Tina Cagampan

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found that the applicant's limitations in activities of daily living were predominantly caused by his physical impairments rather than a mental or behavioural disorder.

The applicant failed to establish a Class 4 (marked) impairment in activities of daily living, and thus could not meet the requirement of three Class 4 impairments.

Claims for various treatment plans were dismissed as the applicant's funding limits were exhausted.

However, the adjudicator granted an award of 25% under s. 10 of O. Reg. 664, finding that the respondent unreasonably delayed the payment of two invoices that it had previously agreed to pay.

The applicant was involved in a motor vehicle accident and sought a determination of catastrophic impairment based on a mental and behavioural disorder.

The respondent denied the claim, arguing the applicant's impairments were pre-existing and did not meet the threshold.

The Tribunal found that the accident was a necessary cause of the applicant's psychological impairment, applying the 'but for' test.

Preferring the evidence of the applicant's psychological expert over the respondent's assessors, the Tribunal concluded the applicant sustained a marked impairment in all four spheres of functioning.

The application for a catastrophic impairment determination was granted, but the claim for an award for unreasonable delay was dismissed.