Dr. Out

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he was not catastrophically impaired under Criterion 8 of the Statutory Accident Benefits Schedule.

The applicant argued the adjudicator breached procedural fairness by providing inadequate reasons, displaying bias, and failing to address production order breaches, and that the adjudicator made errors of law and fact in assessing his psychological and social functioning impairments.

The Vice-Chair dismissed the request, finding the adjudicator provided clear and adequate reasons, no reasonable apprehension of bias was established, and the adjudicator's weighing of the expert evidence and application of the legal test for marked impairment were reasonable and free of error.

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 of the Schedule and claimed entitlement to a post-104 income replacement benefit (IRB) following a motor vehicle accident.

The Tribunal found that the applicant did not meet the threshold for catastrophic impairment, as he did not demonstrate a marked impairment in at least two of the four functional domains, specifically finding his social functioning was compatible with some useful functioning.

However, the Tribunal granted the applicant's claim for a post-104 IRB, finding that the combination of his physical, psychological, cognitive, and visual impairments resulted in a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience.

Interest was awarded on the overdue IRB payments.

The applicant sought entitlement to statutory accident benefits for occupational therapy, psychological treatment, and an activity rest schedule evaluation following a motor vehicle accident.

The respondent insurer had removed the applicant from the Minor Injury Guideline but denied the specific treatment plans.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide sufficient medical evidence to prove on a balance of probabilities that any of the disputed treatment plans were reasonable and necessary.

The Tribunal relied on the respondent's section 44 multidisciplinary assessors, who concluded the treatments were not required.