The claimant sought a determination that his impairments were outside of the MIG and entitlement to NEBs, the cost of prescription medication, and one treatment plan. Adjudicator Driesel found that the claimant was within the MIG and was not entitled to the disputed benefits.
The claimant sought entitlement to four treatment plans – two for psychological services (which were partially approved), and two for physiotherapy services. Adjudicator Boyce awarded one treatment plan for physiotherapy, but denied the remainder of the claims. Regarding the partial psychological treatment plan amounts, the adjudicator held that the claimant failed to prove that the denied amounts were reasonable and necessary, and wrote that just because a maximum was available under the SABS did not mean that the maximum was always payable. In terms of the physiotherapy treatment plans, the adjudicator held that the earlier treatment plan may have provided benefit, while the latter would not.
The claimant sought entitlement to chiropractic treatment and the denied portion of catastrophic impairment assessments. Adjudicator Boyce denied the claims for further chiropractic treatment because the claimant failed to prove the treatment was reasonable and necessary. He awarded the FAE component of the catastrophic impairment assessments, as well as the cost of the OCF-19 completion, but denied the remainder. He wrote that the denied psychiatric assessment and neuropsychological assessment were just attempts to garner two payments for an already approved assessment. The proposed biopsychosocial assessment was not reasonable and necessary.
The claimant sought entitlement to a treatment plan for physiotherapy. Adjudicator Grant held that the treatment plan was not reasonable and necessary. The claimant’s evidence did not show that physiotherapy was anticipated to provide any benefit. Further, the claimant stated to IE assessors that physiotherapy was not providing long-term benefit.
The claimant sought entitlement to two medical benefits, and a series of catastrophic impairment assessments. Adjudicator Reilly rejected all of the claims. She held that the proposed benefits were not reasonable and necessary. The medical records from the family physician shows no ongoing accident-related impairments.
The claimant sought reconsideration of the Tribunal’s denial of part of a chronic pain program, a bone growth stimulator, and an MRI. Adjudicator Lake dismissed the reconsideration. She held that the claimant failed to prove that the Tribunal made an error of law or fact. In essence, the claimant was seeking a re-weighing of the evidence, which was not the purpose of a reconsideration.
The claimant sought entitlement to IRBs and medical benefits. She also sought entitlement to an accounting report. Adjudicator Watt denied the claim for IRBs, as the claimant had been paid IRBs up to the date she returned to work on a modified basis. He found the treatment plans not reasonable and necessary. Finally, he held that the cost of the accounting report was not payable because it was the claimant’s behaviour which resulted in difficulties calculating the IRB. She withheld information regarding disability benefits and her return to work. Furthermore, she was not a self-employed person.
The claimant judicial review of the dismissal of her claim on two grounds: that she her family physician should be entitled to give opinion evidence, and that the adjudicator did not properly address causation. The Divisional Court agreed with the claimant and remitted the matter for a new hearing. It held that the Tribunal erred in not permitting the family physician to give opinion evidence at the hearing. The Divisional Court also wrote that the Tribunal had not set out the causation test it had applied, and that it was no appropriate for the test to be “implied.”
The insurer sought reconsideration of the Tribunal’s decision that the claimant suffered a catastrophic impairment and that she was entitled to two medical benefits for physical therapy. Adjudicator Parish rejected the reconsideration. She found that all of the insurer’s arguments essentially amounted to re-argument of the case. The Tribunal was not required to make note of every finding of every expert in its decision, nor was it required to address all case law submitted by the parties. The Tribunal’s decision to accept the opinion of the claimant’s assessors over the insurer’s assessors was not an error of law. Nor was use of the California Method for converting a GAF into WPI.
The claimant sought entitlement to ongoing IRBs and over $20,000 in assessments related to the IRB claim. Adjudicator Parish held that the claimant was entitled to IRBs up to the 104-week mark, but that the claimant’s functionality did not meet the “complete inability” test. She also awarded the cost of an occupational therapy situational assessment, orthopaedic assessment, and vocational assessment because they were relevant to the claimant’s injuries and claim for IRBs. The proposed psychological assessment, neurological assessment, executive summary, and transportation were not awarded because the claimant had not sought or been referred for psychological or neurological treatment; the executive summary was duplicative of the awarded assessments; and there was no evidence that transportation to the assessments was required.
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Toronto, Ontario M5H 3S5
416.507.1850
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850