The insurer sought reconsideration of the Tribunal’s award of ongoing IRBs based on psychological impairment. Vice Chair Hunter dismissed the reconsideration request. He concluded that the Tribunal provided careful and detailed reasons for its decision, and that there was no basis to interfere with it. He also wrote that the Tribunal correctly found that the claimant had proven that he was substantially unable to perform the essential tasks of his pre-accident employment as a real estate agent.
The claimant sought entitlement to IRBs, removal from the MIG, and three medical benefits. Adjudicator Lake concluded that the claimant had proven entitlement to only three months of IRBs, but that his injuries fell within the MIG. The remainder of the MIG limits was awarded on one of the treatment plans.
The claimant sought entitlement to IRBs and two medical benefits. Adjudicator Gosio concluded that the claimant suffered a substantial inability to perform her job as a bartender up to the end of the 104 week period, but she did not meet the “complete inability” test. He accepted that there were other similar employment options available to the claimant, and for which opportunities existed in her community. The medical benefits for physical therapy and psychological therapy were found reasonable and necessary.
The claimant sought entitlement to IRBs, removal from the MIG, and two treatment plans. Adjudicator Norris rejected the claim for IRBs, but removed the claimant from the MIG and awarded the medical benefits for psychological and physical treatment. The claimant failed to attend an IE regarding IRBs, so was not entitled to IRBs between April and June 2016. Outside of that period, Adjudicator Norris concluded that the claimant was not rendered unable to complete the essential tasks of her employment as a collector at a collections agency. In terms of the MIG, Adjudicator Norris held that the claimant suffered psychological injuries. He concluded that a psychological assessment was reasonable and necessary, as was a treatment plan for physical therapy.
The claimant alleged that a stroke six weeks after the accident was caused by the accident. She sought entitlement to IRBs and an electric scooter. The parties agreed that the “but for” test was the appropriate test for causation. Adjudicator Parish concluded that the medical evidence did not prove that the stroke was caused by the accident. The injuries the claimant did sustain in the accident did not support entitlement to IRBs or an electric scooter.
The claimant sought entitlement to IRBs; the insurer argued that the dispute was barred by the limitation period. Adjudicator Ferguson agreed with the insurer and held that the denial of IRBs had been more than two years prior to the LAT application, and that the denial was clear and unequivocal. The claimant’s argument that he interpreted the denial as allowing him to seek IRBs at a later date was not accepted. It was further noted that the denial was to be considered in an objective manner rather than a subjective manner.
The insurer sought repayment of $9,673.38 in IRBs and accountant fees of $2,353.93. Adjudicator Ferguson concluded there was an overpayment of IRBs because the claimant had misrepresented his pre-accident income and that the insurer’s payment of IRBs was therefore made in error. He held that he had no jurisdiction to order the claimant to reimburse the insurer for the cost of the accounting costs.
The claimant sought entitlement to IRBs. The only issue in dispute was the quantum of IRBs payable. The claimant submitted that she earned $1,500 gross income in the 4 weeks pre-accident whereas the insurer submitted that based on the evidence, the claimant earned $700 gross income in the 4 weeks pre-accident. Adjudicator Neilson found that the testimony of the claimant, her husband, and her employer about her earning $1,500 in the 4 weeks pre-accident was unreliable because it was not supported by financial documentation. Adjudicator Neilson noted that she preferred the evidence of the insurer and relied on financial documents submitted by the claimant, including her T4 and payroll slips, to conclude that the claimant earned $700 gross income in the 4 weeks pre-accident. Adjudicator Neilson concluded that the claimant had not met her onus of proving a gross income of the higher amount of $1,500 in the 4 week pre-accident period.
The claimant disputed her entitlement to eight treatment and assessment plans and post-104 week IRBs. Adjudicator Kershaw awarded all of the medical benefits in dispute, save for a portion of a treatment plan that sought funding for a weighted vest. With respect to the weighted vest, Adjudicator Kershaw agreed with the IE neurologist’s opinion that the vest had no scientific utility and therefore was not reasonable and necessary. As for the claim for post-104 week IRBs, Adjudicator Kershaw noted that it was accepted by both the IE assessors and the claimant’s doctors that the claimant had psychological difficulties. Adjudicator Kershaw also relied on the claimant’s doctors’ reports noting that the claimant had cognitive difficulties and dizziness, which he opined would preclude her from returning to employment. Adjudicator Kershaw did not accept the insurer’s vocational assessor’s evidence identifying other suitable employment opportunities for the claimant, noting that the claimant’s psychological and cognitive issues prevented her from returning to gainful employment. As such, Adjudicator Kershaw concluded that the claimant was entitled to post-104 week IRBs.
The claimant sought entitlement to IRBs. The insurer argued that the limitation period applied. Adjudicator Harmison concluded that the claimant was time-barred from seeking IRBs. She held that the insurer clearly told the claimant that he did not qualify for IRBs in its response to his OCF-1. The insurer also set out the two year time limit and procedure to dispute entitlement. Adjudicator Harmison further held that it was not the date of the OCF-3 submission that triggered the limitation period.
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP