The claimant sought entitlement to IRBs and three treatment plans. Adjudicator Anwar awarded IRBs but denied the treatment plans. He concluded that the claimant’s injuries prevented him from working as a drywaller and steel framer. The medical benefits were denied because the claimant failed to provide the disputed treatment plans as evidence and the Tribunal therefore could not determine that they were reasonable and necessary.
The claimant sought entitlement to IRBs and the cost of a chronic pain assessment. Adjudicator Watt dismissed both claims. Regarding IRBs, he held that the claimant was able to work. None of the claimant’s own physicians said that the claimant was unable to work, and the IE assessors made the same conclusions. Regarding the chronic pain assessment, the claimant made no submissions so the claim was dismissed.
The claimant sought entitlement to an additional seven months of IRBs and entitlement to a special award for IRBs that were paid at a lower rate than mandated by the SABS. Adjudicator Grant concluded that no further IRBs were payable for the disputed period because the medical evidence did not suggest an inability to continue in his pre-accident employment. In terms of the past IRBs, Adjudicator Grant concluded that although the insurer had corrected the weekly amount and paid with interest, the deduction of EI was unreasonable and the insurer did not correct the error until the LAT application was filed. An award of 50 percent was granted.
The claimant sought entitlement to two years of IRBs, removal from the MIG, and six treatment plans. Adjudicator Punyarthi concluded that the claimant sustained a concussion and that his injuries were therefore not minor. All of the disputed treatment plans were awarded because they directly addressed the impairments the claimant was suffering. Finally, Adjudicator Punyarthi awarded IRBs on the basis that the claimant could not complete the essential tasks of his employment as a produce clerk at a grocery store.
The claimant sought entitlement to IRBs and three medical benefits. Adjudicator Go dismissed all of the claims other than the claimed psychological assessment. She held that there was insufficient information to support objective limitations or restrictions to support the IRB claim, and the claimant had not provided sufficient information to quantify the IRB even if it had been awarded. In terms of the medical benefits, two of the treatment plans were submitted to the wrong insurer and had never been submitted to the proper insurer. The claimed psychological assessment was awarded because Adjudicator Go favoured the evidence of the claimant’s assessor over that of the IE assessor.
The claimant sought entitlement to IRBs and interest. The insurer raised a third issue at the hearing, as to whether the claimant had complied with a production order. The claimant argued that she was entitled to IRBs, as she continued to receive treatment for her accident-related injuries. Adjudicator Boyce disagreed, noting that the test for IRBs was different than that for awarding medical benefits. Adjudicator Boyce preferred the evidence of the insurer’s assessors, and denied the claimant’s application for IRBs and interest.
The claimant sought removal from the MIG and entitlement to IRBs and various medical benefits. The insurer argued that the claimant failed to attend an IE, which barred payment of further IRBs. Adjudicator Norris concluded that the claimant did not suffer pre-existing conditions that would prevent recovery under the MIG and that the claimant did not suffer psychological injuries in the accident. He also held that the claimant was not entitled to further IRBs, and that the claimant’s non-attendance at an IE without reasonable explanation barred payment of IRBs for the period of non-compliance.
The insurer denied medical benefits for physiotherapy, the cost of an orthopedic assessment, and the cost of a chronic pain assessment based on its finding that the claimant’s injuries fell within the MIG. The insurer also terminated the claimant’s income replacement benefit approximately nine months after the accident on the recommendations made in three IE reports. The claimant disputed the termination. Adjudicator Norris held that the claimant sustained a minor injury and therefore was not entitled to the medical benefits in dispute. He also found that claimant was not entitled to any additional income replacement benefits. Adjudicator Norris was compelled by the insurer’s expert evidence, which was more recent than the applicant’s evidence, and found that the insurer’s evidence outweighed the claimant’s evidence because the claimant had not provided any expert evidence or evidence from a family physician.
The self-employed claimant and insurer disagreed about the quantum of IRBs; the claimant also sought interest on medical benefits approved shortly before the hearing, and a special award. Adjudicator Victor held that it was reasonable to base IRB calculations on the year prior’s gross business income as contemplated in s.4(3) of the SABS, and as such the claimant was entitled to IRBs based on the two income tax returns he provided within the stipulated timeframe. Adjudicator Victor held that requests for further and supporting information were excessive and that the claimant was only required to prove his self-employment income in accordance with the SABS. The claimant went further than required by providing an accounting report. There was a small period of non-compliance by the claimant for which the insurer was entitled to withhold IRB payments. Adjudicator Victor also held that an insurer being incorrect about the claimant not having proved the quantum of IRBs was not enough to grant a special award. Interest was awarded on the approved medical benefits.
The claimant sought entitlement to an income replacement benefit from the time the benefit was terminated approximately one year and one month following the accident onward, and entitlement to medical benefits for chiropractic services, psychological services, and custom orthotics. Adjudicator Sewrattan held that the claimant was not entitled to any of the benefits in dispute. While the claimant advanced evidence to suggest he may have required further counseling and displayed emotional difficulty during an EUO, the evidence did not prove that the claimant was unable to perform the essential tasks of his pre-accident employment. The claimant failed to prove that the chiropractic treatment plans were reasonable and necessary as the goals of the plans were not linked to the claimant’s injuries. The psychological treatment plan was not analyzed because the insurer subsequently approved more sessions of the same treatment in dispute. Lastly, Adjudicator Sewrattan held the claimant was not entitled to payment for custom orthotics because he incurred the expense before submitting a treatment plan.
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP