Roger Foisy

The applicant sought payment of $724.00, representing the unpaid balance of a treatment plan for psychological services, arguing the provider should be paid $145.00 per hour instead of the $99.75 approved by the insurer.

The Tribunal found the applicant failed to prove the provider had specialized training in psychological treatment modalities (such as CBT, DBT, or MBSR) that would justify a higher hourly rate akin to a psychologist.

The Tribunal upheld the insurer's partial approval at $99.75 per hour and dismissed the claims for the balance, interest, and a special award.

The appellant insurer appealed a Licence Appeal Tribunal decision that refused to deduct the respondent's $120,000 long-term disability settlement from her statutory income replacement benefits.

The insurer argued the settlement represented double recovery for income loss.

The Divisional Court dismissed the appeal, upholding the adjudicator's finding that the lump-sum settlement resolved multiple claims, including extracontractual damages, and could not be strictly allocated as an income replacement benefit under section 7(1) of the Statutory Accident Benefits Schedule.

The moving party defendants sought leave to appeal from an interlocutory order dismissing a Rule 21 motion.

The Divisional Court dismissed the motion for leave to appeal without costs, noting that the underlying order was interlocutory and not binding on the trial judge.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the treatment plans for physiotherapy, assistive devices, psychological treatment, and chiropractic treatment based on its insurer's examinations.

The Licence Appeal Tribunal found the respondent's expert opinions unpersuasive and insufficiently explained, preferring the evidence of the applicant and her treating practitioners.

The Tribunal ordered the respondent to pay all disputed treatment plans and overdue interest.

Furthermore, the Tribunal granted a maximum special award of 50% under Regulation 664, finding that the respondent unreasonably delayed or withheld payments by providing reasons for denial inconsistent with its actual reasons and failing to consider medical records on file.

The appellant appealed an arbitrator's decision denying his claim for an Income Replacement Benefit (IRB) following a motor vehicle accident.

The arbitrator had found that the appellant failed to produce requested financial documents regarding a corporation he controlled, making it impossible to calculate his income and resulting in an adverse inference.

On appeal, the Director's Delegate found no error of law in the arbitrator's credibility assessments, evidentiary rulings, or conclusion that the appellant failed to meet his burden of proof.

The appeal was dismissed.