Applicant denied catastrophic impairment and most accident benefits; insurer's defective notice triggered payment for two assessments.
The applicant sought various statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment, income replacement benefits, attendant care benefits, and numerous treatment plans.
The Tribunal found that the applicant did not meet the criteria for catastrophic impairment, as he did not demonstrate a Class 4 impairment in three of four domains.
The Tribunal also dismissed the claims for income replacement and attendant care benefits, finding the applicant failed to meet his evidentiary burden.
While the Tribunal found some of the insurer's notices defective, triggering the 'shall pay' provision for a cognitive assessment, most of the insurer's denials were deemed compliant with the Schedule.
The Tribunal ordered payment for cognitive and neurological assessments but dismissed the remaining claims and the request for a special award.
OLATOntario Licence Appeal TribunalOct 2, 2024
