5, pages 188 to 194 and Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume II, Tab 6, pages 250 to 253
24. 24Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume II, Tab 5, page 190 and Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume II, Tab 6, page 250
25. 25Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume II, Tab 5, pages 195 to 199 and Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume II, Tab 6, pages 256 , 257, 262, 267 and 268
26. 26Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume II, Tab 5, page 203
27. 27Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume II, Tab 6, page 276
28. 28Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume II, Tab 6, page 280
29. 29Exhibit 4
30. 30Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume I, Tab 3, pages 47 to 52
31. 31Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume I, Tab 3, pages 145 to 150
32. 32Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume I, Tab 3, pages 151 to 156
33. 33Exhibit 6, Arbitration Brief ,Tab 32
34. 34Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume I, Tab 3, pages 49 and 51
35. 35Exhibit 3, Supplement to Arbitration Brief ,Tab 2 and Exhibit 6, Arbitration Brief, Tab36
36. 36Exhibit 6, Arbitration Brief, Tab36, page 4
37. 37Exhibit 6, Arbitration Brief, Tab33
38. 38Exhibit 6, Arbitration Brief, Tab3 Exhibit 6, Arbitration Brief, Tab35, pages10 and 11
39. 39Exhibit 3, Supplement to Arbitration Brief ,Tab 2
40. 40Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume I, Tab 3, pages 33 to 38
41. 41Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume I, Tab 3, pages 171 to 173
42. 42Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume I, Tab 3, pages 176 to 178
43. 43Exhibit 7, Arbitration Brief ,Tab 26
44. 44Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume I, Tab 3, pages 35 and 37
45. 45Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume I, Tab 3, pages 172 and 174
46. 46Exhibit 2, Arbitration Brief of the Applicant, Samuel Ramball, Volume I, Tab 3, addendum received September 15, 2009, page 5
47. 47Exhibit 7, Arbitration Brief ,Tab 28
48. 48Exhibit 7, Arbitration Brief ,Tab 29
49. 49Exhibit 10, O.D.S.P. File, page 6
50. 50Exhibit 10, O.D.S.P. File, page 119
51. 51Exhibit 10, O.D.S.P. File, page 88
52. 52Exhibit 6, Arbitration Brief ,Tab 22
53. 53Exhibit 6, Arbitration Brief ,Tab 26, page 7
54. 54Exhibit 6, Arbitration Brief ,Tab 24, pages 7 to 9
55. 55Exhibit 6, Arbitration Brief ,Tab 25, page 7
56. 56Exhibit 6, Arbitration Brief ,Tab 23, page 7
57. 57Exhibit 6, Arbitration Brief ,Tab 27
58. 58Exhibit 1, Arbitration Brief of the Applicant, Sheila Ramball, Volume 1, Tab 3, pages 105 to 111
59. 59Exhibit 6, Arbitration Brief ,Tab 22, page 21
60. 60Exhibit 6, Arbitration Brief ,Tab 24, page 28
61. 61Exhibit 6, Arbitration Brief ,Tab 28, page 30
62. 62Exhibit 6, Arbitration Brief ,Tab 13, page 2
63. 63Exhibit 7, Arbitration Brief, Tab 22, page 2
64. 64Exhibit 7, Arbitration Brief ,Tab 22
65. 65Exhibit 3, Supplement to Arbitration Brief of the Applicants, Tab 1