Dr. Joel Eisen

The applicant sought a determination that she sustained a catastrophic impairment as a result of a 2016 motor vehicle accident under Criteria 6, 7, and 8 of the Statutory Accident Benefits Schedule.

The Tribunal reviewed multidisciplinary assessments from both parties.

For Criterion 6 (physical), the Tribunal found a 36% whole person impairment, preferring the respondent's assessors on headaches and neurocognitive issues but the applicant's assessor on extremity impairments.

For Criterion 7 (combined physical and mental), the Tribunal added a 10% mental impairment rating based on the respondent's psychiatrist, resulting in a 42% combined impairment, falling short of the 55% threshold.

For Criterion 8 (mental/behavioural domains), the Tribunal found moderate impairments across all domains, rejecting the applicant's claims of marked or extreme impairments.

The application was dismissed.

The applicant sought various statutory accident benefits following a 2019 motor vehicle accident, including a determination of catastrophic impairment, income replacement benefits, attendant care benefits, and several treatment plans.

The respondent denied the benefits and argued the applicant was statute-barred from proceeding due to non-attendance at insurer's examinations.

The Tribunal found the applicant was not statute-barred because the notices of examination were non-compliant and she had a reasonable explanation for non-attendance.

However, the Tribunal dismissed the application on the merits.

The applicant failed to prove she sustained a catastrophic impairment under Criterion 7 or 8, largely due to significant pre-existing physical and psychological conditions.

Consequently, she was not entitled to medical or attendant care benefits beyond the 260-week limit, nor did she prove entitlement to post-104-week income replacement benefits or the disputed treatment plans.

The applicant sought a determination that she sustained a catastrophic impairment (CAT) and was entitled to post-104-week income replacement benefits (IRBs) following a 2018 motor vehicle accident.

The Tribunal found that the applicant did not meet the CAT threshold under Criterion 7, as her evidence failed to transparently apply the AMA Guides' methodology and improperly double-counted impairments, whereas the respondent's assessments credibly established a 15% Whole Person Impairment.

The Tribunal also found the applicant did not meet Criterion 8, preferring the respondent's functional observations showing independence in daily activities over the applicant's self-reported limitations.

Finally, the Tribunal dismissed the claim for post-104-week IRBs, concluding the applicant failed to prove a complete inability to engage in reasonably suited employment, given evidence of ongoing functional capacity and post-accident earnings.

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders), income replacement benefits, attendant care benefits, and various treatment plans.

The Tribunal found that the applicant did not meet the catastrophic impairment threshold, as she failed to establish a marked impairment in the sphere of social functioning, noting her ongoing close familial relationships and 18-month post-accident employment at a school.

The Tribunal also dismissed the claims for income replacement benefits, finding the respondent's medical experts persuasive that she did not suffer a substantial inability to perform her pre-accident employment tasks.

The claims for attendant care benefits and treatment plans were dismissed due to a lack of evidence demonstrating the expenses were incurred or reasonable and necessary.

The applicant sought a determination that she sustained a catastrophic impairment as a result of a 2021 motor vehicle accident, relying on Criterion 8 (mental and behavioural impairments).

The respondent denied the claim, arguing the impairments were moderate and partially pre-existing.

The Tribunal preferred the evidence of the applicant's experts, finding that the applicant suffered marked impairments in all four spheres of function (activities of daily living, social functioning, concentration/persistence/pace, and adaptation).

The Tribunal concluded the applicant sustained a catastrophic impairment as a direct result of the accident.

The applicant sought a determination that she sustained a catastrophic impairment under criterion 8 (mental and behavioural impairments) of the Statutory Accident Benefits Schedule following a 2019 motor vehicle accident.

The Tribunal preferred the evidence of the applicant's psychiatric expert over the respondent's expert, finding the applicant suffered marked impairments in all four spheres of functioning: activities of daily living, social functioning, concentration, persistence and pace, and adaptation.

The Tribunal concluded the applicant was catastrophically impaired.

However, the Tribunal dismissed the applicant's claim for a special award under s. 10 of Regulation 664, finding the respondent's adjusting conduct was not unreasonable, excessive, or imprudent.

The applicant sought a determination that she sustained a catastrophic impairment under criterion 8 of the SABS following a motor vehicle accident.

The dispute centered on whether she had marked impairments in Activities of Daily Living and Concentration, Persistence, and Pace.

The Tribunal found that while the applicant suffered moderate impairments, she retained significant useful functioning, such as driving, caring for her autistic son, and attending the gym regularly.

The Tribunal concluded the applicant did not suffer a catastrophic impairment and dismissed the claims for an award and interest.

The applicant sought statutory accident benefits, claiming a catastrophic impairment under Criterion 8 due to mental and behavioural disorders following a motor vehicle accident.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant's self-reporting was inconsistent and unreliable.

The Tribunal concluded that the applicant did not suffer from a marked impairment in three functional domains (activities of daily living, social functioning, and adaptation) and therefore did not meet the definition of a catastrophic impairment.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment under Criterion 7 (55% whole person impairment).

The Licence Appeal Tribunal reviewed competing medical assessments and preferred the respondent's experts, finding the applicant's combined physical and psychological impairments resulted in a 26% whole person impairment, falling short of the 55% threshold.

The Tribunal also dismissed the applicant's claim for a functional abilities evaluation, finding it was not reasonable and necessary, and consequently denied claims for interest and a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she suffered a catastrophic impairment under Criteria 7 and 8 of the Schedule.

The Licence Appeal Tribunal found the applicant failed to establish a whole person impairment of at least 55 per cent, as the physical and psychological impairment ratings provided by her assessors were largely unsubstantiated by contemporaneous medical evidence.

The Tribunal also found the applicant failed to prove marked impairment in at least three areas of function due to a mental or behavioural disorder resulting from the accident.

The application was dismissed.

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a 2012 motor vehicle accident.

The Tribunal found that the applicant's multidisciplinary catastrophic impairment evaluation was conducted in compliance with section 45(2)1 of the Schedule.

However, the Tribunal concluded that the applicant did not sustain a Marked (Class 4) impairment in the domain of Adaptation.

The Tribunal preferred the evidence of the respondent's experts, finding that the applicant's self-reporting was unreliable and that his psychological impairments did not significantly impede his useful functioning.

The applicant sought statutory accident benefits following a 2012 motor vehicle accident, claiming she sustained a catastrophic impairment due to mental and behavioural disorders.

The Licence Appeal Tribunal found that the applicant suffered a Marked impairment in both adaptation and concentration, persistence, and pace, satisfying Criterion 8 of the Schedule.

The Tribunal relied on the evidence of the applicant's treating professionals and experts, preferring them over the insurer's assessors who provided insufficient analysis.

The applicant was awarded attendant care benefits and a treatment plan for psychotherapy.

However, the Tribunal declined to order a special award under s. 10 of O. Reg. 664, finding the insurer's reliance on its medical assessments was not unreasonable.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

She applied for a catastrophic impairment determination based on psychological and neurological impairments.

The Tribunal found the applicant was not catastrophically impaired, as her mental and behavioural disorders resulted in only mild impairments in social functioning and concentration, persistence, and pace, and there was insufficient evidence of a mild traumatic brain injury to meet the 55% whole person impairment threshold.

The Tribunal allowed the applicant to change her election from a non-earner benefit to an income replacement benefit, finding the initial election invalid because the insurer failed to provide a proper explanation of benefits.

The insurer was granted a repayment of the non-earner benefit due to deductible collateral benefits.

The Tribunal approved one occupational therapy treatment plan and awarded a 10% special award under s. 10 of O. Reg. 664, finding the insurer unreasonably maintained its denial despite acknowledging the plan should have been reassessed.

Claims for a massage chair, attendant care benefits, and other assessments were dismissed.

The applicant sought a determination that she sustained a catastrophic impairment due to a 2016 motor vehicle accident, claiming various statutory accident benefits.

The respondent argued her psychological condition was pre-existing and not accident-related.

The Tribunal found the applicant sustained a Class 4 Marked impairment in social functioning and adaptation, satisfying the catastrophic impairment definition.

The Tribunal awarded partial attendant care benefits, costs for an attendant care assessment and a cognitive screen, and interest, while dismissing claims for case management, occupational therapy, a document review fee, and a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to psychological and physical injuries.

The respondent denied the catastrophic impairment designation, non-earner benefits, attendant care benefits, and various treatment plans, arguing her psychological issues and epilepsy were pre-existing.

The Tribunal found that while the accident caused a specific phobia and worsened her pre-existing depression, it did not cause her epilepsy.

The Tribunal concluded the applicant did not meet the threshold for catastrophic impairment under Criterion 7 or 8, relying heavily on surveillance evidence and the respondent's expert reports which showed significant post-accident improvement.

The claims for non-earner benefits, attendant care, and treatment plans were dismissed as the applicant failed to prove a complete inability to carry on a normal life or that the expenses were reasonable and necessary.

The Applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment, attendant care benefits, and medical benefits.

The Insurer denied the claims, arguing the Applicant's ongoing issues were related to pre-existing conditions and that he was malingering.

The Arbitrator found the Applicant and his family members lacked credibility, noting significant inconsistencies between their testimony, the Applicant's pre-accident medical history, his receipt of ODSP benefits, and surveillance evidence showing him performing normal daily activities.

The Arbitrator preferred the evidence of the Insurer's medical experts, who found the Applicant was malingering and that his impairments were not caused by the accident.

The claims for catastrophic impairment, attendant care benefits, and medical benefits were dismissed.

The applicant was struck by a bus in 2012, sustaining multiple fractures and subsequent psychological impairments.

She applied for a determination of catastrophic impairment under two criteria of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not meet the 55% whole person impairment threshold under s. 3(2)(e), as her combined physical and psychological impairments rated between 42% and 46%.

However, the Tribunal concluded that the applicant was catastrophically impaired under s. 3(2)(f), finding she suffered a marked impairment in the functional areas of social functioning and adaptation due to her accident-related mental and behavioural disorders.

A claim for the cost of a psychiatric paper review was denied.

The applicant sought statutory accident benefits for physiotherapy services and orthopaedic and psychiatric assessments following a motor vehicle accident.

The respondent insurer denied the claims based on insurer examinations.

The adjudicator found that the physiotherapy services were reasonable and necessary for managing the applicant's chronic pain, rejecting the insurer's argument that treatment must lead to full recovery.

The adjudicator also approved the assessments, noting the insurer's assessors conducted paper reviews without reviewing key medical reports.

Finding that the insurer unreasonably withheld payments, the adjudicator ordered a special award of 50% of the disputed amounts, plus interest.

The appellant appealed an Arbitrator's decision finding that he was not catastrophically impaired and dismissing his claims for statutory accident benefits.

The appellant argued that the Arbitrator erred in relying on surveillance evidence and the respondent's medical experts rather than his own presentation at the hearing and his family's testimony.

The Director's Delegate dismissed the appeal, finding that the Arbitrator made no errors of law.

The Arbitrator was entitled to weigh the evidence, including surveillance videos showing the appellant engaging in complex activities that contradicted his family's testimony and his presentation to his own medical experts.

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.