Dr. Lionel Gerber

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that dismissed her application for catastrophic impairment benefits.

The original application was dismissed after the applicant's counsel, following instructions from the applicant, refused to proceed with the hearing due to concerns about her capacity.

On reconsideration, the applicant introduced a new psychological report opining that she lacked the capacity to instruct counsel during the hearing.

The Tribunal found this report constituted new evidence that could not have been obtained previously and would likely have affected the result.

The reconsideration was granted, the original decision was cancelled, and a new hearing was ordered.

The applicant's requests for costs and a caution against respondent's counsel were denied.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident, claiming catastrophic impairment due to mental and behavioural disorders.

The Licence Appeal Tribunal found that the applicant's pre-existing severe depression and anxiety were the primary causes of her impairments, and that her condition did not significantly worsen post-accident.

The Tribunal dismissed the claims for catastrophic impairment, attendant care benefits, and disputed treatment plans, finding the applicant failed to meet her burden of proof.

Claims for an award for unreasonable delay and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment due to mental and behavioural disorders, non-earner benefits, and attendant care benefits.

The arbitrator dismissed all claims, finding that the applicant was malingering.

The arbitrator rejected the applicant's expert evidence due to flawed methodology and inconsistencies, preferring the insurer's expert and surveillance evidence which showed the applicant engaging in normal daily activities.

The arbitrator also found the accident involved minor forces comparable to everyday activities, making the claimed severe impairments implausible.

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 Insurer sought its expenses of $75,343.92 following an arbitration where success was divided but predominantly in favour of the Insurer.

The Applicant also sought his expenses.

The Arbitrator considered the criteria under Rule 75.2 of the Dispute Resolution Practice Code, noting the Insurer's written offer to settle for $100,000, which exceeded the Applicant's recovery.

The Arbitrator also noted the Applicant's conduct in failing to comply with production orders, which prolonged the proceedings.

The Arbitrator reduced the Insurer's claimed legal fees and disbursements to reflect the Applicant's partial success and the applicable hourly rates, awarding the Insurer $40,357.10 in expenses.

The Applicant's request for expenses was dismissed.

The insurer appealed an Arbitrator's decision finding the insured catastrophically impaired due to a mental or behavioural disorder resulting in a marked impairment in activities of daily living.

The insurer argued the Arbitrator gave insufficient and inconsistent reasons, failed to separate physical pain from mental disorder, and did not follow the accepted method for determining a marked impairment.

The Director's Delegate dismissed the appeal, finding the Arbitrator's preference for the insured's psychiatric expert was inferable and not contradicted by his findings on whole-person impairment.

The Delegate also held the Arbitrator was entitled to take a cumulative approach to pain and mental disorder, and adequately addressed the three-stage process for evaluating catastrophic impairment.

The Applicant was involved in a minor rear-end motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment, income replacement benefits, attendant care, housekeeping, and medical benefits.

The arbitrator found that the Applicant had provided an inaccurate narrative of the accident to his medical assessors, falsely claiming he had struck his head and lost consciousness.

Relying on the insurer's medical experts, the arbitrator concluded the Applicant did not sustain a catastrophic impairment, as his whole person impairment was 24% and his mental/behavioural impairments were mild to moderate.

The claim for ongoing income replacement benefits was dismissed because the Applicant had returned to work shortly after the accident.

The arbitrator granted the claims for attendant care benefits for the first 104 weeks and the cost of psychological examinations, but dismissed the claims for housekeeping benefits and an orthopedic mattress due to lack of proof and exaggeration.

The applicant sought to proceed to arbitration for income replacement benefits and housekeeping and home maintenance benefits after the two-year limitation period had expired.

She argued the limitation period should be tolled because she lacked capacity to instruct counsel due to severe substance abuse and cognitive impairments.

The arbitrator found the applicant was an unreliable historian and failed to rebut the presumption of capacity, precluding her claim for housekeeping benefits.

However, the arbitrator found the insurer's notices terminating income replacement benefits were confusing and not clear and unequivocal, particularly given the applicant's extremely low cognitive abilities.

Therefore, the limitation period for the income replacement benefits claim did not commence, and the applicant was permitted to proceed to arbitration on that issue.

The applicant was injured in a pedestrian knockdown and sought ongoing income replacement and medical benefits.

The insurer terminated benefits, alleging the applicant was exaggerating her symptoms and sought repayment of an overpayment.

The arbitrator found the applicant's presentation of chronic pain and emotional impairments to be genuine, rejecting the insurer's expert who admitted a bias toward skepticism.

The applicant was awarded ongoing income replacement benefits as she was completely unable to engage in suitable employment.

The insurer's claim for repayment was dismissed as the overpayment resulted from an employer error, not the applicant's wilful misrepresentation.

Medical benefits were partially awarded.