15 total
Application for catastrophic impairment and income replacement benefits dismissed as applicant failed to meet statutory thresholds.
The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment (CAT) based on mental and behavioural disorders, and entitlement to a post-104-week income replacement benefit (IRB).
The Licence Appeal Tribunal found that while the applicant sustained psychological impairments from the accident, she did not meet the Criterion 8 threshold for CAT, as she demonstrated only moderate impairments across the four spheres of functioning.
The Tribunal also dismissed the claim for an IRB, finding the applicant failed to prove a complete inability to engage in suitable employment, preferring the respondent's multi-disciplinary assessment.
The application was dismissed in its entirety.
Application for catastrophic impairment and medication costs dismissed; applicant failed to meet Criterion 8 threshold.
The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming entitlement to medication costs (Cialis) and a determination of catastrophic impairment based on mental and behavioural disorders (Criterion 8).
The Tribunal dismissed the application.
The claim for medication was denied because the applicant failed to prove the prescription was necessitated by the accident rather than other substances, such as hair loss medication or bodybuilding supplements.
On the catastrophic impairment issue, the Tribunal found the applicant had a marked impairment in only one domain (adaptation) and moderate impairments in the other three (activities of daily living; social functioning; concentration, persistence and pace), falling short of the threshold requiring marked impairment in three domains.
Applicant found catastrophically impaired due to psychological disorders and awarded income replacement and attendant care benefits.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment due to mental and behavioural disorders.
The Tribunal found the applicant catastrophically impaired under Criterion 8, as her psychological impairments significantly impeded useful functioning in concentration, persistence, and pace.
The Tribunal awarded post-104 income replacement benefits and partial attendant care benefits, but denied the disputed treatment plans as the applicant failed to establish they were reasonable and necessary.
Judicial review granted; Arbitrator's use of material contribution test for catastrophic impairment involving multiple accidents upheld.
The applicant sought judicial review of a decision by the Director's Delegate, which overturned an Arbitrator's finding that he suffered a catastrophic impairment as a result of a 2013 motor vehicle accident.
The applicant had previously been involved in two accidents in 2002.
The Director's Delegate found that the applicant was already catastrophically impaired before the 2013 accident and that the Arbitrator erred by applying the material contribution test instead of the 'but for' test.
The Divisional Court granted the judicial review, finding the Director's Delegate's decision unreasonable because it relied on an unestablished fact that the applicant was already catastrophically impaired.
The Court also held that the Arbitrator's use of the material contribution test was appropriate in circumstances involving multiple accidents where it is impossible to determine which accident caused the impairment.
Appeal allowed; arbitrator erred by applying material contribution test instead of 'but for' causation.
The insurer appealed an arbitrator's decision finding the insured catastrophically impaired and entitled to medical benefits following a 2013 motor vehicle accident.
The insured had significant pre-existing physical and psychological impairments from prior accidents in 2002.
The Director's Delegate allowed the appeal, finding that the arbitrator erred in law by applying a 'material contribution' test for causation instead of the required 'but for' test.
The Delegate noted that the insured was already catastrophically impaired prior to the 2013 accident, meaning the accident could not have caused the catastrophic impairment.
Furthermore, the arbitrator breached principles of fundamental justice by refusing to even consider the insurer's request for an adjournment after the insured served a 90-page medical report just 31 days before the hearing, improperly fettering her discretion based on the impending closure of the tribunal.
The insured's claims were dismissed and costs were awarded to the insurer.
Applicant found catastrophically impaired as the motor vehicle accident materially contributed to pre-existing psychological conditions.
The Applicant was injured in a motor vehicle accident in 2013 and sought statutory accident benefits from the Insurer, claiming he suffered a catastrophic impairment.
The Applicant had a history of severe pre-existing psychological and physical impairments from prior accidents in 2002.
The Insurer denied the catastrophic impairment designation and various medical benefits, arguing that any impairment was due to the pre-existing conditions.
The arbitrator found that the 2013 accident materially contributed to the Applicant's psychiatric condition, worsening his impairment to a Class 4 marked impairment in activities of daily living.
The arbitrator concluded the Applicant suffered a catastrophic impairment and awarded the disputed medical benefits and examination costs, finding them reasonable and necessary for pain relief and assessment.
The claim for a special award was dismissed, but the Insurer was ordered to pay the Applicant's arbitration expenses and interest on overdue benefits.
Appeal dismissed; Arbitrator's finding of moderate rather than catastrophic psychological impairment upheld.
The appellant appealed an Arbitrator's decision that he did not suffer a catastrophic impairment following a 2009 motor vehicle accident.
The central issue was whether the appellant suffered a marked impairment in the adaptation domain, largely based on his post-accident cannabis dependence and psychological issues.
The Director's Delegate upheld the Arbitrator's findings that the appellant's pre-accident cannabis use and behavioural issues were similar to his post-accident state, and that his impairment was only moderate.
The appeal was dismissed as the Arbitrator correctly applied the law and her factual findings were not subject to review on appeal.
Applicant found catastrophically impaired due to psychological injuries; income replacement benefits denied for late election.
The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment based on psychological injuries, along with income replacement benefits and medical benefits.
The arbitrator preferred the evidence of the applicant's psychological expert, finding she suffered a marked impairment in her ability to adapt, and declared her catastrophically impaired.
The claim for income replacement benefits was dismissed due to an unexplained four-year delay in re-electing benefits.
The requested medical benefits for physiotherapy and psychological treatment were approved as reasonable and necessary.
Application for catastrophic impairment determination dismissed; applicant's mental and behavioural impairments found to be only moderate.
The applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment under the Statutory Accident Benefits Schedule.
The core issue was whether his mental and behavioural impairments, specifically his cannabis dependence and adaptation difficulties, constituted a marked impairment (Class 4).
The arbitrator found the applicant's evidence lacking in credibility and preferred the insurer's expert evidence, concluding that the applicant's impairments were only moderate (Class 3) and his combined whole person impairment did not meet the 55% threshold.
The application was dismissed, and the insurer was awarded partial expenses due to the applicant's conduct prolonging the proceeding.
Insurer's request for further medical examinations denied due to risk of psychological harm to applicant.
The applicant sought accident benefits after a vehicle crashed into her home, causing her severe psychological and cognitive decline.
The insurer sought to stay the arbitration until the applicant attended further insurer examinations (IEs) under section 44 of the Schedule.
The applicant sought interim benefits.
The arbitrator dismissed the insurer's request for a stay, finding that further IEs would not assist the insurer and were not reasonably necessary given the unopposed expert evidence that further assessments risked causing the applicant serious psychological deterioration.
The arbitrator granted the applicant's request for interim benefits in part, awarding $7,000 for past medical expenses based on a demonstrated prima facie case, financial need, and urgency.
Insurer ordered to pay ongoing income replacement and partial housekeeping benefits due to accident-related psychological impairments.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, housekeeping, and attendant care benefits, which the insurer had terminated.
The insurer argued the applicant had removed herself from the workforce prior to the accident due to pre-existing psychological issues.
The arbitrator applied the material contribution test and found that the accident materially contributed to the applicant's pain disorder and exacerbated her depression and anxiety, resulting in a complete inability to engage in employment.
The arbitrator awarded ongoing income replacement benefits and partial housekeeping benefits, but denied attendant care benefits and a special award, finding the insurer's reliance on its medical assessments was not unreasonable.
Arbitrator awards $28,890.86 in expenses following a successful catastrophic impairment claim, rejecting a requested premium.
Following a finding that the applicant sustained a catastrophic impairment in a motor vehicle accident, the parties disputed the quantum of arbitration expenses.
The applicant claimed $99,184.04, including a premium for beating an offer to settle.
The arbitrator rejected the claim for a premium, finding no jurisdiction to award it.
Applying a 4:1 ratio for preparation to hearing time, the arbitrator assessed reasonable legal fees and disbursements, ultimately awarding the applicant $28,890.86 inclusive of HST.
Applicant deemed catastrophically impaired due to accident-caused mental and behavioural disorders resulting in marked impairment.
The applicant was injured in a motor vehicle accident and claimed she sustained a catastrophic impairment due to a mental or behavioural disorder.
The insurer argued the accident was minor and her impairments were pre-existing or caused by unrelated post-accident stressors.
Applying the three-stage process from Pastore, the arbitrator found that the accident materially contributed to the applicant's diagnosed mental and behavioural disorders, including major depressive disorder and pain disorder.
The arbitrator preferred the evidence of the applicant's experts and the insurer's occupational therapist over the insurer's psychiatrist, concluding the applicant suffered a marked impairment in the sphere of deterioration or decompensation in work or worklike settings.
The applicant was deemed catastrophically impaired.
Applicant found catastrophically impaired due to marked mental/behavioural impairments and combined physical/mental impairments.
The applicant, a registered nurse, was struck by a school bus and claimed catastrophic impairment due to physical, cognitive, and psychological injuries.
The insurer disputed the catastrophic designation and denied ongoing attendant care and housekeeping benefits.
The arbitrator found the applicant sustained a catastrophic impairment under both the marked mental/behavioural impairment threshold and the 55% whole person impairment threshold, preferring the evidence of the applicant's experts who properly accounted for her severe depression and chronic pain.
The arbitrator awarded ongoing attendant care, housekeeping benefits, the cost of a cellphone, and a special award due to the insurer's unreasonable delay in reinstating income replacement benefits.
Applicant sustained a catastrophic impairment due to marked mental and behavioural disorders following a motor vehicle accident.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, claiming he sustained a catastrophic impairment due to mental and behavioural disorders.
The insurer denied the claim, relying on an assessment that found only mild impairments.
The arbitrator found the insurer's assessment flawed for failing to follow the AMA Guides and ignoring relevant medical documentation.
Relying on the applicant's experts and treating practitioners, the arbitrator concluded the applicant suffered marked impairments in activities of daily living, social functioning, and adaptation, qualifying as a catastrophic impairment.
The arbitrator also awarded attendant care benefits of $2,460.69 per month and interest on overdue payments.