3 total
Tribunal denies most medical benefits but approves funding for a distinct situational occupational therapy catastrophic impairment assessment.
The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The Licence Appeal Tribunal dismissed claims for amounts exceeding approved treatment plans and for services not covered by the Professional Service Guideline.
Claims for occupational therapy oversight of a fitness trainer and ongoing massage therapy were also dismissed as redundant or unnecessary, given the applicant had reached maximum medical improvement.
However, the Tribunal allowed the claim for a situational occupational therapy catastrophic impairment assessment, finding it distinct from an in-home assessment and necessary for a complete evaluation.
Insurer ordered to produce complete adjuster's file or provide specific rationale for privilege claims.
The applicant, who suffered a spinal cord injury in a snowmobile accident, sought production of the insurer's complete adjuster's file from the date of the Application for Mediation onwards.
The insurer argued that documents created after the mediation application were protected by litigation or solicitor-client privilege.
The arbitrator found that the adjuster's file was reasonably relevant to the ongoing dispute over catastrophic impairment and a special award.
The arbitrator rejected the presumption that the file is automatically privileged after the mediation application date, ordering the insurer to disclose the entire file or provide a specific list of documents with a rationale for any claims of privilege.
Motion to compel in-person vocational assessment denied as it was sought for hearing preparation, not claims assessment.
The insurer brought a motion to compel the insured to attend an in-person vocational assessment examination and to stay the arbitration hearing until she complied.
The insurer had previously obtained a paper review report from its vocational expert, who stated his conclusions were reliable and comprehensive.
The arbitrator found that the insurer's request, made more than four years after benefits were terminated and shortly before the hearing, was for hearing preparation rather than ongoing claims assessment.
The arbitrator concluded the examination was not reasonably necessary under section 42 of the Statutory Accident Benefits Schedule and allowed the arbitration to proceed.
