Sally Anne Nicholson

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.

The applicant was injured in a motor vehicle accident and sought a catastrophic impairment designation under the Statutory Accident Benefits Schedule due to a mental or behavioural disorder.

The respondent insurer denied the designation.

The Tribunal found that the applicant suffered a Class 4 (marked) impairment in the domains of activities of daily living and adaptation to work or worklike settings, caused by an accident-related Somatic Symptom Disorder.

The Tribunal concluded the applicant was catastrophically impaired effective October 19, 2016.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and medical benefits.

The arbitrator found the applicant was entitled to pre-104 week IRBs because the insurer's own occupational therapy expert concluded she could not perform the essential tasks of her pre-accident employment.

However, post-104 week IRBs were denied as the applicant failed to prove a complete inability to engage in any suitable employment, given her ability to manage a household and work part-time as a house cleaner.

A claim for massage therapy was denied as not reasonable or necessary.

The arbitrator awarded a $1,000 special award against the insurer for unreasonably terminating the pre-104 week IRBs despite clear evidence of the applicant's inability to perform her pre-accident job.

The Applicant sought payment for various home repairs, cleaning services, and the cost difference for a dishwasher as rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal found that home repairs can qualify as 'home modifications' under section 16(3)(i) if they serve a rehabilitative purpose.

The Tribunal ordered payment for the repair of a basement step, installation of a handrail, and repair of loose tiles, as these addressed hazards exacerbated by the Applicant's accident-related impairments.

Claims for cleaning services, powder room repairs, and the dishwasher cost difference were dismissed.