Applicant found catastrophically impaired with 65% combined WPI; most retroactive expense claims dismissed for improper submission.
The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment under the Statutory Accident Benefits Schedule.
The arbitrator found that the applicant sustained a catastrophic impairment under both the 55% whole person impairment (WPI) threshold (clause 2(1.2)(f)) and the marked impairment threshold for mental or behavioural disorders (clause 2(1.2)(g)).
The arbitrator accepted the applicant's physical impairment rating of 48% WPI and assessed her mental and behavioural impairment at 33% WPI, resulting in a combined 65% WPI.
The arbitrator also found a marked impairment in three of four functional spheres.
Regarding the claimed expenses totaling $83,417.90, the arbitrator awarded only $1,925.00 for a mental health assessment, dismissing the remainder because they were not properly submitted through the HCAI system as required by the Schedule.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesDec 28, 2017
