Dr. Gayle Kumchy

The applicant was struck by a pickup truck while riding his bicycle, sustaining severe injuries to his left heel and ankle.

He applied for a determination of catastrophic impairment, which the insurer denied.

At arbitration, the arbitrator preferred the evidence of the applicant's experts, finding that his need for two crutches and a short leg brace resulted in a 55% Whole Person Impairment under the AMA Guides.

Furthermore, the arbitrator accepted that the applicant's chronic pain and depression resulted in a Class 4 marked impairment in at least one area of functioning.

The arbitrator concluded that the applicant sustained a catastrophic impairment under both paragraphs 2(1.2)(f) and (g) of the Schedule.

The applicant was severely traumatized in a motor vehicle accident and received extensive psychological treatment for post-traumatic stress disorder.

The insurer terminated payments for the treatments, arguing they were no longer reasonable in frequency or duration.

The arbitrator found that while ongoing psychotherapy was appropriate, the frequency of two to three visits per week over several years was excessive.

The insurer was ordered to pay 50 per cent of the outstanding accounts.

Additionally, the arbitrator granted a special award of $2,500 because the insurer violated the 'pay pending dispute' provision by withholding payments while the dispute was ongoing.