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Applicant deemed catastrophically impaired and awarded income replacement benefits, treatment plans, and a 30% special award.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits from her insurer, Wawanesa.
The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment due to marked impairments in adaptation and concentration, persistence, and pace, stemming from somatic symptom disorder and major depressive disorder.
The Tribunal also found the applicant entitled to both pre-104 and post-104 income replacement benefits, as her physical and psychological impairments prevented her from working as a personal support worker or in any suitable employment.
Several treatment plans were deemed payable because Wawanesa failed to provide proper medical and other reasons for denial in its notices, violating s. 38(8) of the Schedule.
Finally, the Tribunal ordered a 30% special award under Regulation 664, finding that Wawanesa unreasonably withheld benefits by blindly following its assessors' reports without considering the totality of the medical evidence or continuously adjusting the file.
Claim for post-104 week disability benefits dismissed as applicant retained substantial pre-accident abilities.
The Applicant was injured in two motor vehicle accidents in May 1994 and received other disability benefits for 104 weeks.
She applied for ongoing benefits beyond the 104-week mark, which requires a complete inability to carry on a normal life.
The Arbitrator found that while the Applicant's life had changed, she retained a number of abilities and was not continuously prevented from engaging in substantially all of her pre-accident activities.
The claim for ongoing benefits and a special award was dismissed.
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