Deanne Evans

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to mental and behavioural disorders.

The Tribunal found the applicant met the catastrophic impairment threshold under Criterion 8, demonstrating marked impairments in activities of daily living, social functioning, and adaptation.

The Tribunal preferred the evidence of the applicant's assessors, noting the respondent's assessors failed to adequately consider the applicant's reliance on her partner and conducted flawed situational assessments.

The Tribunal awarded the cost of an in-home assessment but denied the claim for attendant care benefits, finding the proposed hours were overestimated and included tasks the applicant could perform independently.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found she did not sustain a catastrophic impairment.

The applicant argued the adjudicator breached procedural fairness by demonstrating a reasonable apprehension of bias against her psychiatric assessor and by failing to consider all expert reports.

She also alleged errors of law and fact regarding the assessment of her pain and adaptation to work-like settings under the AMA Guides.

The Vice-Chair dismissed the request, finding no evidence of bias, noting the adjudicator properly weighed the evidence, and concluding there were no errors in the application of the catastrophic impairment criteria.

The applicant sought a determination of catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule following a 2017 motor vehicle accident.

The respondent insurer denied the designation.

The Tribunal found that the applicant suffered marked impairments in three functional domains: Adaptation, Social Functioning, and Activities of Daily Living.

The adjudicator preferred the applicant's expert evidence, particularly an occupational therapy assessment that included community-based testing and collateral interviews, over the respondent's in-home assessment.

The Tribunal concluded that the applicant's severe psychological decline and alcohol use disorder were directly related to the accident, rendering him catastrophically impaired.

The applicant sought medical and rehabilitation benefits totaling $10,161.36 for goods and services, including an adjustable bed, massage chair, and moving costs, following a motor vehicle accident.

The adjudicator found that while the applicant had been removed from the Minor Injury Guideline (MIG) and suffered from chronic pain, the requested items were not reasonable and necessary.

The evidence showed the applicant already possessed similar items in good condition, and the requested items were not recommended by his chronic pain specialist.

The application was dismissed, along with claims for interest and an award.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought attendant care benefits (ACB) of $4,339.71 per month and assistive devices.

The respondent insurer had reduced her ACB to $1,040.10 per month.

The Tribunal found that the applicant's claim was not statute-barred because the insurer failed to provide proper medical reasons for its refusal, meaning the limitation period had not commenced.

On the merits, the Tribunal accepted the applicant's need for daytime cueing and mobility assistance but rejected the need for nighttime supervisory care, awarding ACB at $1,630.72 per month.

The Tribunal declined to deem the expenses incurred, as the insurer had paid all submitted invoices and did not unreasonably delay payment.

Claims for assistive baby devices and a special award under Regulation 664 were dismissed.

The applicant sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder following a motor vehicle accident.

The respondent argued that the applicant was actively magnifying her symptoms and that her actual functional limitations were minor.

The Tribunal found that the applicant's symptom magnification was itself a symptom of her somatic symptom disorder and pre-existing mental health vulnerabilities.

The Tribunal concluded that the applicant sustained a marked impairment in the domain of adaptation, thereby meeting the definition of catastrophic impairment under the Schedule.