Insured entitled to income replacement benefits and a 25% award for insurer's unreasonable withholding of assessments.
The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, which the respondent insurer denied.
The Licence Appeal Tribunal found that the applicant suffered from ongoing post-concussion symptoms that caused a substantial inability to perform the essential tasks of her pre-accident employment, entitling her to income replacement benefits.
The Tribunal also approved treatment plans for an attendant care assessment, a functional abilities assessment, and a portion of a psychological treatment plan, finding them reasonable and necessary.
The Tribunal dismissed a claim for physical therapy services.
Finally, the Tribunal ordered a 25% award against the respondent under Ontario Regulation 664, finding that the insurer unreasonably withheld the attendant care and functional abilities assessments by failing to properly investigate the applicant's concussion symptoms and relying on flawed independent medical examinations.
OLATOntario Licence Appeal TribunalFeb 11, 2021
