John Dean

The applicant requested a reconsideration of a decision that found him catastrophically impaired but denied post-104 income replacement benefits, attendant care, housekeeping, and a special award.

The applicant argued the denial of these benefits was logically inconsistent with the catastrophic impairment finding.

The adjudicator dismissed the request, finding no significant errors of law or fact in the original decision.

The adjudicator held that the applicant's psychological impairments, which warranted the catastrophic designation, did not preclude him from performing his pre-accident casual work, and that the attendant care and housekeeping benefits were properly denied as they were not incurred.

The applicant was injured in a bicycle-motorcycle collision and sought various statutory accident benefits, including a determination of catastrophic impairment (CAT).

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment due to a marked impairment in the adaptation domain resulting from psychological and behavioural disorders.

However, the Tribunal dismissed the applicant's claims for post-104 week income replacement benefits, finding he did not suffer a complete inability to work.

Claims for attendant care and housekeeping benefits were also dismissed because the applicant failed to prove his father, the service provider, suffered an economic loss.

A claim for a special award was denied as the insurer did not unreasonably withhold benefits.

The appellants appealed a trial judgment dismissing their insurance claim against Pembridge for late reporting and awarding only $4,000 in damages against their neighbours, the Aguiars, for nuisance causing water damage.

The Court of Appeal upheld the dismissal against Pembridge, finding the trial judge reasonably concluded the appellants breached the policy by reporting the claim four months late.

However, the Court allowed the appeal regarding damages against the Aguiars, finding the trial judge misapprehended evidence about standing water.

The Court reassessed damages at $12,500.

The applicant was injured when struck by a vehicle and sought payment from his insurer for a multidisciplinary assessment conducted by DEAHY Medical Assessments Inc., totalling $2,461.

The insurer denied the benefit, arguing the assessments were unnecessary, duplicative, and unreasonably priced.

The arbitrator found that the physiotherapy and functional capacity assessments were reasonable and payable, but the orthopaedic assessment was unnecessary as the applicant should have sought a report from his treating surgeon.

The arbitrator ordered the insurer to pay $1,498 plus interest, and dismissed the applicant's claim for a special award.