Dr. Darren Schmidt

The applicant, a self-employed taxi driver, sought income replacement benefits (IRBs) and a medical benefit for physiotherapy following a motor vehicle accident.

The insurer denied the benefits, relying on surveillance and multidisciplinary assessments that focused primarily on physical impairments.

The Tribunal found that the applicant suffered severe and ongoing psychological impairments, including major depressive disorder and post-traumatic stress disorder, which rendered him substantially unable to perform the essential tasks of his employment for the first 104 weeks, and completely unable to engage in any suitable employment thereafter.

The Tribunal awarded the claimed IRBs and interest.

Furthermore, the Tribunal ordered a 50% lump sum award under O. Reg. 664, finding that the insurer unreasonably withheld benefits by repeatedly ignoring the psychological diagnoses provided by its own assessors.

The claim for physiotherapy was dismissed for lack of evidence.

The applicant was injured in a motor vehicle accident and sought a catastrophic impairment designation under the Statutory Accident Benefits Schedule due to a mental or behavioural disorder.

The respondent insurer denied the designation.

The Tribunal found that the applicant suffered a Class 4 (marked) impairment in the domains of activities of daily living and adaptation to work or worklike settings, caused by an accident-related Somatic Symptom Disorder.

The Tribunal concluded the applicant was catastrophically impaired effective October 19, 2016.

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.