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Non-earner benefits and 40% special award granted due to insurer's unreasonable reliance on flawed assessments.
The applicant, an 18-year-old pedestrian, suffered a severe traumatic brain injury when struck by a car.
He applied for non-earner benefits, which the respondent insurer denied based on insurer examinations suggesting symptom exaggeration.
The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life, noting his inability to return to school, drive, play basketball, or maintain his pre-accident social life.
The Tribunal rejected the insurer's neuropsychological assessments as they were contradicted by the insurer's own catastrophic impairment assessors, who found genuine, severe cognitive deficits.
The Tribunal ordered the payment of non-earner benefits and granted a special award of 40% under Regulation 664, finding the insurer acted unreasonably by maintaining its denial despite its own catastrophic assessors' reports.
Applicant entitled to IRBs but insurer permitted to withhold payments due to applicant's failure to answer EUO questions.
The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and the cost of a neuropsychological assessment.
The respondent insurer had terminated IRBs, alleging the applicant failed to provide requested income information, refused to answer questions at an examination under oath (EUO), and made a material misrepresentation about his employment status.
The Tribunal found that the applicant suffered a substantial inability to engage in the essential tasks of his pre-accident employment as a web designer due to post-traumatic headaches and ocular motor dysfunction.
However, the Tribunal also held that the respondent was entitled to withhold IRBs from June 15, 2016, onwards because the applicant failed to provide reasonably requested income information and refused to answer relevant questions at his EUO without a reasonable excuse.
The respondent's claim for repayment based on material misrepresentation was dismissed.
The Tribunal approved the treatment plan for the neuropsychological assessment and awarded interest on a limited period of overdue IRBs, but denied a special award.
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