The claimant sought entitlement to non-earner benefits and the benefits proposed in three treatment plans. Adjudicator Mazerolle found that the claimant was not entitled to NEBs and two treatment plans for physiotherapy. The claimant was found entitled to the cost of a neurobiofeedback assessment.
The claimant sought entitlement to non-earner benefits. Adjudicator Ferguson found that the claimant was not entitled to NEBs based largely on multidisciplinary IE assessments. Adjudicator Ferguson noted that the claimant’s failure to produce ODSP records raised insurmountable doubts as to what her pre-accident level of housekeeping activity actually was. He found that without evidence of the claimant’s pre-accident activities beyond her own self-reporting, he could not conclude that the claimant met the test for entitlement to NEBs.
The claimant sought entitlement to NEBs and ACBs. Adjudicator Parish dismissed all claims. She held that the claimant was still able to perform many of the activities she engage in prior to the accident, albeit with some pain and at a reduced frequency. Adjudicator Parish also reviewed surveillance which showed the claimant engaging in normal activities of daily living in her community and around her home. In terms of the ACBs claim, although the claimant would have required some assistance while her arm was in a cast, she was not entitled to ACBs prior to submission of the Form 1; for the period after the Form 1 was submitted, Adjudicator Parish held that the claimant did not require any assistance. Further, Adjudicator Parish noted that many of the services provided by the claimant’s friend were housekeeping chores rather than attendant care services.
The claimant sought entitlement to NEBs and ACBs. Adjudicator Parish dismissed all claims. She held that the claimant was still able to perform many of the activities she engage in prior to the accident, albeit with some pain and at a reduced frequency. Adjudicator Parish also reviewed surveillance which showed the claimant engaging in normal activities of daily living in her community and around her home. In terms of the ACBs claim, although the claimant would have required some assistance while her arm was in a cast, she was not entitled to ACBs prior to submission of the Form 1; for the period after the Form 1 was submitted, Adjudicator Parish held that the claimant did not require any assistance. Further, Adjudicator Parish noted that many of the services provided by the claimant’s friend were housekeeping chores rather than attendant care services.
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 NEBs, physical therapy, and various assistive devices. Adjudicator Kershaw awarded NEBs and the assistive devices but denied further physical therapy. NEBs were awarded because the claimant had gone from an independent retiree to one dependent on others to assist with activities of daily living. She no longer drove and was unable to attend most of the religious activities she previously performed. Her grandson attended her home regularly to assist with dishes, cooking, cleaning, and laundry. A new mattress was approved because it would provide pain relief. Further physical therapy was denied because the plaintiff’s range of motion had reached maximum medical recovery and there were no records submitted to show further recovery would result.
The claimant sought entitlement to NEBs. Adjudicator Watt dismissed the claim. He noted that the claimant was still able to be active in most of her pre-accident activities, and that she had recovered by at least 50 percent. Although the claimant suffered pain, the pain was insufficient on its own to meet the “complete inability” test.
The claimant sought entitlement to treatment outside of the MIG, and NEBs. Adjudicator Gosio held that the claimant’s injuries fell within the MIG. Adjudicator Gosio held that while the claimant had pre-existing back pain, she failed to submit compelling evidence that her pre-existing back pain prevented her from achieving maximal medical recovery within the MIG. With respect to NEBs, Adjudicator Gosio held that while the claimant demonstrated that there were some changes in her post-accident life with respect, she failed to establish that those changes amounted to her being continuously prevented from engaging in substantially all of her pre-accident activities.
The claimant sought removal from the MIG, entitlement to NEBs, nine disputed treatment plans, interest, costs, and a special award. Adjudicator Gosio concluded that the claimant’s psychological injuries warranted treatment outside of the MIG, and approved one of the treatment plans sought. However, Adjudicator Gosio held that the claimant was not entitled to NEBs, payment of the remaining treatment plans, or to the costs or award sought.
The claimant sought removal from the MIG and entitlement to various treatment plans, attendant care benefits, and non-earner benefits. Adjudicator Ferguson held that the claimant’s injuries fell within the MIG and that she was not entitled to NEBs. The claimant failed to demonstrate why alleged pre-existing conditions or lingering pain should remove her from the MIG. He also held that the claimant’s inconsistent reporting undermined her claim for NEBs.
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP