Joseph Campisi

The appellant was struck by a car and suffered significant physical injuries that led to chronic pain and mental disorders.

She applied for enhanced statutory accident benefits, claiming a catastrophic impairment under s. 2(1.1)(g) of the SABS.

A designated assessment centre and an arbitrator found she met the criteria because she had a marked impairment in one category of daily living, and they included physical pain in their assessment of her mental disorder.

The director's delegate upheld this decision.

The Divisional Court overturned the delegate's decision on judicial review.

The Court of Appeal allowed the appeal, holding that the Divisional Court erred by applying a correctness standard of review.

Applying the reasonableness standard, the Court of Appeal found the delegate's interpretation of s. 2(1.1)(g)—that a single marked impairment is sufficient and that physical pain can be considered cumulatively with a mental disorder—was reasonable.

The applicant insurer sought judicial review of a Director's Delegate's decision finding that the respondent suffered a catastrophic impairment under s. 2(1.1)(g) of the Statutory Accident Benefits Schedule.

The Divisional Court granted the application and set aside the decision, holding that the Delegate erred in law by concluding that a marked impairment in only one of four areas of functioning was sufficient for a catastrophic impairment designation.

The Court further held that the Delegate erred by failing to exclude pain associated with physical injuries when assessing impairment due to mental or behavioural disorder, as required by the AMA Guides incorporated into the legislation.

The appellant insurer appealed an arbitrator's decision finding that the respondent pedestrian sustained a catastrophic impairment under clause 2(1.1)(g) of the Statutory Accident Benefits Schedule.

The insurer argued that the arbitrator erred by requiring a marked impairment in only one of four areas of functioning, rather than an overall marked impairment, and by failing to separate physical pain from psychological impairment.

The Director's Delegate dismissed the appeal, holding that the plain language of the Schedule requires only a single marked impairment in one area of functioning.

The Delegate also found no error in the arbitrator's conclusion that the respondent's marked impairment in activities of daily living was due to a mental or behavioural disorder, specifically a pain disorder associated with both psychological factors and a general medical condition.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied the claim under section 59(1) of the Schedule, arguing the applicant was a Schedule 1 employee entitled to workers' compensation.

At the preliminary issue hearing, the insurer requested an adjournment to apply to WSIAT for a determination on the applicant's employment status.

The arbitrator denied the adjournment, finding no valid reason to stay the proceeding sine die when the insurer had ample notice to make the WSIAT application earlier.

Following the refusal, the parties consented to withdraw the preliminary issue.

The applicant was injured in a pedestrian motor vehicle accident and sought a determination that she suffered a catastrophic impairment under the Statutory Accident Benefits Schedule.

The arbitrator found that while the applicant's combined physical and psychological impairments resulted in a 39% whole person impairment, falling short of the 55% threshold under clause (f), she did meet the criteria under clause (g).

Specifically, the arbitrator accepted the CAT DAC assessment that the applicant's pain disorder and physical limitations resulted in a Class 4 marked impairment in her activities of daily living.

The arbitrator held that a single marked impairment is sufficient to meet the definition of catastrophic impairment.

The insurer brought a motion to adjourn the arbitration hearing because its expert witness was away on sabbatical.

The applicant opposed the adjournment, noting she had already waited almost a year for a hearing regarding ongoing income replacement benefits and prescription expenses.

The arbitrator denied the adjournment request, finding that a further nine-month delay was unacceptable.

The hearing was ordered to commence as scheduled, but the insurer was permitted to arrange one additional hearing day before May 31, 2006, for the expert to testify if he could not attend the scheduled dates.

The insurer appealed an arbitration decision ordering it to pay interest on outstanding income replacement benefits from the date it stopped paying them following a negative designated assessment centre (DAC) report.

The Director's Delegate dismissed the appeal, finding that when it is finally determined that benefits should not have been stopped, the requirement to pay 'any amounts under the benefit that were not paid' includes compound interest from the date of the negative DAC.

The insurer brought a motion seeking an order to compel the insured to attend psychiatric and vocational assessments.

The insured opposed the motion, arguing that the arbitrator lacked jurisdiction to grant such an order, that the insurer failed to provide proper notice under section 42(2) of the Statutory Accident Benefits Schedule, and that the examinations were not reasonably necessary.

The arbitrator dismissed the motion, finding no jurisdiction to compel attendance at medical examinations.

The arbitrator also found that the notice provided by the insurer was void for failing to meet the statutory requirements and that the requested examinations were sought to bolster the insurer's case rather than to adjust the file.

The applicant was injured in two motor vehicle accidents and applied for statutory accident benefits.

The insurer terminated attendant care, housekeeping, and caregiver benefits, and suspended benefits due to the applicant's refusal to attend insurer examinations.

The arbitrator found that the applicant was entitled to additional benefits for specific periods, but not beyond the end of 2004, as the medical evidence did not support ongoing disability.

The arbitrator also held that the insurer unreasonably suspended benefits by requiring the applicant to sign an undertaking to attend future examinations, and awarded a $500 special award.

The applicant sought to recover expenses following an arbitration decision that awarded her partial housekeeping benefits.

The insurer also sought its expenses.

The arbitrator reviewed the amended Expense Regulation, which removed the broad discretion to consider access to the dispute resolution system and mandated a results-based approach.

Finding that both parties enjoyed some measure of success but neither achieved their ultimate objective, the arbitrator concluded that each party should bear its own expenses.

The applicant's pre-hearing offer to settle was disregarded because subsequent settlements and withdrawals of other claims vitiated the original offer.

The applicant was injured in a rear-end motor vehicle accident and sought housekeeping and home maintenance benefits beyond the insurer's termination date of June 2, 2003.

The arbitrator found that the medical evidence, including the insurer's own multi-disciplinary assessment, supported that the accident materially contributed to a chronic pain condition limiting her ability to perform housekeeping.

However, the arbitrator drew an adverse inference from the applicant's failure to provide evidence regarding the outcome of a recommended 10-week psychotherapy treatment plan, concluding her entitlement ended on September 15, 2003.

Benefits were awarded at a rate of $30 per week based on in-home assessments, rather than the maximum $100 per week claimed.