Dr. T. Ricci

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and various medical benefits.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and she did not suffer a substantial inability to perform the essential tasks of her self-employment.

The Tribunal found the applicant failed to prove entitlement to an IRB, preferring the respondent's assessors who personally evaluated her over the applicant's paper-review assessor.

The Tribunal also concluded the applicant's physical, dental (TMJ), and psychological injuries did not warrant removal from the MIG.

The application was dismissed.

The applicant sought a determination of catastrophic impairment following a motor vehicle accident, claiming a class 5 extreme mental and behavioural impairment.

The applicant moved to exclude the respondent's insurer's examination report by a psychologist, which the Tribunal denied, finding that the restrictions in section 45(2) of the Schedule apply to insured persons, not insurers.

On the merits, the Tribunal found the applicant did not sustain a catastrophic impairment, giving no weight to her psychiatric expert's report due to methodological deficiencies, lack of an occupational therapy assessment, and over-reliance on the applicant's inconsistent self-reporting.

The application for benefits and an award was dismissed.

The applicant was injured in a motor vehicle accident and sought a determination that he sustained a catastrophic impairment due to mental and behavioural disorders.

The insurer brought a preliminary motion to dismiss the arbitration, arguing that a catastrophic determination without a claim for specified benefits was outside the arbitrator's jurisdiction.

The arbitrator dismissed the motion, finding jurisdiction to determine the status.

On the merits, the arbitrator preferred the evidence of the applicant's experts, finding that the insurer's psychiatrist failed to follow the AMA Guides by using a WSIB scale instead.

The arbitrator concluded the applicant suffered a Class 4 (Marked) impairment in deterioration or decompensation in a work or work-like setting, meeting the catastrophic impairment threshold.

The applicant's request for a special award was denied as no specific monetary benefits were unreasonably withheld.

The applicant, a taxi driver, was injured in a rear-end motor vehicle accident and sought statutory accident benefits.

The insurer terminated his income replacement benefits (IRBs) and denied certain medical and assessment treatment plans.

The arbitrator found that the applicant suffered from chronic pain syndrome and psychological impairments, entitling him to both pre-104-week and post-104-week IRBs.

The disputed medical and assessment plans were denied for lack of evidence of reasonableness and necessity at the time of submission.

The arbitrator awarded a maximum 50% special award against the insurer, finding it unreasonably withheld benefits by ignoring mounting medical evidence of the applicant's psychological and cognitive impairments and relying solely on outdated physical assessments.