Dr. Zielinsky

The applicant sought various statutory accident benefits following a motor vehicle accident, having previously been deemed to have sustained a catastrophic impairment.

The respondent argued the applicant was statute-barred from disputing the denial of attendant care benefits because he failed to do so within the two-year limitation period.

Applying the discoverability principles from Tomec, the Tribunal found the limitation period did not apply because the applicant could not have successfully disputed the denial until he had evidence of his catastrophic impairment.

The Tribunal partially granted the applicant's claims for treatment plans, including physiotherapy, psychological treatment, and catastrophic assessments, while denying mileage expenses for service providers.

The Tribunal also awarded attendant care benefits at reduced monthly amounts for specific periods, finding the applicant did not require 24/7 supervision.

The applicant was involved in a minor rear-end collision while driving to her first day back at work following a prior incident that caused a concussion.

She sought a determination of catastrophic impairment due to mental or behavioural disorders, ongoing income replacement benefits, and approval of several treatment plans.

The Tribunal found that the applicant was not catastrophically impaired, as her function had improved to non-catastrophic levels and validity testing raised concerns about symptom magnification.

The Tribunal also dismissed the claim for ongoing income replacement benefits, finding that her current impairments were not caused by the subject accident.

The applicant was awarded one treatment plan for driver rehabilitation therapy and associated interest, while the remaining treatment plans were denied.

The applicant was injured in a serious motor vehicle accident and sought a determination that he sustained a catastrophic impairment under s. 3.1(1)(7) of the Statutory Accident Benefits Schedule.

The applicant submitted his whole person impairment (WPI) rating was 60%, while the respondent insurer argued it was 34%.

The adjudicator evaluated competing expert medical evidence regarding the applicant's orthopaedic, neurological, and psychological impairments.

After assessing the ratings under the AMA Guides, the adjudicator concluded the applicant's total WPI was 46%.

As this fell below the 55% threshold, the application was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant sustained a catastrophic impairment and was entitled to a Non-Earner Benefit (NEB).

The respondent argued the Tribunal made significant errors of fact and law regarding the Whole Person Impairment (WPI) percentages assigned for medication use, sleep disorder, occipital neuralgia, and mental and behavioural disorders, as well as in applying the legal test for the NEB.

The Adjudicator found that while the Tribunal erred in assigning a 3% WPI for medication use, deducting this amount still left the applicant meeting the catastrophic impairment threshold.

The Adjudicator dismissed the remaining arguments, finding no significant errors of law or fact in the Tribunal's assessment of the medical evidence or its application of the Heath test for the NEB.

The request for reconsideration was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder following a motor vehicle accident.

The adjudicator applied the three-step approach from Pastore and found that while the accident caused a mental or behavioural disorder, the impact on the applicant's life was limited.

Preferring the respondent's medical experts who noted symptom exaggeration and validity concerns, the adjudicator concluded the applicant was only mildly impaired and did not meet the threshold for catastrophic impairment.

The application was dismissed.

The applicant was involved in a motor vehicle accident and applied for a determination of catastrophic impairment and entitlement to non-earner benefits.

The Licence Appeal Tribunal found that the applicant sustained a 55% whole person impairment due to a combination of physical and psychological impairments, meeting the threshold for catastrophic impairment under Criterion 7 of the Schedule.

The Tribunal also found that the applicant suffered a complete inability to carry on a normal life, entitling him to non-earner benefits.

The applicant sought non-earner benefits, medical and rehabilitation benefits, and a special award following a 2012 motor vehicle accident.

The arbitrator dismissed all claims, finding the applicant lacked credibility due to numerous inconsistencies, misrepresentations, and evidence of symptom exaggeration.

The arbitrator placed little weight on the applicant's treating practitioners, preferring the evidence of the insurer's assessors who conducted more thorough document reviews and found the applicant did not suffer a complete inability to carry on a normal life and that the proposed treatments were not reasonable and necessary.

Following an arbitration and a subsequent application for variation/revocation regarding statutory accident benefits, the arbitrator determined the issue of expenses.

The insurer was almost entirely successful in the arbitration and entirely successful in the variation/revocation application.

The arbitrator awarded the insurer its expenses, fixing the amount at $27,425.82 inclusive of fees, HST, and disbursements, after assessing the reasonableness of the claimed preparation time and expert witness fees.

The applicant sought statutory accident benefits following a motor vehicle accident.

The arbitrator dismissed the claim for income replacement benefits, finding that post-accident funds provided by the applicant's company to her service provider were deductible employment income.

The claim for attendant care benefits was also dismissed because the service providers were not healthcare professionals and did not suffer an economic loss, and the expenses were not deemed incurred under s. 3(8) of the SABS.

The arbitrator granted claims for rehabilitative coaching, occupational therapy, physiotherapy, and a nutritional assessment, but denied claims for assistive devices, attendant care assessments, and a speech language assessment.

The claim for a special award was dismissed as the insurer's conduct was not unreasonable.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer denied.

The central issue was whether the applicant's injuries met the threshold for catastrophic impairment.

The arbitrator preferred the evidence of the applicant's experts, finding that the applicant suffered a marked psychological impairment and significant physical impairments, rendering her catastrophically impaired.

The arbitrator awarded various medical benefits, attendant care benefits, housekeeping and home maintenance benefits, and the costs of several assessments.

Claims for a driver desensitization assessment, a worksite assessment, and a special award were dismissed.

Interest was awarded on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment due to a mental or behavioural disorder.

The arbitrator dismissed the claims for post-104 week attendant care, housekeeping, and caregiver benefits, finding that the applicant's presentation was characterized by significant symptom fabrication, exaggeration, and malingering.

The arbitrator concluded that the applicant's cognitive and functional abilities significantly exceeded her presentation, undermining her credibility.

However, the arbitrator awarded pre-104 week housekeeping benefits and the cost of certain assistive devices, while dismissing claims for other treatments, assessments, and a special award.