Dr. Sivasubramanian

The applicant sought a determination that she sustained a catastrophic impairment (CAT) as a result of a motor vehicle accident, along with entitlement to attendant care benefits and a special award for unreasonable delay.

The Licence Appeal Tribunal found that the applicant did not meet the CAT threshold under Criterion 8, as she only demonstrated moderate, rather than marked, impairments in the spheres of functioning.

The claim for attendant care benefits was dismissed because the expenses were not incurred.

However, the Tribunal granted a special award under s. 10 of O. Reg. 664, finding that the respondent unreasonably delayed and withheld payment of income replacement benefits and treatment plans.

The respondent was ordered to pay an award equal to 25% of the delayed benefits.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found she was not catastrophically impaired under Criterion 8.

The applicant argued the Tribunal made errors of law and fact in assessing her social functioning impairment under the AMA Guides.

The Vice-Chair dismissed the request, finding the Tribunal properly applied the AMA Guides, appropriately weighed the expert medical evidence, and made no error of law or fact that would have led to a different result.

The respondent insurer requested reconsideration of a Tribunal decision that found the applicant catastrophically impaired and entitled to a post-104 week income replacement benefit (IRB) as of September 1, 2024.

The Tribunal denied the reconsideration request regarding catastrophic impairment, finding that the original adjudicator provided adequate reasons and properly weighed the psychiatric and surveillance evidence.

However, the Tribunal granted the reconsideration request regarding the IRB.

Relying on the Divisional Court's recent decision in Paesano, the Tribunal found that the original adjudicator erred in law by awarding a post-104 week IRB without considering the impact of her findings that the applicant was not entitled to a pre-104 week IRB or a post-104 week IRB for the three years prior.

The IRB decision was cancelled and remitted for a rehearing before a new adjudicator.

The applicant sought a determination that she sustained a catastrophic impairment (Criterion 8) due to psychological impairments following a motor vehicle accident, as well as entitlement to a treatment plan for optometric services.

The Tribunal found that while the applicant had marked impairments in Concentration, Persistence and Pace, and Adaptation, she did not meet the threshold of three marked impairments or one extreme impairment required for catastrophic designation.

The Tribunal also dismissed the claim for optometric services, preferring the respondent's ophthalmological assessment that found no accident-related ocular sequelae over the applicant's neuro-optometrist report.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the respondent's medical evidence, noting the applicant's pre-existing conditions and post-accident functioning, including international travel.

Claims for income replacement and attendant care benefits were dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment and the benefits had expired past the 260-week mark.

The application was dismissed in its entirety.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a 2018 motor vehicle accident.

The respondent insurer denied the claim, arguing her impairments were largely due to a pre-existing 2011 slip and fall injury.

The Tribunal applied the 'but for' test and found the accident was a necessary cause of her current impairments.

Preferring the applicant's expert evidence, the Tribunal concluded the applicant suffered marked (Class 4) impairments in three domains: social functioning, concentration, persistence and pace, and adaptation.

The applicant was deemed catastrophically impaired.

The applicant sought a determination that she sustained a catastrophic impairment (CAT) under Criterion 7 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The applicant relied on expert assessments suggesting a combined whole person impairment (WPI) of 63%, while the respondent's experts assessed her at 38%.

The Tribunal preferred the respondent's experts, finding the applicant's neurological and psychological ratings were largely unsupported by medical evidence and heavily influenced by pre-existing conditions.

The Tribunal concluded the applicant's combined WPI was 41%, falling short of the 55% threshold, and dismissed the application.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, claiming catastrophic impairment under criterion 8 due to mental and behavioural disorders.

The Tribunal found the applicant was not catastrophically impaired, as she failed to establish that her psychological impairments would not have occurred 'but for' the accident, noting a significant time gap and high level of functioning in the intervening years.

The Tribunal granted entitlement to several treatment plans for occupational therapy, assistive devices, and assessments incurred prior to the 260-week mark, but denied plans submitted after that period and denied the claim for living accommodations due to non-compliance with section 38(2) of the Schedule.

The claim for a special award was also dismissed.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a motor vehicle accident, along with entitlement to various attendant care benefits and treatment plans.

The Licence Appeal Tribunal evaluated the applicant's impairments under Criterion 7 (Whole Person Impairment) and Criterion 8 (mental and behavioural disorders).

The Tribunal rejected several of the applicant's physical impairment ratings due to a lack of causal evidence and methodological flaws, concluding the applicant did not meet the 55% WPI threshold.

Under Criterion 8, the Tribunal found the applicant had only mild impairments in activities of daily living and social functioning, failing to meet the threshold of three marked or one extreme impairment.

As the applicant was not catastrophically impaired and had exhausted his non-CAT limits, the claims for attendant care and treatment plans were dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to various statutory accident benefits following a 2018 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment under Criterion 7, accepting a combined Whole Person Impairment rating of 55% based on musculoskeletal, headache, medication, and psychological impairments.

While the Tribunal found the applicant was entitled to attendant care and housekeeping benefits in principle, it held that no benefits were payable because the applicant failed to prove the expenses had been incurred.

The claims for medical benefits, an award, and interest were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she did not sustain a catastrophic impairment.

The applicant alleged the adjudicator committed a material breach of procedural fairness by limiting oral submissions and excluding an Aide Memoire, and made errors of law and fact in assessing her activities of daily living, communication abilities, and expert evidence.

The Tribunal dismissed the request, finding no breach of procedural fairness as the parties were granted ample time for submissions.

The Tribunal also held that the alleged factual errors would not have changed the outcome and that the applicant was improperly attempting to re-litigate the weighing of evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment under Criterion 8 of the Schedule due to marked impairments in Adaptation, Activities of Daily Living, and Concentration, Persistence and Pace.

The adjudicator preferred the respondent's expert evidence, finding that the applicant's psychological testing was invalid due to negative response bias and that she did not suffer from cognitive impairments or struggle with daily tasks.

The adjudicator concluded the applicant was not catastrophically impaired, had reached maximum medical recovery, and was not entitled to the disputed treatment plans, assessments, interest, or a special award.

The appellant was injured in an ATV rollover and applied for a determination of catastrophic impairment under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal (LAT) found she was not catastrophically impaired, giving little weight to the impairment ratings of her chiropractor, who had offered psychological diagnoses beyond his scope of practice.

On appeal, the Divisional Court found no error of law in the LAT's treatment of the chiropractor's evidence, affirming that while a chiropractor may compile impairment ratings under the AMA Guides, they cannot provide medical diagnoses outside their expertise.

The appeal was dismissed.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment based on mental or behavioural impairments, as well as ongoing income replacement benefits and medical/rehabilitation benefits.

The Tribunal found that the applicant sustained a catastrophic impairment under Criterion 8, as the accident exacerbated her pre-existing mental health issues, resulting in marked impairments in activities of daily living, concentration, persistence and pace, and adaptation.

The Tribunal also found the applicant entitled to a post-104-week income replacement benefit, concluding she suffered a complete inability to engage in suitable employment due to her psychological impairments.

Claims for social rehabilitation counselling and a separate file review fee for a catastrophic assessment were dismissed as not reasonable and necessary.

The applicant requested a reconsideration of a decision finding he did not sustain a catastrophic impairment.

He argued the Tribunal committed a material breach of procedural fairness by providing inadequate reasons and raising issues on its own, and that it erred in fact and law in assessing the medical evidence.

The Vice-Chair dismissed the request, finding the reasons were adequate, the evidence relied upon was properly before the Tribunal, and the applicant was improperly attempting to re-weigh the evidence rather than identifying actual errors.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying her catastrophic impairment designation and a special award under s. 10 of Regulation 664.

The Divisional Court found the LAT erred in law by concluding it lacked jurisdiction to make a special award for benefits the insurer had delayed but ultimately agreed to pay before the hearing.

The Court also held the LAT breached procedural fairness by admitting and relying on the report of the insurer's psychiatric expert, who refused to attend the hearing for cross-examination.

The appeal was allowed, and the matter was remitted to a differently constituted tribunal.

The applicant sought a determination that he was catastrophically impaired under Criterion 8 of the Statutory Accident Benefits Schedule due to mental and behavioral disorders resulting from a motor vehicle accident.

While the Tribunal accepted that the applicant sustained post-traumatic stress disorder, a major depressive episode, and substance use disorder as a result of the accident, it found that these impairments did not reach the threshold of a marked (Class 4) impairment in any of the four functional domains.

The Tribunal concluded that the applicant retained some useful functioning in activities of daily living and social functioning, and therefore dismissed the application.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found she was not catastrophically impaired and not entitled to attendant care benefits or a special award.

The applicant argued the initial decision lacked adequate reasons, constituting a breach of procedural fairness and an error of law.

The Vice-Chair dismissed the request, finding that the initial adjudicator's reasons meaningfully grappled with the key issues and evidence, including the competing expert reports on catastrophic impairment and attendant care.

The Tribunal concluded there was no error of law, fact, or breach of procedural fairness that would warrant a reconsideration.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, claiming catastrophic impairment due to psychological injuries, non-earner benefits, treatment plans, and education expenses.

The Licence Appeal Tribunal found the applicant was not catastrophically impaired, preferring the respondent's psychiatric assessment which properly accounted for her significant pre-existing mental health conditions and post-accident stressors.

Claims for non-earner benefits and treatment plans were dismissed as the applicant failed to prove a complete inability to carry on a normal life or the reasonableness and necessity of the plans.

The Tribunal granted the claim for education expenses, finding the applicant was unable to continue her college program due to the accident.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she did not sustain a catastrophic impairment as a result of a motor vehicle accident.

The applicant argued the Tribunal erred in law and fact by misinterpreting the AMA Guides, improperly weighing the evidence of her chiropractor regarding psychological and substance abuse impairments, and violating procedural fairness.

The adjudicator dismissed the request, finding no errors of law or fact, as it was beyond the scope of a chiropractor to assign ratings for psychological impairments or diagnose substance abuse disorders.