Catastrophic impairment claim dismissed as applicant failed to prove accident caused TMJ diagnosis.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment.
The central issue was whether the applicant met the 55% Whole Person Impairment (WPI) threshold under the AMA Guides.
The applicant relied on a 12% WPI rating for a temporomandibular joint (TMJ) diagnosis.
The Tribunal found that the applicant failed to establish on a balance of probabilities that the TMJ diagnosis was caused by the accident, applying the "but for" test.
Without this 12% rating, the applicant's WPI fell short of the 55% threshold.
Consequently, the applicant was not deemed catastrophically impaired and was denied entitlement to the disputed medical, rehabilitation, and case management benefits, as more than 260 weeks had elapsed since the accident.
OLATOntario Licence Appeal TribunalJun 6, 2023