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Catastrophically impaired applicant awarded attendant care and non-earner benefits; insurer penalized for unreasonably withholding payments.
The applicant sustained a catastrophic traumatic brain injury in a motorcycle accident and applied for statutory accident benefits.
The respondent denied several benefits, arguing the applicant was excluded for driving without a valid motorcycle licence and that his impairments were due to pre-existing conditions.
The Tribunal found the applicant's G1 licence was valid for the purpose of the Schedule's exclusion clause.
The Tribunal awarded non-earner benefits, attendant care benefits of $6,000 per month, and rehabilitation support worker services, finding the applicant suffered a complete inability to carry on a normal life and required 24-7 supervision.
A claim for $401,215 in home modifications was dismissed as excessive.
The Tribunal also granted a special award under O. Reg. 664, finding the respondent unreasonably withheld benefits by relying on flawed medical reports and ignoring its own adjuster's recommendations.
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