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Application for non-earner benefits and treatment plans dismissed; functional limitations attributed to pre-existing conditions and weight gain.
The applicant, who was wheelchair-bound prior to the accident, was struck by a truck and sought statutory accident benefits, including non-earner benefits and various treatment plans.
The Licence Appeal Tribunal dismissed the application, finding that the applicant's injuries were soft tissue in nature and that she failed to demonstrate a complete inability to carry on a normal life.
The Tribunal preferred the evidence of the respondent's medical assessors, concluding that the applicant's ongoing functional limitations were largely attributable to a significant post-accident weight gain and pre-existing conditions rather than the accident.
Claims for physiotherapy, psychological services, occupational therapy, and an award for unreasonably withheld benefits were also dismissed.
Insurer ordered to pay ongoing IRBs and a 50% special award for unreasonably ignoring psychological impairments.
The applicant, a self-employed taxi driver, sought income replacement benefits (IRBs) and a medical benefit for physiotherapy following a motor vehicle accident.
The insurer denied the benefits, relying on surveillance and multidisciplinary assessments that focused primarily on physical impairments.
The Tribunal found that the applicant suffered severe and ongoing psychological impairments, including major depressive disorder and post-traumatic stress disorder, which rendered him substantially unable to perform the essential tasks of his employment for the first 104 weeks, and completely unable to engage in any suitable employment thereafter.
The Tribunal awarded the claimed IRBs and interest.
Furthermore, the Tribunal ordered a 50% lump sum award under O. Reg. 664, finding that the insurer unreasonably withheld benefits by repeatedly ignoring the psychological diagnoses provided by its own assessors.
The claim for physiotherapy was dismissed for lack of evidence.
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