Dr. Michael Gadon

The insurer appealed an Arbitrator's decision finding that the claimant suffered a catastrophic impairment due to a mental or behavioural disorder and awarding ongoing attendant care and housekeeping benefits.

The Director's Delegate allowed the appeal, finding that the Arbitrator failed to give adequate reasons, reversed the burden of proof, and failed to fairly consider the evidence.

The medical evidence presented by the claimant did not address the criteria under the AMA Guides, and her uncorroborated evidence was insufficient to prove catastrophic impairment.

The Arbitrator's orders were revoked, and the claimant was ordered to repay interim benefits.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment, along with ongoing attendant care and housekeeping benefits.

The insurer denied the catastrophic designation based on a Designated Assessment Centre (DAC) report.

The arbitrator found the DAC assessment flawed, particularly due to the absence of a mandatory psychological assessment.

Relying on the evidence of the applicant's treating psychologist and psychiatrist, the arbitrator concluded the applicant met the criteria for catastrophic impairment due to a marked mental or behavioural disorder.

The arbitrator awarded housekeeping benefits at the statutory maximum of $100 per week and attendant care benefits at $77.40 per month, declining the higher attendant care claim due to the absence of a supporting Form 1.

The claim for a special award was dismissed.

The self-represented applicant sought a catastrophic impairment designation following a motor vehicle accident.

The insurer denied the claim based on a Designated Assessment Centre (DAC) report.

In an interim decision, the arbitrator found that the DAC assessment was fundamentally flawed because it lacked a mandatory psychological assessor and failed to properly assign impairment ratings for all conditions, including fibromyalgia.

The arbitrator ordered that the applicant be given the option to undergo a new, properly constituted multidisciplinary assessment, or proceed to a final hearing based on the existing evidence.

The applicant was injured in a motor vehicle accident and received weekly income replacement benefits until the insurer terminated them.

The applicant sought arbitration for ongoing income replacement benefits, supplementary medical benefits for physiotherapy, and a determination on the availability of collateral long-term disability benefits.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of her employment due to chronic pain and depression caused by the accident.

The arbitrator awarded ongoing income replacement benefits, partially granted the claim for physiotherapy expenses, and found that long-term disability benefits were not available to reduce the weekly benefits.