Dr. H. Rosenblat

The insured and the insurer both appealed an arbitration decision regarding statutory accident benefits arising from multiple motor vehicle accidents.

The Director's Delegate found that the Arbitrator breached the rules of natural justice by admitting late affidavits from the insurer without allowing the insured to cross-examine the affiant, and by failing to address the insured's submissions on limitation periods.

Furthermore, the Arbitrator's reasons for finding the insured catastrophically impaired were deemed conclusory and inadequate, as they failed to apply the 'but for' causation test or the proper three-stage process under the AMA Guides for assessing psychiatric impairment.

The appeal and cross-appeal were allowed, and the matter was remitted to arbitration for a fresh re-hearing.

The applicant was involved in two motor vehicle accidents and sought statutory accident benefits.

The arbitrator found that the applicant suffered a catastrophic impairment as a result of the second accident, primarily due to psychiatric impairments including major depressive disorder, which resulted in a marked impairment in work adaptation.

The claims for attendant care and housekeeping benefits were dismissed as statute-barred because the applicant failed to provide timely notice and an assessment of attendant care needs prior to mediation.

Various medical and rehabilitation benefits were found to be reasonable and necessary and were awarded.

The claim for a special award was dismissed as the insurer acted reasonably in adjudicating the complex claims.

The applicant sought catastrophic impairment benefits following a motor vehicle accident.

The insurer requested five in-person insurer's examinations.

The applicant agreed to three but refused to attend an in-person physiatry examination and a cardiology examination, arguing they were excessive and unreasonable.

The insurer raised a preliminary issue that the applicant was precluded from proceeding with her application due to her non-compliance.

The Tribunal found that the in-person physiatry examination was not 'reasonably necessary' under section 44 of the Schedule, as it was overly intrusive and the insurer already had sufficient information from other assessments to conduct a paper review.

The applicant was permitted to proceed with her claim.

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 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 injured in a pedestrian motor vehicle accident and sought a determination that she suffered a catastrophic impairment under the Statutory Accident Benefits Schedule.

The arbitrator found that while the applicant's combined physical and psychological impairments resulted in a 39% whole person impairment, falling short of the 55% threshold under clause (f), she did meet the criteria under clause (g).

Specifically, the arbitrator accepted the CAT DAC assessment that the applicant's pain disorder and physical limitations resulted in a Class 4 marked impairment in her activities of daily living.

The arbitrator held that a single marked impairment is sufficient to meet the definition of catastrophic impairment.

The applicant, a heavy equipment mechanic, was injured in a 1993 motor vehicle accident and received statutory accident benefits until the insurer terminated them in June 1996.

The applicant sought ongoing weekly income benefits and medical/rehabilitation benefits, claiming disability due to a tremor, chronic pain, dizziness, and psychological issues.

The arbitrator found that while the applicant was disabled from his pre-accident employment, his ongoing disability was caused by significant pre-existing degenerative conditions and an essential tremor unrelated to the accident.

The claim for ongoing weekly income benefits was dismissed.

The arbitrator awarded $1,129.75 for medical and rehabilitation expenses incurred prior to the termination date, plus a $100 special award for the insurer's unreasonable withholding of pay-pending-dispute benefits.