Suzanne A. Clarke

The respondent insurer requested reconsideration of a Tribunal decision awarding attendant care benefits and occupational therapy services to the applicant.

The respondent argued the Tribunal made errors of fact in its calculations and date ranges, and failed to specify that attendant care benefits are subject to proof of incurred expenses.

The Tribunal granted the reconsideration, correcting a typographical error regarding the end date for benefits, clarifying the full quantum of attendant care benefits subject to section 19(1)(a) of the Schedule, and correcting a calculation error regarding the occupational therapy services.

The respondent insurer requested a reconsideration of a decision awarding the applicant entitlement to chiropractic and physiotherapy services, interest, and an award under the Schedule.

The respondent argued the adjudicator made errors of law and fact and breached procedural fairness by finding its denials non-compliant and penalizing its failure to obtain updated medical assessments.

The adjudicator dismissed the request, finding no significant legal or evidentiary mistakes, and held that the original decision correctly addressed the non-compliant denials and unreasonable delay in treatment.

The applicant sought various statutory accident benefits following a motor vehicle accident.

The Tribunal found that the applicant was not entitled to the disputed physiotherapy, massage, and orthopaedic assessment plans, as they were not shown to be reasonable and necessary.

However, the Tribunal ordered the respondent to pay for two incurred treatment plans for chiropractic and physiotherapy services because the respondent's denial notices failed to comply with s. 38(8) of the Schedule.

The Tribunal also granted a 25% award under s. 10 of O. Reg. 664 on the incurred plans, finding the respondent's conduct in relying on an IE that did not address the disputed plans to be imprudent and inflexible.

The applicant sought statutory accident benefits for physiotherapy and psychological services following a motor vehicle accident.

The respondent denied the physiotherapy treatment plans on the basis that the applicant had reached maximum medical recovery, and disputed the hourly rate claimed for psychological services rendered by a social worker.

The adjudicator found that the applicant had recovered from uncomplicated soft-tissue injuries and had no residual impairments, making further physiotherapy not reasonable and necessary.

The adjudicator also held that the social worker was not entitled to the enhanced hourly rate reserved for psychologists under the Professional Services Guideline.

Claims for an award and interest were dismissed as no benefits were unreasonably withheld or overdue.