Applicant deemed catastrophically impaired and awarded income replacement benefits, treatment plans, and a 30% special award.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits from her insurer, Wawanesa.
The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment due to marked impairments in adaptation and concentration, persistence, and pace, stemming from somatic symptom disorder and major depressive disorder.
The Tribunal also found the applicant entitled to both pre-104 and post-104 income replacement benefits, as her physical and psychological impairments prevented her from working as a personal support worker or in any suitable employment.
Several treatment plans were deemed payable because Wawanesa failed to provide proper medical and other reasons for denial in its notices, violating s. 38(8) of the Schedule.
Finally, the Tribunal ordered a 30% special award under Regulation 664, finding that Wawanesa unreasonably withheld benefits by blindly following its assessors' reports without considering the totality of the medical evidence or continuously adjusting the file.
OLATOntario Licence Appeal TribunalMay 31, 2022
