The claimant sought a determination that her impairments were outside of the MIG and entitlement to medical benefits proposed in three treatment plans. Adjudicator Maleki-Yasdi found that the claimant’s psychological impairment took her outside of the MIG, based on evidence that pre-existing psychological issues were exacerbated by the accident. The claimant was found entitled to payment for physical treatment, a psychological assessment, and psychological treatment.
The claimant sought a determination that his impairments were outside of the MIG and entitlement to medical benefits proposed in five treatment plans. Adjudicator Kepman found that the claimant’s injuries fell outside of the MIG and that he was entitled to payment for two treatment plans for chiropractic services as well as the cost of a functional abilities assessment and an in-home assessment. The claimant was found to be outside of the MIG based on pre-existing chronic lymphocytic leukemia that would prevent maximal medical recovery within the MIG limits.
The claimant suffered a catastrophic impairment following a motorcycle accident which caused a traumatic brain injury. He sought entitlement to NEBs, ACBs, a rehab support worker, home modifications, and a special award. The Fund denied his entitlement to the claimed benefits. It also argued that the claimant did not have a valid licence and was not entitled to NEBs, and that no attendant care services had been incurred. Regarding the exclusion, Adjudicator Hines concluded that it did not apply because the claimant did have a valid driver’s licence (G1) even though it was not the proper licence for operating a motorcycle. She awarded NEBs, concluding that the claimant’s life had changed significantly following the accident. Even though the claimant was receiving ODSP for various disabilities before the accident, the brain injury resulted in significant changes in the claimant’s independent functionality. ACBs were also awarded at the rate of $6,000 per month. Adjudicator Hines concluded that 24 hour care was reasonable based on the claimant’s brain injury and the need for constant supervision. She also held the ACBs to be deemed incurred up to the date of the hearing because the Fund had failed to consider its IEs with a critical eye to ensure that they were medically sound and unbiased. Rehab support worker services were awarded because it was reasonable to teach the claimant skills and strategies to reintegrate into the community. Home modifications were not awarded because the majority of recommended modifications were for someone with severe physical disability rather than a brain injury. Finally, Adjudicator Hines granted a special award in relation to ACBs and the rehab support worker. She concluded that the denials were unreasonable and that the Fund did not critically consider its own IE reports. The Fund also failed to follow the recommendations of its own independent adjustors.
The claimant sought entitlement to two treatment plans for physical and psychological treatment. Adjudicator Grieves denied the claims. She held that the claimant’s physical complaints were not supported by prescriptions or referrals to specialists, and no objective evidence of injury was submitted. Similarly, the adjudicator denied entitlement to the psychological treatment based on the insurer’s IE report, in which the assessor found no diagnosable DSM-5 diagnosis, and noted that there were no references of psychological complaints to the family physician by the claimant.
The claimant sought entitlement to seven medical benefits. Adjudicator Ferguson held that the claimant failed to provide evidence that the disputed treatment plans would provide pain relief or the goals and efficacy of the treatment.
The claimant sought entitlement to ongoing IRBs, and various medical benefits. Adjudicator Anwar found the claimant to be credible, and concluded that he was unable to perform the essential tasks of his pre-accident employment in home construction. IRBs were awarded up to the date of the 104 week anniversary, with IRBs beyond that date to be addressed by the parties at a later date. The adjudicator did not award the claimed treatment plans because the claimant failed to submit them as part of his case brief. Costs and a special award were not issued.
The claimant sought entitlement to a psychological assessment. Adjudicator Punyarthi denied the claim. He held that the claimant failed to explain why the proposed assessment was necessary and that the fees were reasonable. He was also critical of the contents of the Pilowsky report because the diagnoses did not correspond to the evidence that was collected by self-reporting tests.
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 medical benefits for assistive devices, chiropractic treatment, and a functionality assessment, as well as a special award. Adjudicator Boyce held that the claimant was entitled to the medical benefits sought, but not a special award. The adjudicator held that the assistive devices sought were reasonable and necessary as Aviva removed the claimant from the MIG and took the position that she could manage her pain with a home-based exercise plan. The adjudicator also held that chiropractic treatment was reasonable and necessary as the claimant plateaued with physiotherapy and was recommended to explore alternative methods of rehabilitation. The adjudicator further held that the incurred functional abilities evaluation was reasonable and necessary, as it was reasonable to determine how the claimant’s injuries impaired her work and home life to escape the MIG, it was necessary to ensure she did not re-injure herself at work, and it was necessary to educate the claimant on her limitations and prevention of pain. The adjudicator held that Aviva’s minor delay in producing the AB file did not necessitate a special award, as it did not prejudice the claimant or prevent her from receiving benefits.
The claimant sought reconsideration of the Tribunal’s decision that his injuries fell under the MIG. The Tribunal had concluded that the claimant suffered chronic pain, but that it was “clinically associated sequelae” of the initial “minor injury.” Executive Chair Lamoureux reversed the Tribunal’s decision. She held that the Tribunal’s finding that the claimant suffered from chronic pain was sufficient to deem his impairment more serious than a “minor injury.” She also wrote that chronic pain syndrome could not be “clinically associated sequelae” falling under the MIG. Executive Chair Lamoureux awarded four treatment plans that were initially denied by the Tribunal based on the claimant’s injuries falling within the MIG.