Dr. Bacal

The applicant was seriously injured in a motor vehicle accident in Georgia and sought a determination that he sustained a catastrophic impairment under the Statutory Accident Benefits Schedule.

The parties' medical experts disagreed on the applicant's whole person impairment (WPI) rating, with the applicant's experts assessing it between 62% and 71%, and the insurer's experts assessing it between 48% and 51%.

The arbitrator preferred the evidence of the applicant's experts, finding that the applicant's physical and psychological impairments, when combined, exceeded the 55% threshold.

The arbitrator also found that the accident materially contributed to the applicant's impairments, including his atrial fibrillation and peripheral neuropathy, despite the insurer's arguments regarding pre-existing susceptibility.

The applicant was found to have sustained a catastrophic impairment.

The insurer sought to compel the applicant to attend a psychiatric examination to determine his ongoing entitlement to income replacement benefits following a motor vehicle accident.

The applicant refused, arguing the insurer had already fully explored the psychological component of his claim through previous assessments and that the request was untimely.

The arbitrator found that because the applicant had recently obtained his own psychiatric report, which his counsel failed to disclose until the submissions on this motion, it was reasonably necessary for the insurer to obtain its own psychiatric opinion.

The insurer's request for the examination was granted.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, asserting he was a successful self-employed jewellery manufacturer.

The insurer paid the maximum weekly income benefit of $600 based on a purported purchase order.

The arbitrator found that the applicant had fraudulently misrepresented the status of his business and the existence of the purchase order, and that the insurer had erred in calculating benefits based on anticipated rather than earned income.

The applicant was found to be self-employed but only entitled to the minimum weekly benefit of $185.60 for 156 weeks.

The insurer was awarded a repayment of $21,446.40 for the overpayment.

Claims for benefits beyond 156 weeks and a special award were dismissed.