Mr. Diamantis Zervas

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) beyond the 104-week mark, claiming a complete inability to work due to severe psychological impairments, including PTSD and psychosis.

The Licence Appeal Tribunal found the applicant's psychiatric evidence persuasive and concluded she met the test for post-104 IRBs.

The Tribunal also found the insurer unreasonably delayed paying the pre-104 IRB for approximately four years despite having all necessary information, and ordered a 20% award on the pre-104 IRB amount under Regulation 664.

The claim for an award on the post-104 IRB was dismissed.

The applicant sought income replacement benefits, medical and rehabilitation benefits for chiropractic treatment, and the cost of a psychological assessment following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and she did not suffer a substantial or complete inability to work.

The adjudicator dismissed the application, finding no medical evidence supported the applicant's inability to work.

Insurer examination reports consistently showed no physical or psychological impairments preventing a return to employment.

The adjudicator also found the applicant failed to prove the proposed chiropractic treatments and psychological assessment were reasonable and necessary.