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Applicant denied catastrophic impairment status but awarded 25% penalty against insurer for unreasonable delay.
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.
Accident-related immobility found to be a necessary cause of pre-existing disease progression leading to amputation.
The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment.
The central issue was whether the accident caused the rapid progression of the applicant's pre-existing peripheral arterial disease, which ultimately required an above-the-knee amputation.
The Tribunal applied the 'but for' test and found that the applicant's accident-related lack of mobility was a necessary cause of the disease's progression and the resulting amputation, thereby meeting the criteria for catastrophic impairment.
The Tribunal also awarded non-earner benefits, partial attendant care benefits, costs for chiropractic treatment and catastrophic impairment assessments, and interest on overdue payments, while dismissing a claim for a home exercise program.
No co-appearing lawyers found.
No judges found.