Sloan Mandel

The applicant, who sustained catastrophic impairments in a motor vehicle accident, brought a motion for an interim payment of $427,751 for home modifications.

The insurer had requested a section 44 examination involving both a housing expert and an occupational therapist to assess the claim.

The applicant consented to the housing expert but refused to attend an examination involving the occupational therapist.

The arbitrator dismissed the motion, finding that the insurer's request for an occupational therapist assessment was reasonable and necessary to evaluate the applicant's functional requirements.

Because the applicant failed to attend the section 44 examination, he was in breach of the Schedule, making an award of interim benefits inappropriate.

The applicant, who was injured in a motor vehicle accident, sought production of the insurer's entire claims file, including internal activity logs and correspondence created after the application for mediation.

The insurer claimed litigation and solicitor-client privilege over certain documents.

The arbitrator dismissed the motion for production, applying the presumption that documents created after the application for mediation are for the dominant purpose of litigation.

The arbitrator found that the applicant's claim for a special award did not override the insurer's claims of privilege.

The Motor Vehicle Accident Claims Fund (MVAC) appealed an arbitration order requiring it to pay various expenses for R.W., who suffered a severe brain injury in a motorcycle accident and resided in a supportive group home.

The Director's Delegate upheld the arbitrator's findings that R.W.'s rent, mandatory program fees, and transportation costs were reasonable and necessary care and rehabilitation expenses under the Statutory Accident Benefits Schedule.

The Delegate reversed the award for personal care items and confectionary due to a lack of medical evidence.

The special award against MVAC for unreasonably refusing to pay the core expenses was upheld.