Dr. John F. Thornton

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment under the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant sustained a catastrophic impairment under both the 55% whole person impairment (WPI) threshold (clause 2(1.2)(f)) and the marked impairment threshold for mental or behavioural disorders (clause 2(1.2)(g)).

The arbitrator accepted the applicant's physical impairment rating of 48% WPI and assessed her mental and behavioural impairment at 33% WPI, resulting in a combined 65% WPI.

The arbitrator also found a marked impairment in three of four functional spheres.

Regarding the claimed expenses totaling $83,417.90, the arbitrator awarded only $1,925.00 for a mental health assessment, dismissing the remainder because they were not properly submitted through the HCAI system as required by the Schedule.

The insurer appealed an arbitrator's decision awarding the claimant non-earner, medical, attendant care, and housekeeping benefits following a bicycle-streetcar collision.

The central issue at arbitration was whether the claimant's post-accident decline was caused by the accident or the natural progression of a pre-existing polyneuropathy.

The Director's Delegate allowed the appeal and ordered a new hearing, finding that the arbitrator failed to provide adequate reasons for rejecting the insurer's medical evidence and accepting the claimant's medical evidence on the issue of causation.

The applicant, a 69-year-old man, was struck by a streetcar while riding his bicycle.

He applied for statutory accident benefits, which the insurer denied on the basis that his impairments were caused by the natural progression of his pre-existing polyneuropathy rather than the accident.

The arbitrator found that the accident materially contributed to the applicant's physical and psychological impairments, including chronic pain, which rendered him completely unable to carry on a normal life.

The applicant was awarded non-earner benefits, medical benefits, attendant care, housekeeping, and the costs of various assessments.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award under s. 282(10) of the Insurance Act for unreasonably withholding benefits in the face of overwhelming medical evidence supporting the applicant's claim.