Dr. H. Becker

The applicant sought statutory accident benefits following a 2019 motor vehicle accident, claiming catastrophic impairment due to mental and behavioural impairments.

At the outset of the hearing, the adjudicator denied the applicant's request for an adjournment, noting the significant delay, previous adjournments, and the new counsel's lack of preparation.

The hearing proceeded with the applicant self-represented after her counsel failed to appear.

The adjudicator found the applicant did not sustain a catastrophic impairment, as she failed to prove a marked impairment in three of the four spheres of functioning under Criterion 8.

The adjudicator also dismissed the claims for post-104-week income replacement benefits and attendant care benefits, finding insufficient medical evidence of a complete inability to work and no evidence of incurred attendant care expenses.

As the applicant's non-catastrophic limits were exhausted, the claims for medical benefits and expenses were also dismissed.

The applicant was injured in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) of the Statutory Accident Benefits Schedule.

The respondent denied the claim, relying on its psychiatric assessor who found only mild to moderate impairments.

The Tribunal preferred the evidence of the applicant's assessors, noting that they appropriately included pain-related impairments and relied on functional occupational therapy assessments which demonstrated the applicant's significant deterioration when challenged by tasks.

The Tribunal concluded the applicant suffered marked impairments in three of four functional domains and declared her catastrophically impaired.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits, cost of examinations, interest, and an award following a 2007 motor vehicle accident.

The Licence Appeal Tribunal found the applicant sustained a catastrophic impairment under Criterion 8, specifically a Class 4 Marked impairment in the domain of Activities of Daily Living due to chronic pain and psychological impairments.

The Tribunal awarded attendant care benefits at $507.03 per month for feeding, along with the costs of an occupational therapy situational assessment and an in-home attendant care assessment.

Claims for a triage assessment, an award under Regulation 664, and costs were dismissed.

The respondent insurer brought a motion to stay the applicant's LAT application pending her attendance at an occupational therapy catastrophic impairment insurer's examination (OT CAT IE).

The applicant argued she was not required to attend because the insurer's notices denying catastrophic impairment and requesting the IE did not comply with the medical reasons and timeline requirements of section 45(3)(b) of the Schedule.

The Tribunal found that while the insurer's notices were indeed defective and non-compliant, the requested OT CAT IE was still reasonable and necessary to complete a deferred neuropsychological assessment.

The Tribunal granted a four-month stay of the application to allow the insurer to issue a compliant notice and for the applicant to attend the examination.

The applicant was struck by a city bus as a pedestrian, sustaining soft tissue injuries and a mild traumatic brain injury.

She subsequently developed severe depression, anxiety, and post-traumatic stress disorder.

She applied for a determination that her impairments met the catastrophic threshold under the Statutory Accident Benefits Schedule.

The Tribunal found that while her cognitive complaints were largely psychogenic rather than organic, her psychological impairments were genuine and severely debilitating.

Relying on comprehensive neuropsychological and occupational therapy assessments, the Tribunal concluded the applicant suffered a marked impairment in the adaptation domain, thereby meeting the criteria for a catastrophic impairment under s. 2(1.2)(g) of the Schedule.

The appellant insurer sought to appeal an arbitrator's preliminary decision which found that the respondent insured had sustained a catastrophic impairment following a motor vehicle accident.

The arbitrator based this finding on the respondent's Glasgow Coma Scale scores of 9 and a diagnosis of concussion, applying the binding legal test that the severity of the brain injury is irrelevant if the statutory GCS criteria are met.

The Director's Delegate rejected the interlocutory appeal, finding no strong grounds to depart from established case law and concluding that the most efficient resolution was to defer any appeal until all issues in the arbitration were finally decided.

The Delegate also refused to stay the arbitrator's order, noting the hardship a stay would cause the respondent whose minor injury benefits had been exhausted.

The applicant sought a determination that she was catastrophically impaired following a motor vehicle accident, claiming marked or extreme impairment due to a mental or behavioural disorder, or alternatively, a 55% or more whole person impairment (WPI).

The arbitrator found that the applicant did not suffer a marked or extreme mental or behavioural impairment.

After evaluating conflicting medical evidence regarding her physical and cognitive injuries, the arbitrator assessed her combined WPI at 28%, well below the 55% threshold.

The applicant was awarded $6,000 for the costs of catastrophic assessments, but her claims for attendant care benefits were dismissed.

The insurer was awarded its arbitration expenses.

The insurer appealed an arbitrator's decision finding that the insured was entitled to ongoing income replacement benefits and that CPP child benefits were not deductible from those benefits.

The insured cross-appealed the arbitrator's finding that she was not catastrophically impaired, arguing the arbitrator erred in assessing her psychological whole person impairment at 28%.

The Director's Delegate dismissed both appeals.

The Delegate held that CPP child benefits are not 'disability pension benefits' under the Schedule and are therefore not deductible.

The Delegate also found that the arbitrator's factual findings on causation for the insured's disc herniations and conversion disorder were supported by evidence and reasonable.

Finally, the Delegate upheld the arbitrator's use of a hybrid approach to rate the insured's psychological impairment, finding it was a reasonable exercise of discretion that did not constitute an error of law.

The appellant insurer appealed an arbitrator's decision finding that the respondent insured sustained a catastrophic impairment following a motor vehicle accident.

The arbitrator found the respondent met the definition under the Statutory Accident Benefits Schedule based on a Glasgow Coma Scale (GCS) score of 9 recorded four days post-accident.

The insurer argued the score was invalid due to consciousness-lowering drugs and was not taken within a reasonable time.

The Director's Delegate dismissed the appeal, holding that the definition of catastrophic impairment is a legal test, not a medical one, and does not require excluding confounding factors.

The Delegate found no error in the arbitrator's conclusion that the GCS score resulted from a brain impairment and was taken within a reasonable time.

The applicant, a registered nurse, was struck by a school bus and claimed catastrophic impairment due to physical, cognitive, and psychological injuries.

The insurer disputed the catastrophic designation and denied ongoing attendant care and housekeeping benefits.

The arbitrator found the applicant sustained a catastrophic impairment under both the marked mental/behavioural impairment threshold and the 55% whole person impairment threshold, preferring the evidence of the applicant's experts who properly accounted for her severe depression and chronic pain.

The arbitrator awarded ongoing attendant care, housekeeping benefits, the cost of a cellphone, and a special award due to the insurer's unreasonable delay in reinstating income replacement benefits.

The appellant insurer appealed an arbitrator's decision finding that the respondent pedestrian sustained a catastrophic impairment under clause 2(1.1)(g) of the Statutory Accident Benefits Schedule.

The insurer argued that the arbitrator erred by requiring a marked impairment in only one of four areas of functioning, rather than an overall marked impairment, and by failing to separate physical pain from psychological impairment.

The Director's Delegate dismissed the appeal, holding that the plain language of the Schedule requires only a single marked impairment in one area of functioning.

The Delegate also found no error in the arbitrator's conclusion that the respondent's marked impairment in activities of daily living was due to a mental or behavioural disorder, specifically a pain disorder associated with both psychological factors and a general medical condition.

The applicant was seriously injured in a motor vehicle accident, resulting in a through-the-knee amputation of his right leg.

He applied for a catastrophic impairment designation under paragraph 2(1)(f) of the Statutory Accident Benefits Schedule, claiming a whole person impairment (WPI) of 55% or more.

The arbitrator evaluated the applicant's physical, skin, and mental/behavioural impairments using the AMA Guides.

The arbitrator found that the applicant sustained a 37% WPI for his lower extremity, a 20% WPI for skin impairment, a 15% WPI for mental and behavioural disorders, and additional minor ratings for his low back, left knee, and left wrist/elbow.

Combining these ratings, the arbitrator concluded the applicant sustained a 62% WPI, meeting the threshold for catastrophic impairment.

The applicant was injured in a motor vehicle accident and applied for enhanced statutory accident benefits, claiming she sustained a catastrophic impairment.

The insurer denied the claim based on a Designated Assessment Centre (DAC) report that concluded her whole person impairment (WPI) was 21%.

The arbitrator found the DAC assessment lacked thoroughness and failed to assess all of the applicant's impairments, including psychological, dental, and scarring injuries.

Applying the AMA Guides, the arbitrator conducted a holistic assessment and determined the applicant's combined impairments resulted in a 55% WPI.

The arbitrator concluded the applicant sustained a catastrophic impairment under paragraph 2(1)(f) of the Schedule.