Ms. Hisey

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment under Criterion 8, concluding she suffered a class 5 extreme impairment in social function and class 4 marked impairments in concentration, persistence, pace, and adaptation due to mental and behavioural disorders.

The Tribunal awarded attendant care benefits at a reduced rate of $785.25 per month and approved several medical and rehabilitation treatment plans, including occupational therapy, physiotherapy, aquatherapy, and pet therapy.

The Tribunal also ordered the respondent to pay a 50% special award under s. 10 of Reg. 664, totaling $7,336.27, finding that the insurer unreasonably denied critical treatment plans early in the applicant's recovery.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment based on mental and behavioural impairments.

The adjudicator first determined that the applicant was statute-barred from claiming income replacement benefits because they failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident.

On the issue of catastrophic impairment, the adjudicator preferred the evidence of the respondent's psychiatric expert, finding that the applicant's functional impairments were related to a well-documented, long-standing psychiatric history rather than the subject accident.

The adjudicator also dismissed the applicant's claims for unapproved portions of psychological and chiropractic treatment plans, as well as a catastrophic assessment, finding them not reasonable and necessary.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought various medical, rehabilitation, and assessment benefits from the respondent insurer.

The respondent denied the benefits on the basis that they were not reasonable and necessary, relying on insurer examinations.

The adjudicator found that the applicant failed to meet his burden of proving the treatment and assessment plans were reasonable and necessary, noting a lack of objective medical evidence linking his current complaints to the accident and a lack of functional impairment.

Additionally, one claim for chiropractic treatment was found to be statute-barred as the appeal was filed past the two-year limitation period.

The application was dismissed.