Sharla Bandoquillo

The applicant requested a reconsideration of a case conference order that denied an adjournment and refused to add the issue of catastrophic impairment to the hearing.

The Executive Chair granted the reconsideration, finding that the adjudicator did not have the respondent's letter responding to the applicant's OCF-19, which constituted new evidence that would have affected the result.

The written hearing was stayed and the case conference was ordered to resume after the completion of the respondent's catastrophic impairment assessments.

The applicant sought a medical benefit of $2,233.46 for chiropractic treatment and massage therapy following a motor vehicle accident.

The insurance company denied the treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended they suffered from cervical radiculopathy, which falls outside the MIG.

The Tribunal found that the applicant failed to meet the burden of proving their injuries fell outside the MIG, as their medical evidence lacked sufficient objective testing and persuasive analysis to support a diagnosis of cervical radiculopathy.

The Tribunal preferred the insurance company's medical assessment, which diagnosed a whiplash injury.

The application for benefits and interest was dismissed.

The applicant claimed statutory accident benefits following an alleged motor vehicle accident.

In a prior preliminary issue hearing, it was determined that the applicant was not involved in the accident.

The insurer subsequently sought repayment of all benefits paid, alleging wilful misrepresentation.

The arbitrator found that the applicant's claim of being in the vehicle constituted wilful misrepresentation.

However, interpreting section 47 of the 1996 Schedule restrictively, the arbitrator held the applicant liable to repay only those benefits paid directly to him (housekeeping, attendant care, and caregiver benefits), and not medical and rehabilitation benefits paid to third parties.

The applicant was ordered to repay $13,904.19 plus interest and $10,266.88 in expenses.

The applicant sought accident benefits after a vehicle crashed into her home, causing her severe psychological and cognitive decline.

The insurer sought to stay the arbitration until the applicant attended further insurer examinations (IEs) under section 44 of the Schedule.

The applicant sought interim benefits.

The arbitrator dismissed the insurer's request for a stay, finding that further IEs would not assist the insurer and were not reasonably necessary given the unopposed expert evidence that further assessments risked causing the applicant serious psychological deterioration.

The arbitrator granted the applicant's request for interim benefits in part, awarding $7,000 for past medical expenses based on a demonstrated prima facie case, financial need, and urgency.

The respondent was injured while operating a Genie S65 Boom Lift and applied for statutory accident benefits.

The insurer denied the claim on the basis that the boom lift was not an 'automobile'.

The arbitrator found that the boom lift was an off-road vehicle requiring insurance and thus met the enlarged definition of an automobile.

On appeal, the Director's Delegate reversed the decision, holding that under the Off-Road Vehicles Act regulations, a vehicle must have a seat to be prescribed as an off-road vehicle.

Because the boom lift lacked a seat, it was not an automobile, and the respondent was not involved in an accident under the Schedule.

The Appellant appealed an Arbitrator's preliminary decision finding that he was not involved in a motor vehicle accident as defined by the Statutory Accident Benefits Schedule.

The Arbitrator had concluded, based on witness testimony and credibility assessments, that the Appellant was not in the parked van when it was struck by another vehicle.

On appeal, the Director's Delegate held that the Arbitrator's findings were reasonably inferred from the evidence and did not constitute an error of law.

The appeal was dismissed and the Arbitrator's decision confirmed.

The applicant claimed statutory accident benefits, alleging he was injured when a parked van he was occupying was rear-ended by another vehicle.

The insurer denied the claim on the basis that the applicant was not involved in an accident.

At a preliminary issue hearing, the arbitrator found the applicant and his witnesses lacked credibility due to significant inconsistencies in their evidence.

Relying on the testimony of an independent witness and a police officer, the arbitrator concluded that the van was unoccupied at the time of the collision.

Consequently, the applicant was not involved in an accident as defined in section 2(1) of the Schedule.

The applicants were involved in a motor vehicle accident and sought statutory accident benefits.

The insurer settled the outstanding accounts for medical and examination expenses directly with the service providers, obtaining full and final releases.

The applicants subsequently sought to proceed to arbitration for those same expenses.

On a preliminary issue, the arbitrator held that the claims could not proceed, as the insurer had validly settled the accounts directly with the providers under the Schedule and no further expenses were incurred by the applicants.

The insurer's request for costs against the applicants' legal representatives personally was dismissed, as the claims, while lacking merit, did not constitute an abuse of process.

The applicant sought statutory accident benefits for medical treatment following a motor vehicle accident.

The insurer denied the claims, arguing the treatment plan was submitted late and the treatment was not reasonable and necessary.

The arbitrator found that the applicant was precluded from arbitrating the treatment plan because it was submitted beyond the 30-day limit.

In the alternative, the arbitrator relied on insurer examinations and a DAC assessment to conclude the treatment was not reasonable and necessary.

The application was dismissed.