5 total
Applicant found catastrophically impaired due to psychological injuries; maximum attendant care and special award granted.
The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.
The insurer denied claims for attendant care, caregiver, and housekeeping benefits, arguing the applicant's injuries were minor and her presentation was not credible.
The arbitrator found that the applicant suffered significant psycho-emotional injuries, including chronic pain syndrome and post-traumatic stress disorder, resulting in a catastrophic impairment.
The arbitrator awarded attendant care benefits at the maximum rate of $6,000 per month, caregiver benefits for her younger son, and housekeeping benefits.
A claim for home modifications was denied as the renovations were planned prior to the accident.
The arbitrator also ordered a 10% special award against the insurer for unreasonably withholding payments without adequately assessing the medical evidence.
Applicant found catastrophically impaired under both physical and psychological criteria despite insurer's claims of symptom magnification.
The applicant was injured in a motor vehicle accident when he was struck by a minivan while examining his truck on the side of the road.
He applied for statutory accident benefits, claiming he sustained a catastrophic impairment.
The insurer denied the claim, arguing that the applicant's impairments were unrateable due to inconsistent test results and symptom magnification.
The arbitrator preferred the evidence of the applicant's experts, finding that the use of the Gait Derangement Table was appropriate for rating his physical impairments and that his psychological impairments were marked despite invalid psychometric testing.
The arbitrator concluded that the applicant met the definition of catastrophic impairment under both the 55% whole person impairment threshold and the marked mental or behavioural disorder threshold.
Applicant awarded post-104 week income replacement benefits due to accident-related chronic pain and psychological impairments.
The applicant was injured in a rear-end motor vehicle accident and received income replacement benefits until the insurer terminated them at the 104-week mark.
The insurer argued the applicant was capable of returning to work, relying on assessments suggesting symptom magnification and a lack of organic basis for his pain.
The arbitrator found the applicant credible and accepted medical evidence that he suffered from chronic pain syndrome, depression, and adjustment disorder as a result of the accident.
The arbitrator concluded that the combination of the applicant's physical and psychological impairments rendered him completely unable to engage in any employment for which he was reasonably suited by education, training, or experience.
The applicant was awarded ongoing income replacement benefits.
Income replacement benefits reinstated and special award granted where insurer unreasonably relied on flawed medical reports.
The applicant was injured in a motor vehicle accident and claimed ongoing income replacement benefits.
The insurer terminated benefits based on independent medical examinations and a DAC report suggesting the applicant could work.
The arbitrator found the applicant suffered significant cognitive impairments rendering him competitively unemployable, characterizing his post-accident work at his brother's video store as a sheltered workshop.
The arbitrator ordered the reinstatement of income replacement benefits at $340.53 per week and found the insurer liable for a special award for unreasonably withholding benefits by relying on flawed reports that ignored the overwhelming evidence of the applicant's disability.
Accident benefits claims for income replacement and housekeeping dismissed due to lack of objective medical evidence and poor credibility.
The applicant was struck by a vehicle while crossing the street and claimed statutory accident benefits for income replacement, housekeeping, and travel expenses.
The insurer denied income replacement benefits after December 26, 1995, and housekeeping expenses.
At arbitration, the arbitrator found the applicant to be an unreliable historian whose testimony was contradicted by video surveillance showing him walking normally.
The medical evidence did not support the applicant's claims of debilitating physical or cognitive impairments preventing him from performing his job as a furniture assembler.
The claims for income replacement and housekeeping were dismissed, but the applicant was awarded $590 for uncontested travel expenses.
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