Dr. Marc Marciniak

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 insurer appealed an arbitrator's decision awarding the insured person medical benefits and the cost of assessments and reports, arguing the arbitrator erred in law by relying on the evidence of a clinic director with a financial interest in the outcome and poor record-keeping practices.

The insured person cross-appealed the dismissal of claims for translation services and the offsetting of a misdirected payment.

The Director's Delegate found that the arbitrator's findings of fact regarding the medical benefits were supported by the evidence and did not constitute an error of law.

However, the Director's Delegate allowed the appeal in part, finding the arbitrator erred in awarding section 24 expenses for certain reports that served only as advocacy or were prepared after the treatment cut-off date.

The cross-appeal was dismissed.

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.