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C.G. v. Travelers Insurance (18-001021)

  • September 17, 2019

The claimant applied to the Tribunal seeking entitlement to IRBs and medical benefits. The insurer raised a preliminary issue requesting that the Tribunal bar the claimant’s dispute over IRBs due to his failure to attend a s. 44 FAE with a kinesiologist. Adjudicator Létourneau concluded that the claimant was entitled to IRBs for the pre-104 week period but not entitled to IRBs for the post-104 week period. With respect to the preliminary issue, Adjudicator Létourneau concluded that the proposed s. 44 FAE was not reasonably necessary. Adjudicator Létourneau found that the s. 44 neurological and physiatry assessments afforded the insurer ample opportunity to assess the claimant’s physical impairments and that a kinesiologist would not be able to comment more specifically on medical impairments than what was already obtained. Adjudicator Létourneau also noted that the claimant worked as a taxi driver pre-accident and that the FAE would not likely have provided more detail with respect to the claimant’s pre-accident job duties. With respect to the IRB dispute, Adjudicator Létourneau concluded that the claimant had provided sufficient evidence that but for the accident, he would have continued to drive a taxi. Adjudicator Létourneau pointed to the claimant’s back pain with prolonged sitting and mental impairments as causing his inability to complete the tasks of his pre-accident employment. As for the post-104 week period, Adjudicator Létourneau noted that the claimant had returned to driving, evidenced by the claimant’s own reporting and surveillance. Adjudicator Létourneau concluded that the claimant could return to work as a driver in other capacities, such as a chauffeur or delivery driver, and that he therefore did not meet the post-104 week disability test. Finally, Adjudicator Létourneau awarded all of the medical benefits plus interest.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Medical Benefits, IE Non-Attendance
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