2 total
Applicant found catastrophically impaired due to mental disorder despite social media evidence of international travel.
The applicant was injured in a snowmobile accident and sought a determination that he sustained a catastrophic impairment due to a mental or behavioural disorder.
The respondent disputed the catastrophic impairment designation and denied several treatment plans and assessments.
The adjudicator found that the applicant sustained a catastrophic impairment, concluding he had marked impairments in activities of daily living, social functioning, and adaptation, despite the respondent's reliance on social media posts showing the applicant travelling.
The adjudicator awarded the disputed treatment plans at the catastrophic impairment rates and awarded HST on the assessments, but capped the assessment fees at the $2,000 statutory maximum.
Claims for a special award and costs were dismissed.
EI maternity benefits and employer top-ups are deductible from Income Replacement Benefits as gross employment income.
The applicant was injured in a motor vehicle accident and subsequently went on maternity leave, receiving Employment Insurance (EI) maternity benefits.
The insurer conceded entitlement to Income Replacement Benefits (IRB) but sought to deduct the EI maternity benefits and available employer top-up amounts from the IRB quantum.
The Tribunal held that EI maternity benefits and employer top-ups fall within the definition of 'gross employment income' under the Statutory Accident Benefits Schedule and are therefore deductible from IRBs.
The Tribunal also found the applicant was entitled to interest on overdue IRBs but dismissed the claim for a special award, noting the delay was due to the applicant's failure to provide requested employment documentation.
