Dr. T. Mendis

The applicant, an 18-year-old pedestrian, suffered a severe traumatic brain injury when struck by a car.

He applied for non-earner benefits, which the respondent insurer denied based on insurer examinations suggesting symptom exaggeration.

The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life, noting his inability to return to school, drive, play basketball, or maintain his pre-accident social life.

The Tribunal rejected the insurer's neuropsychological assessments as they were contradicted by the insurer's own catastrophic impairment assessors, who found genuine, severe cognitive deficits.

The Tribunal ordered the payment of non-earner benefits and granted a special award of 40% under Regulation 664, finding the insurer acted unreasonably by maintaining its denial despite its own catastrophic assessors' reports.

The applicant sought a determination that her impairments from a motor vehicle accident met the 55% whole person impairment (WPI) threshold for catastrophic impairment under the Statutory Accident Benefits Schedule.

The adjudicator evaluated conflicting medical evidence regarding the applicant's neurological and psychological impairments, including sleep disorders, mental status, and somatic disorders.

While the adjudicator preferred much of the applicant's medical evidence and found the insurer's assessors had underestimated the impairments, the final combined WPI was determined to be 51%.

As this fell short of the 55% threshold, the application was dismissed.

The applicant sought weekly, death, and funeral benefits on behalf of his deceased father, who was involved in two minor motor vehicle accidents in December 1992 and subsequently experienced a rapid decline in health, dying in June 1993.

The arbitrator found that while the accidents caused an initial inability to perform essential tasks, entitling the estate to weekly benefits for a limited period, they did not directly or indirectly cause the death.

Medical evidence suggested an underlying malignancy was the likely cause of the rapid deterioration and death.

Claims for death benefits, funeral expenses, and a special award were dismissed, but the applicant was awarded expenses of the arbitration.