Ben Meikle

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and hearing aids following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was statute-barred from claiming attendant care benefits because she failed to dispute the insurer's denial within the two-year limitation period, and the justice of the case did not warrant an extension.

On the issue of catastrophic impairment, the Tribunal applied the AMA Guides to assess the applicant's physical and psychological impairments, ultimately finding a combined Whole Person Impairment (WPI) of 56%, which exceeds the 55% threshold under Criterion 7.

The Tribunal denied the claim for hearing aids because the applicant incurred the expense without first submitting a treatment plan, contrary to section 38(2) of the Schedule.

The claim for a special award was also dismissed as the insurer did not unreasonably withhold or delay benefits.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care, chiropractic, psychological, and occupational therapy services, as well as the cost of a catastrophic impairment assessment.

The Licence Appeal Tribunal found that the insurer failed to provide timely notice of denial for one chiropractic treatment plan, rendering it payable for the period of delay under s. 38(11) of the Schedule.

The Tribunal also approved an in-home assessment.

However, the Tribunal dismissed the claims for attendant care benefits and the remaining treatment plans, finding the applicant failed to prove they were reasonable and necessary, largely preferring the objective findings of the insurer's examiners over the applicant's subjective complaints.

The claim for a special award under s. 10 of Regulation 664 was also dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and income replacement benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not meet the criteria for catastrophic impairment under either Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the evidence of the respondent's experts, noting significant validity concerns and sub-maximal effort during the applicant's assessments.

Consequently, the applicant was not entitled to enhanced attendant care benefits, having exhausted her non-catastrophic limits.

The Tribunal also dismissed the claim for income replacement benefits, finding the applicant failed to prove a substantial inability to perform the essential tasks of her pre-accident employment as a personal support worker.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The Tribunal found the applicant sustained a catastrophic impairment due to marked impairments in activities of daily living, concentration, persistence and pace, and adaptation.

The Tribunal approved three treatment plans for Botox injections, an attendant care assessment, and psychotherapy/social worker counselling, but denied thirteen other plans.

Claims for a special award and costs were dismissed, but interest was awarded on overdue benefits.

The applicant requested a reconsideration of a decision finding he did not sustain a catastrophic impairment following a motor vehicle accident.

He argued the adjudicator breached procedural fairness by failing to address his testimony and the four spheres of Criterion 8, and that new evidence in the form of addendum reports should be considered.

The Vice-Chair dismissed the request, finding the adjudicator's reasons adequately explained the preference for the respondent's medical evidence over the applicant's.

The Vice-Chair also found the addendum reports did not constitute new evidence and would not have changed the outcome.

The respondent's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment, attendant care, caregiver, medical, and housekeeping benefits.

The arbitrator found that the applicant failed to prove her entitlement on a balance of probabilities, noting significant issues with her credibility, evidence of malingering, and a failure to disclose pre-existing medical conditions.

The arbitrator preferred the evidence of the insurer's medical experts, who concluded that the applicant had reached maximum medical recovery and did not meet the threshold for catastrophic impairment.

All claims for benefits were denied.

The applicant was injured in a rear-end motor vehicle accident and subsequently developed complete hearing loss in his left ear and partial hearing loss in his right ear due to a labyrinthine concussion.

He applied for non-earner benefits, housekeeping benefits, and a determination of catastrophic impairment.

The arbitrator found that the applicant's hearing loss and resulting psychological impairments continuously prevented him from engaging in substantially all of his pre-accident activities, entitling him to non-earner benefits.

The arbitrator also concluded that the applicant sustained a catastrophic impairment under criterion (g) of the Schedule, as his psychological impairments resulted in a Class 4 marked impairment in the sphere of social functioning.

The claim for housekeeping benefits was dismissed.

The insurer was ordered to pay the applicant's arbitration expenses.

The appellant was injured in a motorcycle accident and sought a determination of catastrophic impairment.

The arbitrator found the appellant had a 49% Whole Person Impairment (WPI) by only considering physical neurological impairments and excluding psychological impairments to avoid double counting.

On appeal, the Director's Delegate held that the arbitrator erred in law by failing to combine the physical and psychological impairments.

When combined, the WPI totaled 59%, exceeding the 55% threshold.

The appeal was allowed in part, declaring the appellant catastrophically impaired, while upholding the denial of attendant care benefits and a special award.

The defendant, State Farm, brought a motion for a neuropsychological examination of the plaintiff, Tie Cindy Li, by Dr. Mark Dowhaniuk.

The motion was brought under ss. 40(1) and 42(1) of the Statutory Accident Benefits Schedule (SABS) and, alternatively, Rule 33 of the Rules of Civil Procedure and s. 105 of the Courts of Justice Act.

The plaintiff claimed catastrophic impairment due to a motor vehicle accident, alleging cognitive impairment, among other issues.

The court found the examination necessary to determine the plaintiff's entitlement to benefits and whether the impairment was catastrophic, preferring the defendant's experts' opinions over the plaintiff's.

The motion was granted, and costs were awarded to the defendant.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment, income replacement benefits, and medical benefits.

The arbitrator found that the applicant sustained a catastrophic impairment due to a marked impairment in the adaptation domain (deterioration or decompensation in a work-like setting) under the AMA Guides.

The applicant was awarded ongoing income replacement benefits of $400 per week, as she suffered a complete inability to engage in any employment for which she was reasonably suited.

Claims for various medical benefits and a special award were dismissed.

The applicant's request for an anonymity order was also denied.

The applicant was injured in a motorcycle accident and sought a determination that he sustained a catastrophic impairment, along with claims for attendant care benefits and a special award.

The arbitrator evaluated competing medical assessments and preferred the insurer's experts, finding the applicant's combined physical and psychological impairments amounted to 49% Whole Person Impairment, falling short of the 55% threshold.

The claim for attendant care benefits was dismissed as the applicant failed to demonstrate an economic loss incurred by his wife and medical assessments indicated he was independent in self-care.

The request for a special award was denied because the insurer had not unreasonably withheld benefits.

The applicant was ordered to pay the insurer's hearing expenses.

The insurer appealed an Arbitrator's decision finding the insured catastrophically impaired due to a mental or behavioural disorder resulting in a marked impairment in activities of daily living.

The insurer argued the Arbitrator gave insufficient and inconsistent reasons, failed to separate physical pain from mental disorder, and did not follow the accepted method for determining a marked impairment.

The Director's Delegate dismissed the appeal, finding the Arbitrator's preference for the insured's psychiatric expert was inferable and not contradicted by his findings on whole-person impairment.

The Delegate also held the Arbitrator was entitled to take a cumulative approach to pain and mental disorder, and adequately addressed the three-stage process for evaluating catastrophic impairment.

The moving party sought court approval of a proposed $650,000 accident benefits settlement arising from a motor vehicle accident that caused catastrophic brain injury to the plaintiff as a child.

The court reviewed the medical evidence, future care needs, and the proposed allocation of settlement funds, including structured settlement arrangements and funds to be managed by the plaintiff’s mother.

The judge identified significant concerns regarding the adequacy of the settlement relative to future care needs, missing medical and economic reports, unclear accounting for certain funds, and the proposed guardianship and care arrangements.

The court concluded that the evidentiary record was insufficient to determine whether the settlement was in the plaintiff’s best interests.

The proposed settlement was therefore not approved and the matter was ordered to return with further evidence.

The applicant was injured in a motor vehicle accident in August 2005.

Nine months later, she suffered severe disc herniations resulting in a cauda equina-like syndrome and a conversion disorder.

The insurer denied ongoing income replacement and attendant care benefits, arguing the disc herniations were not causally related to the accident.

The arbitrator found that the accident materially contributed to the disc herniations and the subsequent conversion disorder.

However, the arbitrator concluded the applicant was not catastrophically impaired, as her combined physical (21%) and mental/behavioural (28%) whole person impairment rating was 43%, falling short of the 55% threshold.

The applicant was awarded an ongoing income replacement benefit and attendant care benefits capped at $3,000 per month for the 104-week period following the accident.

The applicant was struck by a vehicle and claimed statutory accident benefits, including attendant care and housekeeping benefits beyond the 104-week mark.

The insurer terminated these benefits on the basis that the applicant did not suffer a catastrophic impairment.

The arbitrator reviewed the medical evidence, including a Designated Assessment Centre (DAC) assessment, and found that the applicant's whole person impairment was 30 per cent, falling short of the 55 per cent threshold required for a catastrophic impairment.

The arbitrator also found no evidence of a class 4 or 5 mental or behavioural disorder.

The claims for attendant care, housekeeping, and auto repair expenses were dismissed, and the applicant was ordered to pay the insurer's arbitration expenses.