Dr. H. Berry

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 appellant insurer sought to appeal a preliminary arbitration order which found that the respondent insured had sustained a catastrophic impairment based on Glasgow Coma Scale scores.

The Director's Delegate declined to exercise discretion to hear the appeal at this time, noting that the issues raised were not novel and that hearing the appeal would prejudice the respondent by delaying the final substantive arbitration hearing scheduled for two months later.

The appeal was rejected without prejudice to it being raised after all issues in dispute have been finally decided.

The Appellant appealed an Arbitrator's decision dismissing his claim for income replacement benefits (IRBs) beyond 104 weeks following three motor vehicle accidents.

The Arbitrator had found that the Appellant failed to prove he was unable to return to his pre-accident employment under the 'own occupation' test, and consequently failed the more onerous 'any occupation' test.

On appeal, the Director's Delegate held that the Arbitrator made no error of law, as the Arbitrator's preference for the insurer's medical evidence over the Appellant's experts was a non-appealable finding of fact.

The appeal was dismissed.

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 sought interim payment of dental and chiropractic accounts under the 'pay pending dispute' provisions of the Statutory Accident Benefits Schedule following a 1993 motor vehicle accident.

The insurer moved to dismiss the arbitration as duplicitous with the applicant's civil action and sought to introduce defence medical reports obtained in that action.

The arbitrator admitted the medical reports, finding the interests of justice outweighed the deemed undertaking rule, but refused to dismiss the arbitration, holding the claims were distinct.

The arbitrator ordered the insurer to pay the medical accounts on an interim basis, finding the applicant had established the requisite de minimis connection between the accident and the treatment.