OFSCDRS 2012

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits for massage therapy, chiropractic care, and a magnetic resonance stimulation machine (MRS 2000).

The Insurer denied the claims.

The Arbitrator found the Applicant to be highly credible and motivated, and concluded that the massage therapy and chiropractic care were reasonable and necessary to support her active rehabilitation and pain management goals.

The claim for the MRS 2000 was dismissed as its cost was not reasonable given the minor degree of success and lack of supporting evidence.

Interest was awarded on the overdue benefits.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer terminated housekeeping benefits and refused to pay for certain medical benefits and costs of examinations.

The arbitrator found that the applicant's testimony was not credible, noting he did not take time off work and did not mention the accident to his family doctor for two years.

The arbitrator dismissed the claims for medical benefits, housekeeping benefits, and costs of examinations, finding them not reasonable or necessary.

The appellant insurer sought to appeal an arbitrator's preliminary order denying an adjournment of the arbitration hearing following the death of its expert witness.

The appellant subsequently requested to stay or adjourn the appeal, or alternatively to withdraw it.

The Director's Delegate refused the stay, finding it would run counter to the goal of cost-effective and efficient dispute resolution.

The Delegate permitted the appellant to withdraw the appeal without prejudice, on the condition that it pay the respondent's legal expenses of $881.40.

If not withdrawn within seven days, the appeal would be rejected on the same terms.

The Applicant sought an adjournment of an arbitration hearing regarding statutory accident benefits, which the Insurer initially opposed but later conceded.

The Arbitrator granted the adjournment to allow the catastrophic impairment issue to be heard together with other issues.

On a preliminary issue regarding the quantum of income replacement benefits, the Arbitrator ruled that the Canada Pension Plan (CPP) child's benefit is not a 'disability pension benefit' under subsection 2(9) of the Schedule and therefore cannot be deducted from the Applicant's income replacement benefits.

The Arbitrator awarded the Applicant $11,960 in expenses due to the Insurer's failure to consent to the adjournment earlier.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) after the insurer terminated them.

The insurer argued the applicant's pain complaints were not credible and lacked objective medical evidence.

The arbitrator found the applicant to be a credible witness whose testimony was corroborated by lay witnesses and medical professionals.

The arbitrator concluded the applicant suffered a substantial inability to perform his pre-accident employment and a complete inability to engage in any employment for which he is reasonably suited.

The applicant was awarded pre-104 week and post-104 week IRBs, interest, and arbitration expenses.

The applicant was seriously injured in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder.

The insurer argued that her marked impairment was a manifestation of malingering or factitious disorder, pointing to an initial period of improvement followed by deterioration.

The arbitrator reviewed extensive medical and lay evidence, finding that the applicant's current presentation of severe depression, anxiety, and pain focus was a direct result of the accident.

The arbitrator rejected the insurer's allegations of malingering, noting the lack of pre-existing conditions and the consistency of the applicant's presentation over time.

The arbitrator concluded the applicant suffered a catastrophic impairment.