Dr. C. West

The Applicant was injured in a motorcycle accident and sought a determination that she sustained a catastrophic impairment under the Statutory Accident Benefits Schedule.

The Tribunal assessed her mental and behavioural impairments under criterion 8, applying the AMA Guides.

The Tribunal preferred the evidence of the Applicant's psychiatrist over the respondent's psychologist, finding the latter's report inconsistent with his testimony and test results.

The Tribunal concluded the Applicant suffered a marked impairment in three spheres of function (Activities of Daily Living, Social Functioning, and Adaptation) due to Somatic Symptom Disorder, Major Depressive Disorder, and Posttraumatic Stress Disorder.

The Tribunal declared the Applicant catastrophically impaired.

The applicant sought a determination that he sustained a catastrophic impairment due to a traumatic brain injury following a motor vehicle accident.

The Tribunal found that the applicant's medical reports, which relied on a GOS-E assessment conducted by an occupational therapist and a psychiatrist, failed to comply with the Statutory Accident Benefits Schedule.

The Tribunal preferred the respondent's neuropsychological assessment, which concluded the applicant's ability to drive negated a finding of Lower Moderate Disability.

The application was dismissed.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident.

The respondent denied certain treatment plans and assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant's credibility was undermined by his failure to report a subsequent 2016 accident and pre-existing pain to his expert assessors.

Preferring the respondent's physiatry and psychology experts over the applicant's, the Tribunal concluded the physical injuries were soft tissue strains and there was no diagnosable psychological impairment.

The Tribunal held the injuries were predominantly minor and the disputed treatment plans and assessments were not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

Following a reconsideration decision that removed the applicant from the Minor Injury Guideline, a rehearing was held to determine entitlement to disputed treatment plans and assessments.

The Tribunal found the applicant was entitled to three physiotherapy treatment plans and a psychological assessment, as the medical evidence, including reports from an orthopaedic surgeon and the respondent's own psychological assessor, established they were reasonable and necessary.

Claims for an attendant care assessment and a TMJ assessment were dismissed due to insufficient medical evidence linking the conditions to the accident or demonstrating necessity.

The applicant's request for a special award was denied as the respondent had not unreasonably withheld or delayed payments.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended that chronic pain syndrome, psychological impairments, jaw injury, and post-traumatic headaches removed her from the MIG.

The Tribunal found the applicant's evidence, including an orthopaedic report diagnosing chronic pain syndrome, lacked objective medical findings and corroboration.

Conversely, the Tribunal accepted the respondent's independent medical examinations, which concluded the injuries were predominantly minor soft tissue sprains and strains.

The Tribunal held the applicant sustained predominantly minor injuries and dismissed the claims for treatment plans, cost of examinations, and an award for delayed payments.

The applicant's request for costs was also denied.

The applicant sought non-earner benefits following a motor vehicle accident.

The respondent denied the benefits based on insurer's examinations which concluded the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal preferred the detailed reports of the respondent's assessors over the brief letter from the applicant's family physician.

The Tribunal found the applicant was able to continue his pre-accident activities and dismissed the claim for non-earner benefits, interest, and costs.

The applicant was injured in a motor vehicle accident and sought funding for a psychological assessment under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plan based on an insurer's examination report which suggested the applicant was amplifying symptoms.

The Tribunal found the applicant's evidence, including consistent self-reported symptoms and prescriptions for antidepressants from family physicians, more compelling than the insurer's examination.

The Tribunal ordered the respondent to pay $1,995.33 for the psychological assessment and interest on overdue amounts.

The applicant was struck by a city bus as a pedestrian, sustaining soft tissue injuries and a mild traumatic brain injury.

She subsequently developed severe depression, anxiety, and post-traumatic stress disorder.

She applied for a determination that her impairments met the catastrophic threshold under the Statutory Accident Benefits Schedule.

The Tribunal found that while her cognitive complaints were largely psychogenic rather than organic, her psychological impairments were genuine and severely debilitating.

Relying on comprehensive neuropsychological and occupational therapy assessments, the Tribunal concluded the applicant suffered a marked impairment in the adaptation domain, thereby meeting the criteria for a catastrophic impairment under s. 2(1.2)(g) of the Schedule.

The applicant, an 88-year-old pedestrian, was struck by a pole knocked over by a truck insured by the respondent.

She sought interim medical, rehabilitation, and attendant care benefits pending a full arbitration hearing to determine if she is catastrophically impaired.

The applicant had exhausted her non-catastrophic limits and required 24-hour care.

The arbitrator found that the applicant established a prima facie case for catastrophic impairment, noting that the insurer's own neurologist found severe cognitive impairment secondary to the accident, which was improperly omitted from the insurer's multidisciplinary whole person impairment rating.

Considering the applicant's financial hardship, the risk of irreparable harm, the low risk of prejudice to the insurer (who was also the tort insurer), and the delay in scheduling the hearing, the arbitrator granted interim benefits of up to $3,000 per month.

The applicant, who was injured in a motor vehicle accident, sought interim benefits for psychological treatment pending the arbitration hearing.

The insurer opposed the request, relying on an assessment that suggested symptom exaggeration.

The arbitrator applied the test for interim benefits, requiring a prima facie case of entitlement along with need or urgency.

Relying on the evidence of the applicant's treating psychologists, which documented severe depression, suicidal and homicidal ideation, and a risk of harm to himself and others, the arbitrator found that the applicant met the test.

The insurer was ordered to pay $5,953.46 for sixteen sessions of psychological treatment.