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No objective evidence of insured's complaints and insured not considered credible.

July 05, 2014, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Heard Before: Adjudicator Richard Feldman

Date of Decision: May 9, 2014

 

 

Ahmad Jawid Ata Mohammad in a car accident on April 16, 2010.  He was a rear-seat, seat-belted passenger in a car that was rear-ended.  Mr. Mohammad testified the collision was of medium severity and he did not strike any part of his body on the inside of the vehicle.  He did not feel anything so he took a taxi home and went to sleep.  The next morning Mr. Mohammad began to feel pain in his head, neck, left shoulder, lower back, left hip and feet.  He didn’t go to his doctor about the pain, but within a week he began treatment at a rehabilitation clinic, had retained a legal representative and had filed a claim with State Farm for accident benefits. Mr. Mohammad was a new immigrant and at the time of the accident he was helping at home with his wife and young children.

 

He applied for and received statutory accident benefits from State Farm, but disputes arose concerning Mr. Mohammad’s entitlement to certain accident benefits.  The parties were unable to resolve their disputes through mediation and the Mr. Mohammad applied for arbitration at the Financial Services Commission of Ontario.

 

The issues:

 

  1. Is Mr. Mohammad entitled to receive weekly caregiver?

  2. Is Mr. Mohammad entitled to attendant care?

  3. Is Mr. Mohammad entitled to receive payments for housekeeping and home maintenance services?

  4. Is Mr. Mohammad entitled to receive a medical benefit for the following with respect to various treatment plans from Kia Wellness Centre Inc.:

  5. Is Mr. Mohammad entitled to interest for the overdue payment of benefits?

 

Background

 

Mr. Mohammad attended a wellness centre for treatment after the accident which immediately began submitting proposals to State Farm for all sorts of assessments and extensive treatment.  Within a month of the accident, it was recommended by these facilities that Mr. Mohammad receive assistance with housekeeping and caregiving tasks and some attendant care.

 

In good faith State Farm agreed to pay for most assessments and treatment plans, housekeeping, home maintenance benefits, caregiver benefits and attendant care benefits for 10 months.  In total, State Farm has paid over $30,000 for treatment (excluding cost of assessments).  According to Mr. Mohammad the treatment has not improved his condition. 

 

The focus of the parties at this hearing are on whether Mr. Mohammad is entitled to housekeeping and home maintenance, caregiver and attendant care benefits for any period after those benefits were terminated by State Farm.

 

Mr. Mohammad called no witnesses and provided no documents. He testified for himself relying on State Farm’s documents.

 

At the hearing the Arbitrator heard testimony from Mr. Mohammad.  Mr. Mohammad called no other witnesses and adduced no documents (he was content to rely upon the documents filed by State Farm).  State Farm called Mr. Mohammad’s family doctor as its only witness

 

The preponderance of the evidence suggests that Mr. Mohammad suffered only soft-tissue injuries in the accident.  His claims are entirely subjective and in the absence of objective evidence, the credibility of Mr. Mohammad is crucial and it is due to a lack of credible evidence that Mr. Mohammad's claims fail.

 

Mr. Mohammad failed to disclose to any of his treating or assessing medical professionals his significant history of pre-accident chronic pain in his low back, left hip, scrotum and heels (including complaints as little as seventeen days prior to the accident).  Consequently, these professionals assumed that all of Mr. Mohammad's complaints were attributable to the accident.  Mr. Mohammad also failed to mention the accident and related injuries to his family physician for over 2 years.

 

It was not until State Farm obtained the clinical notes and records of Mr. Mohammad's former family physician that this pre-accident history came to light.  This raises serious questions both about the cause of Mr. Mohammad's alleged symptoms and about his credibility and reliability as a historian.  It also means that little, if any, weight can be given to the opinions of medical professionals who clearly were not provided by Mr. Mohammad with an accurate, relevant medical history.

 

The records Mr. Mohammad provided for personal care were also not reliable and were given no weight. He also inflated the amounts he claimed for caregiver benefits. He changed his testimony before the Arbitrator. The reports of his injuries by Dr. SB are problematic as Mr. Mohammad did not disclose previous injuries. These facts make his testimony not credible.

 

Result:

 

  1. The Mr. Mohammad’s claims are dismissed.

Posted under Accident Benefit News, Automobile Accident Benefits, Car Accidents, Chronic Pain, Motorcycle Accidents, Pain and Suffering, Spinal Cord Injury, Treatment

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About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us toll-free at 1-866-414-4878.

It is important that you review your accident benefit file with one of our experienced personal injury / car accident lawyers to ensure that you obtain access to all your benefits which include, but are limited to, things like physiotherapy, income replacement benefits, vocational retraining and home modifications.

Practice Areas

  1. Car accidents
  2. Motorcycle accidents
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  4. Catastrophic injury
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  5. Fractures or broken bone injury
  6. Pedestrian accidents
  7. Chronic pain
  8. Truck accidents
  9. Amputation and disfigurement
  10. Fibromyalgia
  11. Nursing Home Fatality Claims

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