Dr. Lawson

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

The respondent denied several treatment and assessment plans, including chiropractic services, cognitive devices, a driving reintegration assessment, a chronic pain assessment, and a fitness membership assessment.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed plans were reasonable and necessary, preferring the respondent's section 44 examination reports which found no objective evidence of impairment and concluded the applicant had reached maximal medical recovery.

The application was dismissed.

The applicant sought reconsideration of a Tribunal decision denying her entitlement to psychological and chronic pain assessments.

She argued the Tribunal erred in finding her assessor was not qualified to diagnose chronic pain and erred in finding no medical evidence linked her psychological complaints to the accident.

The Tribunal found no error regarding the chronic pain assessor's qualifications.

While acknowledging an error of fact regarding the psychological evidence, the Tribunal concluded it would not have changed the outcome, as the applicant had already been diagnosed with an accident-related psychological impairment by an insurer's examination, making an additional assessment unnecessary.

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits for a chronic pain assessment and multidisciplinary chronic pain treatment following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the treatment and assessment were reasonable and necessary, noting her significant pre-accident medical history of fibromyalgia and chronic pain, her return to full-time work, and the lack of corroborating medical evidence beyond a flawed expert report.

The application was dismissed, and claims for interest and an award under O. Reg. 664 were also denied.

The applicant was involved in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder.

The respondent denied the claim, arguing her impairments were mild to moderate and complicated by other factors.

The Tribunal applied Chapter 14 of the AMA Guides and preferred the evidence of the applicant's experts, finding that the applicant's psychological and cognitive symptoms significantly impeded her useful functioning.

The Tribunal concluded that the applicant sustained a marked (Class 4) impairment in the domains of Concentration, Persistence and Pace, and Adaptation, thereby meeting the threshold for catastrophic impairment.

The applicant was struck by a streetcar as a pedestrian and sought a catastrophic impairment designation under the Statutory Accident Benefits Schedule due to psychological, emotional, and behavioural impairments.

The respondent denied the designation.

The Tribunal found that the applicant sustained a traumatic brain injury resulting in a Class 4 (Marked) impairment in the Adaptation domain under Chapter 14 of the AMA Guides.

The Tribunal preferred the evidence of the applicant's experts, noting the applicant's inability to cope with stressors, recurring need to escape uncontrolled situations, and suicidal ideations.

The Tribunal concluded the applicant sustained a catastrophic impairment and is entitled to extended medical and rehabilitative treatment limits.

Following a four‑week jury trial arising from a motor vehicle collision caused by an impaired driver, the plaintiffs obtained a damages verdict of $220,000 but a much smaller net judgment after statutory deductions and accident benefits offsets.

Both parties sought costs, relying on competing Rule 49 settlement offers and arguments concerning proportionality and the impact of statutory deductibles.

The court held that statutory deductibles are not considered when determining entitlement to costs and rejected the defendant’s argument that its offers were more favourable.

After reviewing the complexity of the trial, expert evidence, motions, and proportionality considerations, the court fixed the plaintiffs’ costs at $250,000 in fees plus $126,598.48 in disbursements and applicable HST.

The court further concluded that recent amendments to the Insurance Act affecting cost calculations should not apply retroactively to this litigation.

Following a preliminary hearing where the applicant was found to be catastrophically impaired, the applicant sought arbitration expenses of $144,279.21.

The insurer disputed the amount, arguing the dockets were vague, excessive, and included non-compensable items.

The arbitrator agreed with the insurer's critique, noting the applicant's counsel unnecessarily lengthened the hearing by cross-examining the insurer's experts whose reports were already deficient, and provided superficial submissions.

Applying the principles of reasonableness and global assessment, the arbitrator fixed the applicant's expenses at $60,000 inclusive of taxes.

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

The applicant argued he met the criteria under s. 2(1.2)(g) for marked mental or behavioural impairment and s. 2(1.2)(f) for 55% Whole Person Impairment.

The arbitrator found that the applicant had significant pre-existing substance abuse and psychological issues, and that his current impairments were moderate rather than marked.

The arbitrator also preferred the insurer's medical experts, finding the applicant's experts relied on flawed methodology and incomplete medical histories.

The application for catastrophic impairment was dismissed, limiting the applicant's entitlement to housekeeping and attendant care benefits to the 104-week post-accident period.

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

The applicant relied on assessments indicating a 74% whole person impairment, while the insurer's assessors concluded she had a 31% combined impairment.

The arbitrator rejected the applicant's primary expert evidence, finding the assessor opined outside his expertise and acted as an advocate.

Preferring the insurer's experts and finding the applicant's evidence lacked credibility, the arbitrator concluded the applicant's combined physical and mental impairments resulted in a 28% whole person impairment.

The application for catastrophic impairment benefits was dismissed.