Applicant designated catastrophically impaired due to mental disorder despite flawed DAC assessment; housekeeping and attendant care awarded.
The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment, along with ongoing attendant care and housekeeping benefits.
The insurer denied the catastrophic designation based on a Designated Assessment Centre (DAC) report.
The arbitrator found the DAC assessment flawed, particularly due to the absence of a mandatory psychological assessment.
Relying on the evidence of the applicant's treating psychologist and psychiatrist, the arbitrator concluded the applicant met the criteria for catastrophic impairment due to a marked mental or behavioural disorder.
The arbitrator awarded housekeeping benefits at the statutory maximum of $100 per week and attendant care benefits at $77.40 per month, declining the higher attendant care claim due to the absence of a supporting Form 1.
The claim for a special award was dismissed.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesNov 15, 2011
