Dr. Andrew Gomez-Vargas

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 a determination of catastrophic impairment and entitlement to income replacement benefits (IRB), attendant care benefits (ACB), and various treatment plans following a 2018 motor vehicle accident.

The Tribunal found the applicant did not meet the 55% whole person impairment threshold under Criterion 7, concluding his combined physical and mental impairment rating was 40%.

The Tribunal also found the applicant failed to prove a complete inability to engage in suitable employment, dismissing the claim for post-104-week IRB.

As the applicant was not catastrophically impaired and had exhausted non-catastrophic limits, the claims for ACB and treatment plans were also dismissed.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including treatment plans for physiotherapy, occupational therapy, a chronic pain assessment, and catastrophic impairment assessments.

The respondent denied the benefits.

The Tribunal found that the respondent's notices of denial were compliant with the Statutory Accident Benefits Schedule.

On the merits, the Tribunal held that the applicant failed to prove the treatment plans were reasonable and necessary, noting that the applicant's cognitive impairments were pre-existing and that she had reached maximal medical recovery for her accident-related physical injuries.

The application was dismissed.

The applicant sought various medical assessments following a 2010 motor vehicle accident.

The respondent insurer denied the assessments.

The Licence Appeal Tribunal found that the chronic pain and physiatry assessments were reasonably required due to consistent medical evidence of ongoing ankle pain and the risk of progressive osteoarthritis.

However, the Tribunal dismissed the claims for work site, psychological, attendant care, and function and impairment assessments, finding insufficient evidence to support their necessity, particularly given the applicant's independence in self-care and lack of documented psychological symptoms prior to 2014.

Interest was awarded on the overdue payments for the approved assessments.