Licence Appeal Tribunal File Number: 22-008162/AABS
In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
S.J.
Applicant
and
Industrial Alliances Auto & Home Insurance
Respondent
DECISION
VICE-CHAIR:
Craig Mazerolle
APPEARANCES:
For the Applicant:
S.J., Applicant
Peter Kazdan, Counsel
Kiet Truong, Counsel
For the Respondent:
Trevor Crowe, Adjuster
James Brown, Counsel
HEARD:
Review of the Transcript and Exhibits from the Videoconference Hearing Held from October 30 – November 3, 2023 with Written Submissions from the Applicant (dated July 30, 2024)
OVERVIEW
1S.J., the applicant, was involved in an automobile accident on January 2, 2014, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the “Schedule”). The applicant was denied benefits by the respondent, Industrial Alliances Auto & Home Insurance, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2Following a videoconference hearing held from October 30 – November 3, 2023, the Tribunal released a decision on December 21, 2023. The Tribunal found, in part, that the applicant was entitled to a non-earner benefit (“NEB”), an award, and interest.
3On June 21, 2024, Vice-Chair Logan released a reconsideration decision finding an error in the initial decision as it related to the Tribunal’s assessment of the respondent’s s. 44 reports, see S.J. v. Industrial Alliances Auto & Home Insurance, 2024 CanLII 59543 (ON LAT) (“reconsideration decision”), at paragraphs 45 and 46:
I agree that the Tribunal erred when it stated that none of the other section 44 reports addressed whether the applicant suffers a complete inability to carry on a normal life… Dr. McCutcheon determined that “from a psychological perspective [the applicant] did not suffer a complete inability to carry on a normal life as a result of and within 104 weeks of the accident”.
While the applicant argues that Dr. McCutcheon’s report was considered because it was listed at paragraph 19 of the decision as one of the reports relied upon by the respondent, I do not find this to be the case. While I agree it is listed at paragraph 19, I find that the Tribunal explicitly stated at paragraph 20 that the none of the other section 44 reports, which included Dr. McCutcheon’s report, specifically addressed the applicant’s non-earner benefit claim. I find that the Tribunal erred when it made this finding, and I also find that the error is one that would likely have changed the outcome of the decision. I agree with the respondent that the Tribunal placed less weight on Dr. McCutcheon’s report because it concluded, in error, that it did not address non-earner benefits.
4Vice-Chair Logan ordered a rehearing of the NEB by a new adjudicator based on a review of the existing record. Further, as the Vice-Chair found that (at paragraph 51) “the grounds for the… award are rooted in the respondent’s actions related to the non-earner benefits”, the award was also ordered to the rehearing.
5The respondent provided a transcript of the videoconference hearing to the Tribunal and the applicant on July 2, 2024. Then, on September 4, 2024, the applicant provided written submissions to the Tribunal about the award request.
6Pursuant to an order made in the initial Tribunal decision, the applicant’s name has been anonymized.
ISSUES
7The issues in dispute are:
i. Is the applicant entitled to an NEB in the amount of $185.00 per week from August 1, 2014 to date and ongoing?
ii. Is the respondent liable to pay an award under s. 10 of O. Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
8I find the applicant has established entitlement to the NEB in the amount of $185.00 per week, from August 1, 2014 to date, along with interest on any overdue payment of benefits, pursuant to s. 51 of the Schedule.
9I find the applicant has not established entitlement to an award.
ANALYSIS
Non-Earner Benefit
10I find the applicant has established entitlement to the NEB.
11Section 12(1) of the Schedule provides that an insurer shall pay an NEB to an insured person who sustains an impairment as a result of the accident, if the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident. Section 3(7)(a) defines a “complete inability to carry on a normal life” as “an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged before the accident.”
12The Court of Appeal for Ontario set out the guiding principles for assessing NEB entitlement in Heath v. Economical Mutual Insurance Co., 2009 ONCA 391 (“Heath”), which, generally, focuses on a comparison of the applicant’s pre- and post-accident activities. The Court also advised, at paragraph 50, that the term “engaging in” should be seen from a “qualitative perspective and as meaning more than isolated post-accident attempts”. Then, of note to this case, the Court provided guidance for claims involving pain: “the question is not whether the insured can physically do these activities, but whether the degree of pain experienced, either at the time or subsequent to the activity, is such that the individual is practically prevented from engaging in those activities.”
13The applicant argues that she is entitled to an NEB, as both her testimony and medical evidence demonstrate that her accident-related impairments have completely prevented her from engaging in her pre-accident activities. In particular, her life used to be characterized by exercise, socializing, and a general sense of independence. Now, she struggles to complete basic, daily tasks, and she is dependent on others to assist with grooming, attending appointments, meal preparation, etc. In support of this position, the applicant highlights her testimony, as well as medical evidence from her family physician, Dr. Ashraf Mikhail, her treating chiropractor, Dr. Ali Nouraliei, and others.
14I note that the respondent accepted the applicant’s request during the hearing to allow for certain corrections to the records of Dr. Mikhail. Considering the parties’ consent, I see no issue with allowing these amendments.
15The respondent disputes the applicant’s NEB claim for several reasons. First, the respondent contends that the applicant has not presented sufficient evidence to satisfy the entitlement standard within the first 104 weeks post-accident. Specifically, s. 12(1)1 requires the applicant to show she “suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident”. The respondent submits her evidence from this period does not meet this standard. For instance, while the applicant says she experienced social isolation, she formed a new romantic relationship following the accident—a relationship that included travel to the United States. Further, the respondent notes that its assessors found she did not meet this standard. Its expert opinions include a report from Dr. Kelly McCutcheon, psychologist (dated July 8, 2014), as well as a chiropractic assessment report and Functional Capacity Evaluation from Dr. Nima Pardisnia, chiropractor and physiotherapist (dated July 14, 2014).
16Following the guidance from Heath, the first step in the NEB analysis is to determine an insured person’s pre-accident life circumstances and activities. The Court of Appeal asks decision-makers to do more than take (at paragraph 50) “a snapshot of a claimant's life in the time frame immediately preceding the accident.” Rather, the analysis must look at the insured person’s life for “a reasonable period prior to the accident, the duration of which will depend on the facts of the case.”
17I find the applicant’s testimony provides a comprehensive account of her life circumstances and activities over a “reasonable period prior to the accident”. Specifically, the applicant’s testimony covers both the period immediately preceding the accident (in and around her move to Ontario), as well as the educational and occupational pursuits she completed in British Columbia and Iran. This testimony was not only comprehensive in its scope, crossing several years and places, but the applicant provided specific details about the quantity and quality of the activities she performed during this period—a key aspect of the NEB analysis.
18I take from her testimony that, starting in 2009, the applicant worked as a dental assistant in British Columbia, the first place she lived in Canada after moving from Iran. She then moved to Ontario to live with some family members in Fall 2013. Her life before the accident comprised of spending time with family and friends, exercising (e.g., daily runs, snowboarding, cycling, etc.), as well as regularly cleaning, cooking, and shopping for her and her family. In particular, she testified that she would clean the house once or twice a week, with a similar schedule for the laundry. The applicant also reported having no major health concerns or sleep issues before the accident, and she reported being independent in all her activities of daily living (though her family would assist with some chores, e.g., her ex-partner would help with groceries).
19I also note that she moved to Ontario with the hope of pursuing a career as a dental hygienist. However, according to the applicant, she was unable to start her training as a dental hygienist before the accident. She further testified that she has not worked since the accident.
20I then conclude that this testimony is corroborated by medical evidence produced shortly after the accident—a contemporaneous timeline that provides significant weight to these pre-accident accounts. To start, there is an intake report from Dr. Nouraliei that supports her testimony about pre-accident exercise and recreation, i.e., snowboarding, dance, and aerobics (dated January 20, 2014). This report was produced shortly after the accident, so I place significant weight on this account.
21Further, the psychological assessment report from Dr. Farrokh Sedighdeilami (also referred to as Dr. Deilami; report dated May 8, 2014) provides another account of her pre-accident life from shortly after the accident. The assessor provides details about her occupational/educational history, and then states that: “She reported that she used to enjoy playing volleyball, ice skating, snow-boarding, aerobics, bike riding, and going out with friends in her leisure time.”
22Finally, the applicant’s reported lack of pre-accident health issues is reflected in the reports from Drs. McCutcheon and Pardisnia. For instance, Dr. McCutcheon noted that the applicant reported a change in her medication usage after the accident, as she went from taking no medications to using a muscle relaxant and sleep medication. Again, considering these reports were prepared shortly after the accident, I find there is a high reliability to their accounts of the applicant’s pre-accident condition.
23I am then satisfied, on a balance of probabilities, that the applicant’s activity levels changed significantly after the accident, such that she does not engage in substantially all of her pre-accident activities. I am also satisfied that this significant change was caused by accident-related impairments, namely, a combination of physical pain and psychological symptoms. Further, in light of the applicant’s lack of reported health concerns prior to the accident, I find, on a balance of probabilities, that the applicant’s post-accident complaints and symptoms are accident related. Taken together, I conclude the applicant has established that she sustained “an impairment that continuously prevents [her] from engaging in substantially all of the activities in which [she] ordinarily engaged before the accident.”
24To start, the applicant’s testimony about her post-accident life shows a dramatic change in her activity levels. While her pre-accident life was marked by chores, daily exercise, and socializing, she informed the Tribunal that most of her time since the accident has been spent laying down or sitting in her bedroom. She also reported having little social contact aside from her family, her PSW, and a legal representative. Her family has also become a regular part of her daily tasks, e.g., reminding her to take medications, helping with her hair, helping her get dressed, etc. She further told the Tribunal that she never leaves the house unaccompanied—a significant change from her pre-accident independence. In fact, her sister testified that the applicant is never left alone.
25The applicant also testified about her symptoms and impairments. Specifically, she claimed that, following the accident, she has experienced headaches, upper and lower body pain, numbness, depression, anxiety, bouts of panic, sleep issues, and concentration issues.
26Detailed accounts of the applicant’s post-accident activity levels (and their connection to her accident-related impairments) are found in the medical evidence. For instance, in an OCF-3 prepared shortly after the accident (dated February 10, 2014), Dr. Nouraliei found the applicant sustained a complete inability to carry on a normal life, as well as a substantial inability to perform the housekeeping and home maintenance she performed pre-accident. He anticipated the duration of these impairments would last “more than 12 weeks”, explaining that, in part, the severity of her symptoms supported this finding.
27The treatment notes from Dr. Nouraliei also reference complaints of pain, stress, and sleep issues from January 2014 to October 2016. There are also functional issues: e.g., “unable to lift heavy objects” (December 2, 2014); multiple mentions of “not working” (e.g., June 8 and August 4, 2015); “help for hairstyle & housekeeping” (June 29, 2015); and increased pain from heavy lifting (July 17, 2015). I do note that Dr. Nouraliei was asked on cross-examination about the gaps in his treatment records following October 2016. He confirmed that they exist. However, I place little weight on these gaps, as these consistent complaints establish the existence of accident-related impairments during the essential period immediately following the accident.
28There are also extensive, accident-related complaints and functional limits noted in the records from her family physician, Dr. Mikhail. These notes include, e.g., “she cannot brush her hair” (March 28, 2014); “anxiety andinsomnia [sic]… can’t use her hand properly” (June 5, 2014); “Severe pain… she cannot push with her arms anything” (September 14, 2014).
29A summary of the applicant’s psychological and cognitive complaints from the 104 week post-accident period are then found in a consult note from Dr. Abbas Azadian, psychiatrist (dated June 10, 2015): low mood, irritability, poor concentration, trouble sleeping, etc.
30In light of similar psychological and cognitive complaints, the respondent’s assessor, Dr. McCutcheon, diagnosed the applicant with Adjustment Disorder with Mixed Anxiety and Depressed Mood in her July 2014 report. She also described the applicant’s psychological symptomology as “significant”. For example, the applicant scored in the “moderate to high ranges” for the Beck Anxiety and Depression Indices.
31Finally, I note that many of these pain behaviours and functional limitations noted in these records are reflected in the in-home occupational therapy assessment report from Seemin-Taj Golmohammadi, OT (dated May 9, 2014). The consistency of this reporting lends credence to the applicant’s testimony, as well as the functional issues described in the medical evidence and this OT report.
32Overall, I find the applicant has established, on a balance of probabilities, significantly diminished activity levels post-accident, and I further find she has demonstrated that this inability to engage in substantially all her pre-accident activities is caused by accident-related impairments. Finally, I conclude there is compelling evidence that both the impairments and the applicant’s decreased activity levels arose within 104 weeks of the accident.
33The respondent argues that there is insufficient evidence to show the applicant’s impairments and decreased activity levels arose within 104 weeks of the accident. However, as detailed above, there is a significant amount of medical evidence in the months and years following the accident that establish both a consistent timeline of accident-related complaints, as well as their impact on the applicant’s function. I find this consistent timeline establishes, on a balance of probabilities, that the applicant’s impairments and decreased activity levels arose within the relevant period under the Schedule.
34The respondent also argues there are post-accident activities that do not align with the “complete inability” standard, namely, her post-accident relationship and related travel. I find this argument does not sufficiently challenge the evidentiary basis of the applicant’s NEB claim. For instance, when the respondent asked about this relationship and travel, the applicant testified that she was hiding her pain and psychological complaints from her boyfriend. Then, according to the applicant, when he discovered her struggle with depression, she ended the relationship. During re-examination, the applicant added that it has been her only post-accident relationship. Applying the principles from Heath, I find this attempt at making a new social connection does not negate my conclusions above. Rather, I interpret this new relationship as an “isolated” attempt at a pre-accident activity that she could not fully engage in due to pain.
35The respondent also challenged the applicant’s evidence through cross-examination of her treating practitioners. Overall, I found the respondent’s challenges to the applicant’s evidence did not significantly impact the weight I have assigned above. For instance, the respondent questioned Dr. Azadian about a report he provided for the applicant’s ODSP claim, wherein he stated that there were no concerns about the applicant’s safety, ability to dress, etc. (dated October 10, 2021). Though I recognize that there are several entries in this report that list minimal to no impediments, I find it largely supports the applicant’s claim that she has experienced significant functional challenges following the accident. According to Dr. Azadian, these challenges include: a “severe” limitation to her ability to participate in physical activity, as well as “moderate” limitations to her ability to bathe, groom, housekeep, interact socially, etc.
36Turning to the respondent’s expert reports about the NEB, I find they do not alter my findings. While I accept that these experts found the applicant did not meet this standard, I place limited weight on their opinions about the NEB.
37First, in the chiropractic assessment report from Dr. Pardisnia, I find this assessor’s opinion was not supported by an extensive analysis of the applicant’s pre- and post-accident activities. Though the assessor concluded that the applicant “does not suffer a complete inability to carry on a normal life”, there is little engagement with her activity levels. For instance, in the section entitled “Occupational, Family, Social History and General Health”, Dr. Pardisnia made no comments about her pre-accident exercise routines, nor is there any engagement with the applicant’s personal care or housekeeping. These are essential components to the analysis described in Heath.
38Additionally, while I recognize the assessor found the applicant is “able to sit, stand, walk, bend, reach, stoop, carry, handle, and finger”, there is also a finding that her actions are marked by “pain avoidance behaviors… quite commonly associated with fear of exacerbating existing injuries.” This fear calls back to the guidance from Heath about claims involving pain: “the question is not whether the insured can physically do these activities, but whether the degree of pain experienced… is such that the individual is practically prevented from engaging in those activities”. I also note that pain behaviours were observed in the contemporaneous OT assessment report from Seemin-Taj Golmohammadi.
39Then, while I recognize that there was a more detailed assessment of her pre-accident activities in the Functional Capacity Evaluation, I still find this report is limited in scope. For instance, Dr. Pardisnia does review the functional skills needed to perform the applicant’s pre-accident employment, as well as those skills that would be required for a dental hygienist program. Yet, there is no discussion about the applicant’s pre-accident chores, exercise, socialization, etc.
40I do note that both of Dr. Pardisnia’s reports were the subject of a motion order made by the original hearing adjudicator. Specifically, the adjudicator declined the applicant’s request to strike these reports from the hearing record, but—in light of concerns raised by the applicant—instead ordered that arguments could be made about their weight. In light of my findings regarding the minimal weight that I have placed on Dr. Pardisnia’s reports regarding the NEB, I find it is not necessary to comment further on the issues raised by the applicant about these reports in her earlier motion.
41Turning to the psychological report from Dr. McCutcheon, I accept that there is a comprehensive understanding of the applicant’s pre- and post-accident activity levels, including the degree to which others provide assistance. Also, as noted above, there is a recognition of the severity of the applicant’s symptomology. However, despite accepting these psychological and cognitive challenges, the assessor concluded that “this impairment is not of a sufficient incapacitating degree” to establish a complete inability to carry on a normal life.
42I place minimal weight on Dr. McCutcheon’s conclusion about the NEB, as I find the rest of her report paints a picture of the applicant’s post-accident life that largely mirrors the significant issues presented in both her testimony and medical evidence. Specifically, there are references to a number of the same post-accident issues that have been explored above: sleep difficulties; “unable to engage in any housekeeping chores”; less socialization; no home exercise, etc. Then, even though the assessor wrote the applicant reported being largely independent with personal care, this comment came with the following caveat:
She indicated that although she is independent with self-care activities including grooming, dressing and bathing, “it takes a long time to dress and shower”; she added that her niece’s friend comes over to assist her with personal care on occasion.
This account of the applicant’s ability to dress herself is mirrored in the contemporaneous OT assessment report from Seemin-Taj Golmohammadi.
43On the whole, I find this account of the applicant’s post-accident life largely aligns with the information gleaned from the other evidence explored above. As such, I find Dr. McCutcheon’s opinion does not sufficiently challenge the conclusions I have made about the applicant’s entitlement to the NEB.
44For these reasons, I find the applicant has established, on a balance of probabilities, entitlement to the NEB in the amount of $185.00 per week from August 1, 2014 to date.
Interest
45Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. The applicant is entitled to interest on any overdue payment of benefits, pursuant to s. 51 of the Schedule.
Award
46The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
47I find, on a balance of probabilities, that the applicant has not established entitlement to an award.
Non-Earner Benefit
48Most of the applicant’s award arguments involve her NEB claim. The applicant first argues that the respondent never informed her that the IEs being conducted in the Summer of 2014 were addressing her NEB and attendant care benefit claims. Second, the applicant claims the respondent has never provided her with a compliant denial for her NEB claim: i.e., no Explanation of Benefits; missing “medical and any other reasons”; and no information about her right to dispute. Third, the applicant relies on certain s. 33 requests from the respondent to demonstrate its unreasonable behaviour, specifically, its requests for information about her ex-spouse. Fourth, the applicant highlights a letter from September 1, 2020, where the respondent relied on an incorrect version of the Schedule to state that her entitlement to certain benefits had expired. Finally, the applicant made claims regarding the respondent’s former counsel, as well as its “unwavering insistence” on a limitations defense. The applicant’s vulnerability was also mentioned as a strong factor in favour of granting a substantial award.
49The respondent claims an award may only be granted on the benefits at issue before the Tribunal. Therefore, while it accepts that there may have been some “hiccups” in the adjustment of this file (an understandable occurrence considering its age), the respondent submits there is no deficiency before the Tribunal that justifies an award.
50First, I find the letter setting up the IEs with Drs. McCutcheon and Pardisnia indicated that the NEB would be assessed. Specifically, in correspondence dated May 29, 2014, the respondent informed the applicant that: “This examination will determine your entitlement to a Non-Earner Benefit.” I also note that this letter set up an occupational therapy in-home assessment with Rasul Kassam, OT, and that this part of the letter included the comment “(Att.Care)”.
51Second, while I accept the respondent did not provide a compliant denial letter for the NEB, I do not find this breach merits payment of an award. The applicant challenges the respondent’s denial letters in three ways, but I find she has only established one of these three grounds. Briefly, I have not been pointed to a requirement that an insurer must provide both an Explanation of Benefits form and a denial letter, nor has the applicant established that the NEB denial letters lacked “medical and any other reasons”, pursuant to s. 36(4) of the Schedule. Rather, I find the letters (dated July 10 and July 22, 2014) both cite the respondent’s expert reports as the basis for the denial. I note that the initial letter with Dr. McCutcheon’s report is a bit sparse in its details about this report. However, there is a greater level of detail about Dr. Pardisnia’s reports in the second letter that allows me to find the requirement for reasons was met.
52I do find a breach though of s. 54 of the Schedule: “If an insurer refuses to pay a benefit… the insurer shall provide the person with a written notice advising the person of his or her right to dispute the refusal”. Neither letter contains any written notice advising the applicant of her right to dispute the NEB refusal. In fact, neither letter states there is such a right.
53Yet, in the weeks leading up to these letters, the applicant was provided with correspondence (dated May 27, 2014) where this information was provided. Specifically, when addressing the denial of a treatment plan, the respondent wrote:
Should you wish to dispute this determination, you may apply for Mediation with the Financial Services Commission of Ontario. We have appended further information in this regard. Please review the attachment “Applicant’s Right to Dispute.”
54Though this earlier notice does not rectify the s. 54 breach for the NEB, I find it does lessen the prejudice facing the applicant from this breach. Put another way, for the purpose of determining whether to grant an award based on the s. 54 breach, I find this contemporaneous letter helps to mitigate the negative impact of the breach on the applicant. Therefore, while I accept the vulnerability of the applicant, I find she has not shown how this s. 54 breach merits an award.
55Turning to the s. 33 requests, I accept the respondent’s position that, while it was incorrect to link payment of accident benefits to a priority dispute, there does not appear to have been any delay in adjusting the NEB due to these requests. Specifically, the respondent’s IE reports were sent to the applicant in July 2014, while the applicant’s potential entitlement to the NEB did not start until July 2, 2014, i.e., 26 weeks following the accident. Since the assessors found the applicant was not entitled, I find the applicant has not shown how the s. 33 requests had any meaningful impact on the respondent’s withholding of the NEB.
56Finally, for the applicant’s arguments concerning the September 1, 2020 letter, as well as the respondent’s former counsel and limitations defense, I find the applicant has not established how these arguments had any significant impact on the NEB. For instance, even if the respondent had erroneously believed that the applicant’s entitlement to medical and rehabilitation benefits had elapsed on in September 2020, this mistake would not have impacted the NEB. I then find that there is an insufficient explanation to link her other arguments to the respondent’s decision to withhold payment of the NEB. The applicant has the onus of demonstrating that the respondent’s behaviour unreasonably withheld payment of a benefit, and I find there is no compelling explanation for why any of these submissions relate to the respondent’s adjustment and payment of the NEB.
Other Benefits
57In the applicant’s written award submissions (dated July 30, 2024), there are references to several other benefits. However, I find this present rehearing is limited to the applicant’s NEB claim and any award arguments related to the NEB.
58The reconsideration decision focused on the applicant’s NEB claim and its connection to the initial adjudicator’s findings about the award. For instance, when addressing the need to reconsider this adjudicator’s findings about the award, the Vice-Chair Logan reached the following conclusion (at paragraph 51, my emphasis added):
As the respondent has established grounds for reconsideration with respect to the non-earner benefits, and the grounds for the section 10 award are rooted in the respondent’s actions related to the non-earner benefits, I order that the section 10 award be reheard by the adjudicator assigned to the rehearing of the issue of non-earner benefits.
59She made similar comments when setting up this present rehearing in the “Order” section of the reconsideration decision (at paragraph 55, my emphasis added):
The rehearing will be conducted by a new adjudicator reviewing the existing record. That is, the recording and/or transcript of the hearing, if available; the applicant’s written submissions dated October 20, 2023 with respect to the section 10 award; and the exhibits from the initial hearing that are relevant to non-earner benefits and the section 10 award.
60Taken together, these comments demonstrate that the award arguments addressed in this rehearing are meant to focus on the NEB claim, and not all the issues that were before the Tribunal at first instance.
61Regardless, I note that, in the applicant’s written award submissions, one of the only benefits explicitly mentioned aside from the NEB is the applicant’s request for payment of medication expenses. Yet, in the initial decision, the adjudicator concluded that the applicant did not meet her burden to demonstrate that any of the disputed medication expenses were payable. This finding was not cancelled as part of the reconsideration decision. As such, there is no basis for finding an award based on this category of benefits, since there is no payment owing to the applicant for these medication expenses.
ORDER
62For the reasons above, I find:
i. The applicant has established entitlement to the NEB in the amount of $185.00 per week, from August 1, 2014 to date, along with interest on any overdue payment of benefits, pursuant to s. 51 of the Schedule.
ii. The applicant has not established entitlement to an award.
Released: April 25, 2025
__________________________
Craig Mazerolle
Vice-Chair