Jeff Ford

The applicant sought a determination of catastrophic impairment and various medical, rehabilitation, and attendant care benefits following a 2016 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under either Criterion 7 (55% whole person impairment) or Criterion 8 (marked impairment due to mental or behavioural disorder).

The Tribunal preferred the evidence of the respondent's assessors, finding the applicant's impairments were primarily physical and did not significantly impede her useful functioning.

Claims for attendant care, occupational therapy, and physiotherapy were dismissed as not reasonable and necessary, while a small claim for prescription medication was allowed with interest.

The applicant was injured in a motor vehicle accident in February 2020 and subsequently involved in a second accident in December 2020.

He sought pre- and post-104 week income replacement benefits (IRBs) and approval for occupational therapy treatment plans.

The Tribunal found that the first accident was a necessary cause of the applicant's impairments, which were exacerbated by the second accident.

Relying on the evidence of the applicant's treating family doctor, chiropractor, and occupational therapist, the Tribunal concluded that the applicant suffered a substantial inability to perform his pre-accident tasks as a courier driver, and a complete inability to engage in any employment for which he was reasonably suited.

The Tribunal awarded the IRBs and approved the treatment plans as reasonable and necessary, but denied the applicant's request for a special award, finding the insurer's denials were based on medical opinions and not unreasonable.

The applicant sought statutory accident benefits following a 2012 motor vehicle accident, claiming she sustained a catastrophic impairment and was entitled to non-earner benefits.

The Tribunal found the applicant did not meet the 55% whole person impairment threshold under Criterion 7, nor did she demonstrate the required marked impairments under Criterion 8.

The Tribunal preferred the evidence of the respondent's assessors, noting the applicant successfully attends university full-time and maintains part-time employment.

The claims for catastrophic impairment and non-earner benefits were dismissed.

The applicant was involved in a motorcycle accident and sustained a traumatic brain injury.

He applied for a catastrophic impairment determination under Criterion 4 of the Statutory Accident Benefits Schedule, relying on the Extended Glasgow Outcome Scale (GOS-E).

The adjudicator found that the applicant met the threshold for a lower moderate disability, primarily due to his inability to return to work in his previous capacity, and thus qualified for catastrophic impairment status.

The adjudicator also awarded partial attendant care benefits and approved several treatment plans for occupational therapy, psychological services, and a laptop, while denying other claimed medical benefits and a claim for a special award.

The applicant sought statutory accident benefits, including a non-earner benefit and various medical benefits, following a motor vehicle accident.

The respondent denied the claims, arguing the accident was minor and the applicant's ongoing complaints were related to pre-existing conditions.

The Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life, noting that video surveillance and medical assessments contradicted her claims of severe impairment.

The Tribunal also dismissed the claims for medical benefits, finding the proposed treatment plans were not reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought a determination that she was catastrophically impaired due to a traumatic brain injury sustained in a motor vehicle accident.

The central issue was whether she met the threshold under the Glasgow Outcome Scale Extended (GOSE) structured interview.

The tribunal found that the applicant's assessors took an overly specific view of the GOSE questionnaire, while the respondent's assessors correctly applied a more generalized approach.

The tribunal also held that under section 45(2) of the Schedule, an occupational therapist cannot complete the GOSE questionnaire for catastrophic determination.

The tribunal concluded that the applicant did not meet the required criteria and dismissed the application.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a motor vehicle accident, along with entitlement to attendant care and various medical and rehabilitation benefits.

The Licence Appeal Tribunal found that the applicant failed to prove a catastrophic impairment under Criterion 7, as his whole person impairment rating fell below the 55% threshold.

Consequently, the claim for attendant care benefits beyond the 104-week mark was denied.

However, the Tribunal ruled that the cost of a multidisciplinary catastrophic impairment assessment does not count towards the non-catastrophic medical and rehabilitation limits.

The Tribunal partially granted the claims for physiotherapy, chiropractic treatment, and specific assessment costs, while denying claims for an iPad, rehabilitation therapy, and an award for unreasonably withheld benefits.

The applicant sought Attendant Care Benefits following a motor vehicle accident.

The insurer denied the benefits after an insurer's examination assessed the needs at $0.00.

The applicant filed for mediation on other benefits but did not dispute the attendant care denial within the two-year limitation period.

Almost three years later, the applicant submitted new assessments and argued that a subsequent finding of catastrophic impairment restarted the limitation clock.

The Tribunal held that the initial denial was clear and unequivocal, triggering the limitation period.

The Tribunal found that subsequent applications and a change in circumstances do not restart the limitation clock, and therefore the applicant was precluded from proceeding with the claim.

The applicant, an 88-year-old pedestrian, was struck by a pole knocked over by a truck insured by the respondent.

She sought interim medical, rehabilitation, and attendant care benefits pending a full arbitration hearing to determine if she is catastrophically impaired.

The applicant had exhausted her non-catastrophic limits and required 24-hour care.

The arbitrator found that the applicant established a prima facie case for catastrophic impairment, noting that the insurer's own neurologist found severe cognitive impairment secondary to the accident, which was improperly omitted from the insurer's multidisciplinary whole person impairment rating.

Considering the applicant's financial hardship, the risk of irreparable harm, the low risk of prejudice to the insurer (who was also the tort insurer), and the delay in scheduling the hearing, the arbitrator granted interim benefits of up to $3,000 per month.

The applicant was injured in a motor vehicle accident and sought a determination that he suffered a catastrophic impairment due to a mental or behavioural disorder, as well as entitlement to attendant care benefits.

The arbitrator applied the three-stage test from Pastore v. Aviva Canada Inc. and found that the accident materially contributed to a cognitive disorder that significantly impaired the applicant's daily life.

The arbitrator concluded the applicant had a marked impairment in concentration, persistence, pace, and work adaptation, meeting the threshold for catastrophic impairment.

The arbitrator awarded a monthly attendant care benefit of $3,036.82, finding the applicant required some supervisory care but not the constant supervision claimed.

The applicant was injured in a motor vehicle accident while driving a tractor-trailer in Ohio, resulting in a collision that killed one person.

He was convicted of vehicular manslaughter and vehicular assault in the US.

He applied for statutory accident benefits.

The insurer denied housekeeping benefits based on the criminal conviction exclusion in s. 30 of the Schedule.

The arbitrator upheld this exclusion, finding it applies to convictions in any jurisdiction.

The arbitrator also dismissed the claims for caregiver and attendant care benefits, finding the applicant was not the primary caregiver before the accident and did not suffer a substantial inability to perform his pre-accident activities, relying heavily on surveillance video showing him performing strenuous truck repairs.

However, the arbitrator ordered the insurer to pay for previously approved medical treatment and assessments, and granted a special award against the insurer for unreasonably withholding these payments.

The applicant was injured in a motor vehicle accident while riding his bicycle.

The insurer paid income replacement benefits for 104 weeks but terminated them, arguing the applicant did not meet the more stringent test of complete inability to engage in suitable employment.

The arbitrator found the applicant, who was functionally illiterate in English and had a history of heavy physical labour, suffered from chronic pain and psychological impairments caused by the accident.

The arbitrator rejected the insurer's expert evidence that the applicant was malingering, finding instead that he was completely disabled from working.

The applicant was awarded ongoing income replacement benefits.

However, his claim for a multidisciplinary pain management program was dismissed as he failed to prove it was reasonable and necessary, given a previous similar program had not yielded further recovery.