Dr. Ameis

The applicant was seriously injured in a motor vehicle accident, resulting in a through-the-knee amputation of his right leg.

He applied for a catastrophic impairment designation under paragraph 2(1)(f) of the Statutory Accident Benefits Schedule, claiming a whole person impairment (WPI) of 55% or more.

The arbitrator evaluated the applicant's physical, skin, and mental/behavioural impairments using the AMA Guides.

The arbitrator found that the applicant sustained a 37% WPI for his lower extremity, a 20% WPI for skin impairment, a 15% WPI for mental and behavioural disorders, and additional minor ratings for his low back, left knee, and left wrist/elbow.

Combining these ratings, the arbitrator concluded the applicant sustained a 62% WPI, meeting the threshold for catastrophic impairment.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer terminated weekly income replacement benefits after 104 weeks.

The arbitrator found that the applicant suffered from a chronic pain disorder and met the test of a complete inability to engage in any employment for which he was reasonably suited.

The arbitrator awarded ongoing income replacement benefits, attendant care benefits, medical and rehabilitation expenses, and the costs of various medical reports.

Furthermore, the arbitrator granted a special award of $2,500 against the insurer for unreasonably withholding and delaying payments for medical and attendant care benefits recommended by its own experts.

The applicant was injured in two motor vehicle accidents in 1995 and sought statutory accident benefits, including caregiver benefits, housekeeping expenses, and medical/rehabilitation costs.

The insurer terminated caregiver benefits in 1996 based on surveillance and medical assessments suggesting the applicant was exaggerating her symptoms.

The arbitrator dismissed the claim for ongoing caregiver benefits, finding the applicant's evidence unreliable and her limitations overstated.

However, the arbitrator partially granted the claims for housekeeping expenses, recognizing some ongoing impairment, and ordered the insurer to pay outstanding medical, chiropractic, and transportation expenses.

The applicant was struck by a car while walking on a sidewalk, sustaining a head injury that resulted in chronic severe headaches.

The insurer paid weekly income benefits and medical benefits until November 1994, when it terminated benefits on the basis that the applicant was physically capable of returning to work.

The applicant applied for arbitration, seeking ongoing weekly income benefits and payment for chiropractic treatments.

The arbitrator found the applicant's subjective complaints of severe headaches to be credible and concluded that he was continuously prevented from engaging in any occupation for which he was reasonably suited, entitling him to ongoing weekly income benefits.

The arbitrator remained seized of the issue regarding the reasonableness of the chiropractic expenses due to insufficient evidence.

A post-hearing request by the insurer to reopen the proceedings to admit fresh evidence was dismissed, as the evidence could have been produced with due diligence and would not have changed the outcome.

The Applicant sought ongoing weekly income benefits and medical/rehabilitation benefits following a rear-end motor vehicle accident.

The Insurer had terminated benefits based on surveillance evidence showing the Applicant performing heavy lifting, which contradicted his presentation during medical assessments.

The Arbitrator found the Applicant lacked credibility and that his ongoing complaints were primarily attributable to pre-existing obesity, severe sleep apnea, and degenerative back changes, rather than the accident.

The Applicant's claims for ongoing benefits and a special award were dismissed.

The Insurer's claim for repayment of benefits was also dismissed, as the Applicant did not materially contribute to the overpayment through error or fraud.

In an assessment of expenses following an arbitration where the applicant was unsuccessful, the arbitrator determined the appropriate quantum of costs payable by the insurer.

The arbitrator ruled that the applicant's former counsel had standing to represent her at the assessment, as any expenses awarded were subject to a court order requiring payment into court.

The arbitrator held that while the Legal Aid Tariff sets maximum hourly rates, arbitrators may also consider Tariff A under the Rules of Civil Procedure when assessing the reasonableness of hours claimed.

The applicant was awarded $6,288.40 in fees and disbursements, including reduced allowances for expert medical reports.