Application for catastrophic impairment dismissed; pre-existing conditions and flawed expert methodology undermined claims of marked impairment.
The applicant was injured in a head-on motor vehicle collision and sought a determination of catastrophic impairment under the Statutory Accident Benefits Schedule.
The applicant argued he met the criteria under s. 2(1.2)(g) for marked mental or behavioural impairment and s. 2(1.2)(f) for 55% Whole Person Impairment.
The arbitrator found that the applicant had significant pre-existing substance abuse and psychological issues, and that his current impairments were moderate rather than marked.
The arbitrator also preferred the insurer's medical experts, finding the applicant's experts relied on flawed methodology and incomplete medical histories.
The application for catastrophic impairment was dismissed, limiting the applicant's entitlement to housekeeping and attendant care benefits to the 104-week post-accident period.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJul 5, 2012
