Pedestrian with brain injury deemed catastrophically impaired under GOS; insurer liable for special award.
The applicant, a pedestrian struck by a motor vehicle, sustained a traumatic brain injury and multiple skull fractures.
She applied for catastrophic impairment designation under the Statutory Accident Benefits Schedule based on a Glasgow Outcome Scale (GOS) score of 3 (severe disability).
The insurer denied the designation, relying on a neurologist who found no physical neurological deficits.
The arbitrator rejected the insurer's narrow interpretation of the GOS, preferring the applicant's physiatrist who considered cognitive and behavioural impairments that rendered the applicant dependent on daily support.
The arbitrator found the applicant catastrophically impaired, awarded past and ongoing attendant care benefits for services provided by her husband, approved most of the disputed medical and rehabilitation treatment plans, and held the insurer liable for a special award for unreasonably withholding benefits.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJun 26, 2015
