Dr. Maser

The applicant was severely injured when pinned between two vehicles, sustaining massive abdominal trauma including a subtotal colectomy and partial kidney infarction.

He applied for a catastrophic impairment determination under Criterion 7 of the SABS.

The Tribunal conducted a detailed analysis of his Whole Person Impairment (WPI) ratings under the AMA Guides, assigning 15% for musculoskeletal, 9% for scarring, 25% for gastrointestinal (Class 3), 2% for medication, and 20% for mental and behavioural impairments.

The combined WPI of 54.5% rounded to 55%, meeting the catastrophic threshold.

The Tribunal denied attendant care benefits because the applicant failed to prove the expenses were incurred, but approved several medical treatment plans including psychological services and nutrition counselling.

Costs of $250 were awarded against the respondent for late production of adjuster log notes.

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

The Tribunal found the applicant sustained a catastrophic impairment under Criterion 7, reaching a 57% whole-person impairment rating.

The Tribunal also found the applicant met the test for post-104 income replacement benefits due to a complete inability to engage in suitable employment, but denied payment because the applicant failed to file income tax returns as required by section 4(5) of the Schedule.

Finally, the Tribunal determined the applicant was entitled to attendant care benefits of $889.21 per month, but denied payment because the expenses were not incurred.

The applicant sought reconsideration of a Tribunal decision denying medical benefits and post-104 week income replacement benefits.

The applicant introduced fresh evidence in the form of a psychiatric assessment by the respondent's own expert, which causally linked the applicant's severe alcohol use disorder and depression to the accident.

The Tribunal admitted the fresh evidence and found that the applicant sustained psychological impairments as a result of the accident.

Consequently, the Tribunal concluded the applicant suffered a complete inability to perform any occupation and awarded post-104 week income replacement benefits, as well as medical benefits for a psychological assessment and occupational therapy.

The request for personal training services was dismissed.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The applicant argued that pre-existing shoulder and psychological issues, along with accident-related chronic pain and psychological impairment, removed him from the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims, noting inconsistencies between the applicant's self-reports, his family physician's records, and the insurer's examinations.

The Tribunal concluded the injuries were predominantly minor and subject to the MIG limit, which the respondent had already substantially paid.

The disputed treatment plans were therefore not payable.

The applicant sought dispute resolution at the Licence Appeal Tribunal after being denied post-104 week income replacement benefits, medical benefits, and costs of examinations following a motor vehicle accident.

The adjudicator found that while the applicant suffered physical impairments from the accident, he did not suffer a complete inability to engage in any employment for which he was reasonably suited.

The adjudicator preferred the respondent's vocational evidence, finding the applicant could work as a delivery driver.

The adjudicator also found the applicant's psychological issues were caused by subsequent life stressors, not the accident.

The claims for medical benefits and assessments were dismissed as not reasonable or necessary.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied payment, arguing the injuries were predominantly minor and subject to the $3,500 treatment limit under the Minor Injury Guideline, or alternatively, that the injuries were caused by a subsequent accident.

The Licence Appeal Tribunal found that the applicant suffered from a concussion with post-concussive symptoms caused by the first accident, which is not a predominantly minor injury.

The Tribunal ordered the insurer to pay for a driving rehabilitation assessment and an occupational therapy assessment, finding them reasonable and necessary.

The applicant was awarded interest on overdue payments but denied an award for unreasonable denial, as the insurer's belief regarding the cause of the injuries was reasonable.