Wendy H. Sokoloff

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.

The applicant insurer sought repayment of $19,170.90 in attendant care benefits paid to the respondent insured.

The insurer had paid the benefits based on the respondent's mother's Employment Insurance statement, pending further proof of her economic loss.

In a prior Tribunal decision, it was determined that the respondent failed to prove his mother sustained an economic loss in providing care.

The Tribunal found that the insurer paid the benefits directly to the respondent in error, as no evidence of economic loss was ever provided.

The Tribunal ordered the respondent to repay the $19,170.90 plus interest, finding that the insurer had provided proper notice within the 12-month limitation period.

The applicant sought judicial review of a decision regarding the retrospective application of an amendment to the Statutory Accident Benefits Schedule capping attendant care benefits.

During the hearing, it was revealed that the applicant's mother's income exceeded the maximum benefit amount, meaning the applicant would continue to receive the maximum benefit regardless of the amendment.

It was also revealed that another insurer, not the respondent fund, was liable to pay the benefits.

The Divisional Court dismissed the application as moot, finding that the outcome would have no practical effect on the rights of the parties and that the case lacked the necessary factual foundation to decide the important issues raised.

The insurer brought a motion to compel the applicant to attend six insurer examinations to assess his entitlement to post-104 week income replacement benefits, and to stay the arbitration pending his attendance.

The insurer also sought production of the applicant's employment file from 2006 to date.

The arbitrator found that four of the six requested examinations were reasonable and necessary, given the late production of voluminous medical records by the applicant that raised new psychological and neurological issues.

The arbitration was stayed pending the applicant's attendance at the four examinations.

The arbitrator also ordered the applicant to produce his employment file, but limited the scope to one year pre-accident to date.

The defendant insurer sought leave to appeal a decision upholding a Master's order that required a claims examiner to answer certain questions on discovery.

The questions related to whether health professionals who assessed the plaintiffs under s. 42 of the Statutory Accident Benefits Schedule had requested certain records.

The appeal judge had found that these professionals were 'assessors' rather than 'experts' under rule 31.06(3), and thus the prohibition against cross-examining experts on discovery did not apply.

The Divisional Court granted leave to appeal, finding that the issue of whether rule 31.06(3) applies to s. 42 assessors is open to serious debate and raises a new question of principle.