Dr. J. Douglas Salmon

The applicant was injured in a motor vehicle accident and sought approval for a multi-disciplinary catastrophic impairment assessment totaling $22,416.69.

The respondent partially approved the treatment plan for $7,006.00.

The applicant applied to the Licence Appeal Tribunal for the unapproved balance of $15,410.69.

The adjudicator found that most of the disputed assessments were either duplicitous, ancillary to the psychological assessment, or exceeded the $2,000 statutory cap per assessment under s. 25(5)(a) of the Schedule.

The applicant was awarded $2,000 for the CAT Rating/Executive Summary and $200 for the OCF-19 completion fee, plus interest, with the remainder of the claim dismissed.

The insurer appealed the Arbitrator's finding that the insured sustained a catastrophic impairment, arguing the Arbitrator applied the wrong causation test.

The insured cross-appealed the denial of Non-Earner Benefits, Housekeeping, and Attendant Care Benefits.

The Director's Delegate held that the 'but for' test, not the 'material contribution' test, is the correct causation test in accident benefits cases.

The Delegate found the Arbitrator misapprehended critical evidence regarding both the catastrophic impairment and Non-Earner Benefits claims, and remitted those issues for re-hearing.

The denial of Housekeeping and Attendant Care Benefits was upheld as the Arbitrator reasonably found the expenses were not incurred.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident, claiming catastrophic impairment, attendant care, housekeeping, and non-earner benefits.

The insurer argued the applicant's impairments were solely due to pre-existing rheumatoid arthritis.

The arbitrator found the accident was a material contributing factor to the applicant's catastrophic impairment, relying on expert medical and psychological evidence.

However, the claims for attendant care and housekeeping benefits were dismissed because the applicant failed to provide documentary evidence that her service providers suffered an economic loss.

The claim for non-earner benefits was also dismissed due to insufficient evidence comparing pre- and post-accident activities.

The applicant was awarded $3,100 for the cost of examinations.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer terminated weekly income replacement benefits after 104 weeks.

The arbitrator found that the applicant suffered from a chronic pain disorder and met the test of a complete inability to engage in any employment for which he was reasonably suited.

The arbitrator awarded ongoing income replacement benefits, attendant care benefits, medical and rehabilitation expenses, and the costs of various medical reports.

Furthermore, the arbitrator granted a special award of $2,500 against the insurer for unreasonably withholding and delaying payments for medical and attendant care benefits recommended by its own experts.