Financial Services Commission des Commission services financiers of Ontario de l’Ontario

Neutral Citation: 2012 ONFSCDRS 103

FSCO A10-003390

BETWEEN:

BASSEL HADDAD

Applicant

and

ECONOMICAL MUTUAL INSURANCE COMPANY

Insurer

Before: Deborah Pressman

Heard: February 8, 9, 10, 13, 14, 15 and 16, 2012, at the offices of the Financial Services Commission of Ontario in Toronto.

Appearances: Savannah Chorney and Altor Shields for Mr. Haddad

Christopher Schnarr for Economical Mutual Insurance Company

Issues:

Bassel Haddad, the Applicant, was injured in a motor vehicle accident on April 1, 2008, when he collided head-on with a tractor-trailer. As a result of this accident, he suffered a fracture of his left femur, a dislocation of his left hip, soft tissue injuries, and psychological impairments. Mr. Haddad applied for and received statutory accident benefits from Economical Mutual Insurance Company (Economical), payable under the Schedule.¹

Disputes arose over the payment of benefits as Mr. Haddad has used up the maximum normally available to a non-catastrophic applicant. He applied to Economical for a determination of catastrophic impairment and underwent a series of assessments at SOMA Medical Assessments in May and June 2011. The opinion of Economical’s assessment team was that Mr. Haddad is not catastrophically impaired under either of sections 2(1.2)(f) or 2(1.2)(g) of the Schedule.

The parties were unable to resolve this dispute through mediation. Mr. Haddad applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c. I.8, as amended.

The issues in this hearing are:

Is Mr. Haddad catastrophically impaired according to section 2(1.2)(g) of the Schedule?
Is Mr. Haddad catastrophically impaired according to section 2(1.2)(f) of the Schedule?
Is Mr. Haddad entitled to housekeeping and home maintenance expenses in the amount of $100.00 per week from April 1, 2010 to date and ongoing pursuant to the Schedule?
Is Mr. Haddad entitled to an attendant care benefit from April 1, 2010 to date and ongoing, and if so, in what amount, pursuant to the Schedule?
Is Mr. Haddad entitled to interest for the overdue payment of benefits pursuant to the Schedule?

Result:

Mr. Haddad is not catastrophically impaired according to section 2(1.2)(g) of the Schedule.
Mr. Haddad is not catastrophically impaired according to section 2(1.2)(f) of the Schedule.
Mr. Haddad is not entitled to housekeeping and home maintenance expenses beyond April 1, 2010.
Mr. Haddad is entitled to an attendant care benefit at the rate of $933.31 per month from November 2008 to April 1, 2010, less any amounts already paid by Economical for this period.
Mr. Haddad is entitled to interest for the overdue payment of attendant care benefits pursuant to the Schedule.

Overview:

In order to receive further benefits, Mr. Haddad must prove, on a balance of probabilities, that he has sustained a “catastrophic impairment” as defined in the Schedule.

Mr. Haddad’s CAT assessment team found that he is catastrophically impaired according to section 2(1.2)(f) of the Schedule because he meets the 55% Whole Person Impairment (WPI) threshold as a result of a combination of physical and psychological impairments.

Mr. Haddad also submitted that he meets the catastrophic impairment definition under section 2(1.2)(g) because his overall level of impairment due to a mental or behavioural disorder is marked.

However, there are significant issues that undermine Mr. Haddad’s case.

His assertion that he was a functioning individual prior to this accident is at odds with the evidence in his medical file, which revealed severe substance abuse, psychological illness and a scarce employment history before the accident. Therefore, it could not be said that the accident itself made a significant contribution to his emotional and behavioural impairments.

In addition, Mr. Haddad was not an accurate historian, deliberate or otherwise, and there was considerable inconsistency in his self-reporting with respect to his past and current functioning, which was relied upon by his assessors.

Mr. Haddad’s CAT assessors admitted to shortcomings in their methodology, including an incomplete review of his medical file, problems with the timing of his assessments, and errors in impairment ratings. Other assessors focused on psychological diagnosis instead of on his function and did not provide assistance in determining Mr. Haddad’s level of impairment across the relevant domains.

Pursuant to the reasons outlined in this decision, I find that Mr. Haddad has not proved, on a balance of probabilities, that he suffered a “catastrophic impairment” as defined under the Schedule pursuant to either section 2(1.2)(f) or 2(1.2)(g).

As a result, I must also deny his claims to housekeeping and home maintenance and attendant care benefits beyond April 1, 2010, as there is no entitlement to these benefits without catastrophic impairment according to the Schedule.

I find that Mr. Haddad is entitled to attendant care benefits at the rate of $933.31 per month from November 2008 to April 1, 2010, less any amounts already paid by Economical, plus interest in accordance with the Schedule for reasons outlined at the end of the decision.

Background:

Mr. Bassel Haddad is a 32-year-old single man who has been struggling with serious substance abuse issues and psychological problems since his adolescence.

At the age of 11 he escaped wartorn Lebanon and immigrated to Canada with his mother and brother while his father stayed behind for another 14 years. In 2004, Mr. Haddad’s father arrived in Canada but unfortunately, passed away that same year.

For the majority of his life, Mr. Haddad lacked supervision and had a relatively poor support system. His mother suffers from schizophrenia and his brother did not play an active role in his day-to-day life.

It is an undeniable fact that Mr. Haddad was a drug addict before the accident. He testified that he was a polysubstance abuser who used substances in non-discriminatory ways, ingesting and injecting all kinds of street drugs and overusing prescription medication and methadone.

In addition to substance abuse, Mr. Haddad has been struggling with psychological issues. Medical evidence revealed problems with anxiety and depression both before and after the accident.

Mr. Haddad’s work history prior to the accident is vague. After completing grade 10 in high school, he became a bricklayer through an apprenticeship program and worked in construction. In 2007, he was let go as a local 183 union member. In February 2008, two months before this accident, Mr. Haddad claims that he was working as a warehouse supervisor for DMS Packaging and Warehousing; a company that Economical alleges does not exist. Generally, Mr. Haddad is not able to recall the chronology of his employment history due to memory problems arising out of his addiction.

Despite all of these difficulties, Mr. Haddad maintains that, notwithstanding regular drug use in the years prior to the accident, he functioned in his daily life and was an active young man who attended at the gym, played sports and went out with friends on a regular basis.

The April 1, 2008 collision was a serious accident. Mr. Haddad was driving a small vehicle, VW Golf, and travelling north on Woodbine Avenue in Newmarket. He was forced into the oncoming lane as a result of heavy winds and collided head-on with a tractor-trailer. His air bag deployed and paramedics had to use the “Jaws of Life” to get him out. He was then transported via air ambulance to Sunnybrook hospital where he required surgery due to a fracture of his left leg and a dislocation of his left hip.

In the years following the accident, Mr. Haddad diligently attended outpatient physiotherapy and rehabilitation programs on a regular basis and has nearly exhausted the $100,000 policy limit available to a non-catastrophic applicant. He also required additional surgeries on his left leg as it was subsequently discovered that the first surgery had failed to properly unite the bone and he was walking around with a non-union in his left leg and a leg length discrepancy. As a result of his last surgery in October 2011, the non-union was repaired and his leg length discrepancy was reduced. Presently, Mr. Haddad walks with a single point cane and continues to struggle with psychological problems.

EVIDENCE AND ANALYSIS:

Issue 1 - Is Mr. Haddad catastrophically impaired according to section 2(1.2)(g) of the Schedule?

I find that Mr. Haddad is not catastrophically impaired according to section 2(1.2)(g) of the Schedule because he does not have an overall marked impairment on account of his mental or behavioural disorders. I also find that Mr. Haddad has failed to meet his burden of proving causation.

Did the accident materially contribute to Mr. Haddad’s impairment?

The question before me is whether Mr. Haddad shows, on a balance of probabilities, that he was catastrophically injured as a result of the motor vehicle accident of April 1, 2008. This means that Mr. Haddad must establish that this accident caused or “materially contributed” to his current condition and complaints.²

The theory of Mr. Haddad’s case is that prior to this accident he was a functioning individual despite many pre-existing conditions related to psychological problems and serious substance abuse. In fact, his case is premised on significant pre-accident improvement. However, his oral evidence, the medical reports and other evidence of witnesses and documents in the file left a very different impression of Mr. Haddad’s pre-accident life.

Mr. Haddad has a history of psychological problems that pre-date the 2008 accident.

For example, the clinical notes and records of Dr. Hsieh, his family physician, show that Mr. Haddad was experiencing anxiety and depression like symptoms since 2000 due to ongoing family stress and his mother’s struggle with schizophrenia. Mr. Haddad admitted that in 2004, after his father’s death, he struggled with psychological problems.

In September and October of 2007, six months before the accident, Dr. Hsieh noted that Mr. Haddad is experiencing decreased concentration and increased anxiety and prescribed anti‑anxiety and anti-depressant medication, as well as sleeping aids.

In January of 2008, just three months before the accident, Dr. Hsieh described Mr. Haddad’s emotional state as “depressed mood, depressed energy and depressed concentration”. He also noted that Mr. Haddad is not functioning and increased his anti-anxiety and anti-depressant medication.

Mr. Haddad also has a history of drug abuse and addiction problems that pre-date this accident.

His medical file revealed that in January of 2001, he was addicted to percocet and other substances. Although he pursued several addiction treatments and programs, he ultimately became addicted to methadone. In December 2004, Dr. Hsieh noted that Mr. Haddad is still addicted to methadone, cocaine and marijuana. Alcohol abuse is also noted in Mr. Haddad’s medical records. Mr. Haddad testified that he abused prescription medication, often taking prescribed medication that belonged to his uncle or buying it on the street.

There is also evidence of financial and other personal instability. In 2006, Mr. Haddad applied for help through social assistance. At this time he was having memory problems and living in stairwells after getting kicked out of a shelter.

In 2006 and 2007, Mr. Haddad attended at the emergency room for infected injection sites and for the removal of a syringe stuck in his forearm. In December 2007, Dr. Grant, a drug specialist, noted that that Mr. Haddad is smoking ½ a gram of heroine a day and using cocaine occasionally.

On the day of the accident, the ambulance call report stated that Mr. Haddad has an unknown quantity of unknown drugs and Sunnybrook’s clinical notes and records noted a narcotic dependence.

Apart from Mr. Haddad’s testimony on his daily functioning before this accident, he relied on the testimony of his friend, Ms. Julie Eliadis, who has known him for over 20 years. I did not find her testimony helpful regarding his pre-accident behaviour and function. Not because she was being untruthful but because she was likely unaware of the extent of his problems. Although Mr. Haddad admitted his problems to Ms. Eliadis in 2004, his medical record revealed that he was struggling with addiction issues since 2001.

Prior to this accident, Ms. Eliadis described Mr. Haddad as an outgoing, sociable, good spirited, confident guy that worked hard and liked to socialize with friends. During her testimony, she stated that he “was my go to guy, calm, confident, gave me good advice, logical.” She also commented on his physical appearance and stated that he was extremely fit, worked out often and was known for his built and defined muscular appearance.

She supported her testimony with two pictures that included Mr. Haddad as a physically fit young man.³ These pictures were taken in the summer of 2005, more than three years before the accident and I find them to be too remote to be relevant or helpful in assessing Mr. Haddad’s pre-accident psychological functioning.

In addition, Ms. Eliadis attempted to downplay the significant stressors in Mr. Haddad’s life. She minimized as isolated episodes the serious drug addiction issues that are evident elsewhere in the evidence. For example, she did not agree that his hospital attendances due to infected injection sites or a syringe stuck in his forearm were signs of serious addiction problems; she called them “scenarios”. Therefore, I was not persuaded that her recollection of events with respect to Mr. Haddad’s functioning in the years prior to this accident was particularly accurate or reliable.

Causation is “essentially a practical question of fact which can best be answered by ordinary common sense.”⁴ In this case, the evidence of Mr. Haddad and Ms. Eliadis with respect to his condition at a certain time in the past must be weighed against the contemporaneous information in the medical files and reports from the treating doctors and assessors. Ultimately, the evidence is at odds with the positive image of Mr. Haddad’s pre-accident life that he attempted to portray at the hearing. In my view, the medical evidence does not support Ms. Eliadis’ and Mr. Haddad’s testimony that he had significantly improved prior to the April 1, 2008 accident. I find that Mr. Haddad was likely unable to function in the years leading up to the accident due to serious psychological and addiction problems.

Certainly Mr. Haddad has deteriorated since the motor vehicle accident of 2008 and I agree that it is likely that this accident has made it more difficult to deal with his emotional and addiction issues. However, the medical evidence confirms that Mr. Haddad continued to deal with psychological and substance abuse problems up to the 2008 accident and beyond.

As a result, I find that Mr. Haddad was not a functioning individual prior to this accident and I am not persuaded, on the balance of probabilities, that this accident played a significant role in his mental and or behavioural disorders.

Even if the accident played a significant role, I still find that Mr. Haddad is not catastrophically impaired because he did not sustain an overall marked impairment due to mental or behavioural impairments as a result of this accident.

Mr. Haddad’s level of impairment on account of a mental or behavioural disorder[^5]

I find that Mr. Haddad has an overall Class 3, moderate impairment, on account of his mental or behavioural disorders.

Under the Schedule, mental or behavioural impairment is assessed in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment⁶, across four domains of function:

activities of daily living (ADLs)
social functioning
concentration
adaptation

Catastrophic impairment is defined as the presence of a Class 4, marked impairment, where “impairment levels significantly impede useful functioning” or a Class 5, extreme impairment, where “impairment levels preclude useful functioning” across these domains of function.⁷

In order to find that Mr. Haddad is catastrophically impaired under this clause of the Schedule, I must be satisfied that he has at least a Class 4, marked impairment, with respect to his overall level of impairment due to a mental or behavioural disorder.

I agree with the recent decision by the Divisional Court in Pastore,that all four areas of function must be considered in undertaking the proper assessment of catastrophic impairment.⁸ In addition, one must weigh the relationship between each of the areas being assessed.⁹

I also agree with the Guides and the case law that “…it is important not to confuse the seriousness of a diagnosis with the level of impairment because a person can be diagnosed with a serious condition but have little or no impairment of function…”¹⁰ The Guides are not concerned with specific diagnosis or impairment of a function but the life of a person as a whole.

Mr. Haddad suffers from limitations in function on account of symptoms of mental disorders such as major depressive disorder, adjustment disorder, post-traumatic stress disorder and pain disorder. Generally, I find that these psychiatric diagnoses and illnesses do not affect Mr. Haddad’s crucial daily functions in the four domains to the extent that there is a marked impairment of function in any or all areas. I find that his impairment levels are moderate, “compatible with some, but not all, useful functioning.”¹¹

In concluding that Mr. Haddad is moderately impaired I relied on evidence that speaks to his function. I did not rely on the psychologists and psychiatrists that diagnosed Mr. Haddad under the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) because their opinions do not properly address the question of catastrophic impairment or function.¹²

Although they confirm that there is a significant psychological component that plays a major role in Mr. Haddad’s condition, they do not clarify how it impacts his function across the four spheres. Generally, I find that they do not provide assistance for determining whether Mr. Haddad suffers from a marked impairment because they do not conduct their assessments or rate Mr. Haddad’s impairments in accordance with the Guides.

The strength of any medical support for an impairment rating or diagnosis depends on the completeness and reliability of the medical documentation, even more so in the case of pre‑existing problems. Here, as noted above, Mr. Haddad had a history of psychological problems and substance abuse. Yet, most of the assessors who examined Mr. Haddad relied heavily on his inconsistent self-reported complaints and were not privy to important medical documentation with respect to his pre-existing problems.

None of the assessors properly account for causation. In assessing his current function in the four domains, they overlook whether the psychological diagnosis applied to Mr. Haddad existed well before the accident and which part of his impairment is attributable to the accident.

In addition, I find that most of his assessors ignored the physical reasons for his limitations in function and did not identify the various complications that arose as a result of the non-union of the bone, the leg length discrepancy, the physical pain and the impact of prescription medication and other substances.

I find that the overall picture of Mr. Haddad’s life does not reflect the kind of limited function that meets the threshold of catastrophic impairment under clause 2(1.2)(g) of the Schedule. I base this conclusion on the following analysis.

Mr. Haddad’s level of impairment in his ADLs[^13]

I find that Mr. Haddad’s level of impairment in his ADLs is moderate.

In concluding that Mr. Haddad does not have a marked impairment in his ADLs, I considered all of the assessments and his function related to ADLs, including the functional limitations owing to symptoms of depression, post-traumatic stress, adjustment disorder and chronic pain.

In my view, the effects of Mr. Haddad’s psychological disorders do not contribute considerably to his limitation in ADLs. Overall, I find that Mr. Haddad is able to function on a moderate basis throughout his daily routine. I base this finding on the following evidence.

Mr. Haddad is able to have some useful functioning in his daily life. He is mostly independent in his self-care, hygiene, shower and toileting. All of his assessors consistently comment that he presents as a well groomed and appropriately dressed individual.

He enjoys food but only eats once or twice a day. He is able to make himself tea, coffee and a sandwich, if necessary. He often arranges for a pizza delivery. Mr. Haddad lives in an apartment building and is able to take the elevator downstairs on his own. He also manages on his own to do light shopping at a grocery store. He sometimes joins his friend, Ms. Eliadis, for larger grocery shopping at a supermarket.

Mr. Haddad attends to his banking. He goes to the pharmacy on a regular basis by himself. He arranges his own transportation and calls Wheel-Trans, a taxi or a friend when he has needs to get somewhere.

He is entirely responsible for attending his own rehabilitation and assessment appointments and is able to use his cellphone to keep track of his schedule. He was never late or forgetful of his appointments and, for the most part, attended on his own and arrived early.

Despite his emotional issues, Mr. Haddad remains a mild mannered, cooperative and pleasant person who is able to smile and maintain his sense of humour. There was no evidence to indicate any inappropriate communication or behaviour. He was never rude, violent or socially inappropriate to his treatment providers, assessors or friends. In fact, Mr. Haddad initiates communication with friends, his uncle, brother and mother. He sometimes takes the elevator downstairs and joins friends for a cigarette. There is also evidence that Mr. Haddad is capable of helping his mother with her own daily functioning.

The totality of the evidence indicates that Mr. Haddad is able to maintain useful functioning on a daily basis. As such, his impairment cannot be characterized as marked or “significantly impeding his useful functioning.”

My conclusion is supported by Mr. Haddad’s own assessor, Dr. Cooper, who rated Mr. Haddad’s impairment in ADLs as Class 3, moderate impairment. Dr. Reznek, a psychiatrist, rated his impairment in ADLs as Class 2, mild impairment. Dr. Lawson, a neuropsychologist, rated him between Class 2 and Class 3, in the mild to moderate category.

Mr. Haddad relied mainly on the CAT assessment by Dr. Salmon, a neuropsychologist, who found marked impairment in all the spheres of function.¹⁴ Dr. Salmon stated that Mr. Haddad’s predominant source of impairment in his ADLs is depression and anxiety. I disagree with Dr. Salmon’s opinion and generally find his ratings to be unreliable with respect to Mr. Haddad’s functional abilities for the following reasons.

Dr. Salmon did not follow the proper catastrophic assessment protocol outlined by the Guides, which state “the first step in assessing an individual’s impairment is gathering thorough and complete historical information on the medical condition (s) and then carrying out a medical evaluation supported by appropriate tests and diagnostic procedures.”¹⁵

Dr. Salmon admitted that the timing of the assessment did not permit for a comprehensive review of Mr. Haddad’s medical history. As a result, Dr. Salmon did not have the complete picture of Mr. Haddad’s substance abuse and pre-existing psychological illness. In fact, he only reviewed a summary of medical documents prepared by another assessor in his team and he did not review important source documents that speak to Mr. Haddad’s function. Therefore, I question the foundation of Dr. Salmon’s conclusions and impairment ratings. Based on the evidence, I do not accept that a marked impairment rating is an accurate reflection of Mr. Haddad’s functional abilities.

The other assessors who found Mr. Haddad to be limited in his ADLs to a degree of marked impairment overplayed the contribution of his psychological disorder to his functional abilities and ignored the physical injuries and associated pain which dominate the evidence.

According to Pastore, an impairment assessment under section 2(1.2)(g) of the Schedule must distinguish and exclude impairments that are due to physical injuries from an assessment of impairments that are due to mental or behavioural disorders.¹⁶

I find that Mr. Haddad’s impairment in this area is very much related to physical injuries as well as to mental or behavioural disorders. My conclusion in this regard is supported by the findings of many assessors who suggested that it is likely that Mr. Haddad’s difficulties and ability to function in this and other areas of life were due to his pain levels. In fact, most of the post-accident entries in the clinical notes and records are with respect to pain and physical complaints.

For example, in February 2010, Dr. Hsieh noted that Mr. Haddad is still having pain, is not active and not doing anything due to pain.¹⁷ In September 2010, Dr. Gratzer, a psychiatrist, stated “at this point in time though, given his physical injuries and the amount of medication he takes, it is difficult for me to tell exactly how much of this is just pain and how much of this is depression.”¹⁸ In July 2011, Mr. Haddad “experiences sharp, shooting pain into the left leg with weight bearing. Pain in his back and bilateral knee pain worsen with prolonged walking. These are negatively affecting the patient’s ADLs.” ¹⁹ In May 2011, he complained that he is not able to sleep well because of pain.²⁰ In October 2011, more than three years after the accident, orthopaedic specialists finally identified the cause for Mr. Haddad’s pain by diagnosing the non‑union in his left leg and performing surgical intervention to correct it.

Those assessors who found Mr. Haddad to be catastrophically impaired on account of mental and behavioural disorders relied in part on his pain, which is a symptom of his identifiable physical injuries. They improperly considered pain in their psychological impairment rating of Mr. Haddad’s ADLs.

In assessing limitations in function, the observations and admissions of what Mr. Haddad is able to do (e.g. keep all of his appointments and arrive on time, travel by himself, complete long assessments without difficulty or irritable outbursts, attend rehabilitation treatments three times a week, smile, make his own coffee and sandwich, help his mother and communicate with friends) are reflective of his true impairment levels. In the face of such and other evidence of function, I do not find support for Mr. Haddad’s self-reported complaints of what he is no longer capable of doing.

Mr. Haddad’s ability to engage in usual daily activities may have been decreased as a result of his psychological illness. However, I did not find that his psychological illness and related symptoms impacted him to a degree of marked impairment in his ADLs. The evidence of what he is able to do leads me to conclude that Mr. Haddad can still carry out many of his daily routines. I find that Mr. Haddad’s degree of impairment in this area on account of his mental and behavioural disorders is moderate rather than marked.

Mr. Haddad’s level of impairment in socialization[^21]

I find that Mr. Haddad’s level of impairment in socialization is moderate. Mr. Haddad’s actual level of interaction and communication reflects some useful functioning and despite his limitations he is able to have reciprocity in his relationship with friends, family and others.

Several assessors opined that Mr. Haddad’s social functioning does not reach marked impairment levels. Dr. Reznek rated him in a Class 2, mild impairment. Dr. Lawson rated him in a Class 3, moderate impairment, and Ms. Freedman, occupational therapist (OT), rated him in a Class 2 to Class 3, mild to moderate impairment.²²

Dr. Salmon and Dr. Cooper rated Mr. Haddad in a Class 4, marked impairment. Dr. Salmon opined that the core depressive features of his mental state, loss of interest, inability to focus and attend to conversation and inner motivational issues indicate difficulties functioning in this sphere. I disagree. Here, as noted above, I find that Dr. Salmon’s and Dr. Cooper’s rating was founded mostly on Mr. Haddad’s self-reported complaints and did not account for his actual social functioning abilities.

The evidence revealed that Mr. Haddad initiates communication and interacts with family and friends. He calls his uncle and brother to arrange visits with his mother. He also has a few good friends, who come over once a week or so, which sometimes cheers him up.

According to Ms. Eliadis, Mr. Haddad is able to interact appropriately with everyone around him and maintain an ongoing relationship with several family members and friends. She also stated that he has a loving relationship with his mother.

Mr. Haddad also displayed appropriate communication and interaction with individuals beyond his family and friends. All of his treatment providers and assessors found him to be cooperative, pleasant and an engaging individual that is able to follow conversation, express himself clearly and logically and maintain good eye contact. Several assessors even commented that he has a sense of humour, can be lighthearted and smiled during the assessment. I find that Mr. Haddad demonstrated similar social functioning abilities during the hearing.

I agree that Mr. Haddad’s injuries may have impacted on his socialization. Mr. Haddad is a young man, yet he is no longer physically active, does not go out much with friends, is not involved in romantic relationships and spends much of his time at home with his mother. However, Dr. Reznek noted that someone with a psychological disorder, such as depressed mood, can have a degree of social withdrawal and may still be functional. I agree with Dr. Reznek because despite Mr. Haddad’s social withdrawal, he exhibits many functional abilities in this domain.

Overall, I find as a fact that Mr. Haddad is able to communicate and interact appropriately and effectively with his family, friends, assessors, treatment providers, lawyers and others. Based on the evidence, his impairment in this sphere is moderate.

Mr. Haddad’s level of impairment in concentration[^23]

I find that Mr. Haddad’s level of impairment in concentration is moderate.

Multiple medical assessors noted that Mr. Haddad demonstrates reasonable concentration, persistence and pace during his interviews and assessments. In fact, most of the assessors rated his impairment level in this sphere between mild and moderate. Dr. Cooper, Mr. Haddad’s own assessor, rated him at a Class 3, moderate impairment.²⁴ Dr. Reznek found that he has a Class 2, mild impairment. Ms. Freedman rated him in a Class 2 - 3, mild to moderate impairment.

Dr. Lawson was also of the opinion that Mr. Haddad suffers from a mild deficit and rated him in a Class 2, mild impairment. His rating was based on a clinical interview, psychometric tests, data specific to concentration, review of substantive medical information, and independent validity tests.

Dr. Salmon is the only assessor that rated Mr. Haddad with a Class 4, marked impairment, in concentration but he relied heavily on Mr. Haddad’s self-reported complaints and on a flawed situational assessment, which I discuss under adaptation. Here, as noted above, I do not find Dr. Salmon’s opinion to be reliable in the face of his admissions and shortcomings in his assessment methodology. Dr. Salmon testified that he was not aware that Mr. Haddad had pre-accident difficulties with concentration and had he known, he may have rated him differently.

Considering Mr. Haddad’s physical impairments, emotional problems and the effects of various medications and substances, I accept that Mr. Haddad has some difficulty with concentration. However, I find that his impairment level in this sphere is not so severe that it meets the marked impairment threshold. On the balance of the evidence, I find his impairment level in concentration to be moderate.

Mr. Haddad’s level of impairment in adaptation[^25]

I find that Mr. Haddad’s level of impairment in adaptation is moderate.

In assessing function in adaptation, the Guides and the case law focus their analysis on the psychological stress tolerance of the individual, beyond just an inability to work.²⁶

Dr. Reznek, Dr. Lawson and Ms. Freedman found Mr. Haddad’s impairment level to be between mild and moderate in this sphere. I prefer their opinions because they measured Mr. Haddad’s function beyond the work setting. They also placed less weight on Mr. Haddad’s self-reporting and more weight on the medical documentation and their own observations of his capacity to adapt to complex and stressful circumstances.

Mr. Haddad’s capacity to function in a complex setting and his ability to tolerate stress was also evident during the arbitration hearing, which typically presents as complex and stressful circumstances to most applicants. My observations of Mr. Haddad during a seven day hearing are yet another telling example of his ability to tolerate stress with adaptability and concentration. Although he was physically uncomfortable and at times exhibited tearfulness, I found him for the most part to be alert, focused and involved. On occasion he corrected counsel or a witness when they made a mistake. I find that Mr. Haddad’s capacity to function in this complex and stressful setting did not reflect a marked impairment level.

I disagree with Drs. Salmon and Cooper who concluded that Mr. Haddad has a marked impairment in this sphere because I find that their ratings are unreliable and largely based on a flawed situational assessment and on the unfounded assumption that Mr. Haddad was working before this accident.

I find that prior to the accident, Mr. Haddad had significant psychological and addiction problems that interfered with his ability to maintain a job. Mr. Haddad was not able to recall the chronology of his employment due to memory problems related to his drug use. Dr. Hsieh confirmed that he had no information in the medical file regarding Mr. Haddad’s vocation and that he was unaware of his employment.

In addition, Economical presented four largely uncontested affidavits in support of their assertion that Mr. Haddad’s last place of employment, DMS Packaging and Warehousing, did not actually exist and that Mr. Haddad was not employed prior to this accident.²⁷ This assertion was further supported by the testimony of Dr. Hsieh. When asked during cross-examination if Mr. Haddad presented as someone that was capable of working in January of 2008 (three months before the accident), Dr. Hsieh replied that if he was increasing Mr. Haddad’s anti-depressants than it is likely he was not working at that time.

Therefore, I cannot accept any marked impairment rating that is based on the assumption that Mr. Haddad was properly employed prior to the accident. In fact, Dr. Salmon admitted that had he known Mr. Haddad was not working before the accident, he would amend his opinion and downgrade his impairment rating in the area of adaptation.

Dr. Salmon also based Mr. Haddad’s impairment rating on his inability to tolerate work as demonstrated in a situational work assessment.²⁸ However, the situational assessment was not a true picture of Mr. Haddad’s disability, as it was conducted on December 5, 2011, less than two months after his last surgery (October 2011), during an acute stage of recovery. Mr. Haddad was experiencing considerable pain, fatigue, taking many medications and using crutches. The entire assessment was conducted with Mr. Haddad in a seated position attempting to complete fairly sedentary tasks (mail sorting, alphabetizing, visual maze and payroll computation) without adequately measuring validity and participation. The assessment was also terminated early due to Mr. Haddad’s fatigue, and therefore, certain performance measurements were difficult to calculate. In their conclusion, the assessors did not distinguish Mr. Haddad’s physical difficulties from his emotional and behavioural problems.

Based on the evidence, I do not accept that Mr. Haddad’s situational assessment is an appropriate or conclusive measure of his functioning in the sphere of adaptation. As a result, I find that Dr. Salmon’s reliance on this assessment yielded a flawed impairment rating.

Mr. Haddad relied on the opinion of Dr. Pilowsky, who rated him with an overall marked impairment.²⁹ I do not accept her opinion because she did not conduct her assessment in accordance with the Guides and did not provide individual ratings in the relevant spheres of function to support her marked impairment rating. Ultimately, she concluded that Mr. Haddad’s WPI is within the moderate range.

Mr. Haddad equated his receipt of income replacement benefits as evidence of marked impairment in adaptation and relied on assessments conducted by Dr. Alcock, Dr. Zielinsky and Dr. Waisman, which opined on his entitlement to income replacement benefits. Here, as noted above, I find that these assessments were not conducted in accordance with the Guides and did not properly address the question of catastrophic impairment due to mental and behavioural disorders.

In any event, I do not accept that Mr. Haddad’s entitlement to income replacement benefits under the Schedule automatically translates to a marked impairment in adaptation or in any other sphere. The two have very different threshold tests according to the Schedule.

Based on the totality of the evidence, I conclude that despite Mr. Haddad’s emotional difficulties, he has not shown, on a balance of probabilities that he suffers from a marked impairment in adaptation or in any of the spheres of function. Overall, I find his impairment level across the four spheres to be moderate.

Even if I were to find that Mr. Haddad suffers from catastrophic impairment in accordance with the Guides, his pre-existing problems as they relate to his pre-accident function, would render a conclusion that this accident did not materially contribute to his impairment.

Issue 2 - Is Mr. Haddad catastrophically impaired according to section 2(1.2)(f) of the Schedule?

I find that Mr. Haddad is not catastrophically impaired according to section 2(1.2)(f) of the Schedule because he does not meet the 55% WPI threshold.

According to the Schedule, impairment is defined as a “loss or abnormality of a psychological, physiological or anatomical structure or function”. According to section 2(1.2)(f) of the Schedule, catastrophic impairment also includes an impairment that, in accordance with the Guides, results in 55% or more impairment of the whole person.

I find that a 12% WPI is an accurate reflection of Mr. Haddad’s physical impairments and that he does not reach a 55% WPI rating on account of his physical limitations alone.

As a result of Desbiens and a number of subsequent decisions³⁰, arbitrators and judges have concluded that when considering section 2(1.2)(f) of the Schedule, it is appropriate to assign a percentage rating to mental and behavioural impairments and to add that percentage, using the applicable tables in the Guides, to the other percentage rating of impairments to determine WPI. I agree and find that 22% WPI is an accurate reflection of Mr. Haddad’s psychological impairments.

The question is whether Mr. Haddad’s physical and psychological limitations, when combined and rated in accordance with the Guides under section 2(1.2)(f) of the Schedule, result in a rating of 55% WPI. Overall, I find that Mr. Haddad’s impairment ratings, even when combined, at 31% WPI, do not meet the threshold of catastrophic impairment under section 2(1.2)(f) for the reasons that follow.

Mr. Haddad’s WPI is calculated by rating the following impairments:

Lower Extremity - Left Leg, Knee and Hip
Scarring
Medication
Back Pain
Psychological

Mr. Haddad’s WPI ratings on account of his physical impairments

Dr. Paitich, an orthopaedic specialist, rated his physical injuries at 12% WPI. Dr. Crawford, a chiropractor, rated Mr. Haddad’s physical injuries at 33% WPI. I prefer Dr. Paitich’s WPI rating because I find it was a reasonable and informed exercise of clinical discretion as permitted by the Guides, while Dr. Crawford’s rating was undermined by the timing of his assessment and his admissions that he made several errors in his methodology and ratings.

Lower extremity - left leg, knee and hip

I find that the correct rating for Mr. Haddad’s lower extremity is 12% WPI.

Mr. Haddad sustained a fracture involving his left leg. This was treated with surgery which used hardware to screw in the broken bone. Subsequently, it was discovered that the hardware backed out and failed to properly unite the bone and Mr. Haddad underwent two more surgeries to repair this problem. During the last surgery in October 2011, the non-union was repaired and the leg length discrepancy was reduced.³¹

Chapter 3.2 of the Guides is the relevant section for a lower extremity problem. There are 13 different ways to look at a patient and the assessor has options in choosing which method is most appropriate in calculating an impairment rating.

Dr. Paitich rated Mr. Haddad’s lower extremity limitations at 12% WPI by utilizing the Range of Movement method and applying measurements taken during Mr. Haddad’s physical examination as follows:³²

Range of movement measurement of the left hip – 2%
Range of movement measurement of the left knee – 0%
4 cm leg length discrepancy on the left side – 8%³³
1 cm atrophy in the left lower leg – 2%
Rating based on infection – 0%

I agree that the Range of Movement method was the correct method for assessing Mr. Haddad because the primary feature of Mr. Haddad’s impairment was his restriction of movement. This method also allowed for a comprehensive rating of all the problems encountered by Mr. Haddad as a result of the fracture and its complications.³⁴ I also agree with the measurements taken by Dr. Paitich, as they are relatively similar to other measurements of Mr. Haddad in the evidence.³⁵

Mr. Haddad relied on Dr. Crawford’s ratings of 40% and 20% WPI. I disagree with Dr. Crawford’s opinion and generally find his assessment to be inconsistent with the Guides for the following reasons.

The Guides specifically preclude performing an evaluation when illness is present.³⁶ Yet, Dr. Crawford performed his evaluation two months after Mr. Haddad’s last surgery, during an acute phase of recovery. In addition, Dr. Crawford utilized the Gait Derangement method to assess Mr. Haddad’s lower extremity limitations despite the fact that the Guides direct assessors not to use the Gait Derangement method when the impairment is temporary and a more specific method applies.³⁷

Generally, the Guides attempt to limit the role that subjective reporting plays in rating injuries.³⁸ Dr. Crawford rated Mr. Haddad’s left leg, knee and hip limitation at 40% WPI based on his use of crutches at the time of the assessment. Yet, he was not able to conclude that Mr. Haddad’s use of crutches or a cane was consistent with his injury. Dr. Crawford admitted that he did not review x-rays or notes from an orthopaedic specialist, nor could he point to any pathology to support Mr. Haddad’s use of assistive walking devices. I find that Dr. Crawford arrived at Mr. Haddad’s WPI ratings without physiological and objective evidence.

Dr. Crawford also provided an alternative rating of 20% based on anticipation that Mr. Haddad will improve and his capacity to weight bear will lead to the eventual use of one cane. I find this approach and rating to be highly speculative because it is based on a future event. Dr. Crawford may have been correct in his assumption that Mr. Haddad will improve with time but the Guides do not allow for an impairment rating into the future.

Dr. Oshidari, a physiatrist, opined that if the Gait Derangement method is used, Mr. Haddad’s WPI will be around 20%.³⁹ I do not accept Dr. Oshidari’s impairment rating because he did not examine Mr. Haddad or conduct any physical measurements and considered Mr. Haddad’s impairment in a paper review of an OCF-22. Ultimately, like Dr. Ameis, Dr. Oshidari did not find support for a catastrophic determination on account of Mr. Haddad’s physical impairments.⁴⁰

Based on the evidence, I find that 12% WPI appropriately captures Mr. Haddad’s impairment on account of his lower extremity.

Scarring

I find that the correct rating for Mr. Haddad’s scar is 0%.

Mr. Haddad sustained surgical scars over his left leg.⁴¹ Dr. Paitich assigned 0% for Mr. Haddad’s scar because Mr. Haddad does not have any symptoms that arise as a result of the scar such as a skin condition, the requirement of further treatment or some alteration of behaviour as a result of the disfigurement.

If there is an alteration of behaviour as a result of the scar, an impairment rating under Chapter 13 of the Guides is not appropriate and the scar must be assessed in accordance with Chapter 14 of the Guides and under section 2(1.2)(g) of the Schedule.⁴²

I agree that Mr. Haddad does not qualify for a positive rating under the Guides. I was not presented with any evidence, other than a photograph, that successfully contradicts Dr. Paitich’s opinion. My conclusion in this regard is supported by the admission of Mr. Haddad’s own assessor, Dr. Crawford, who stated that his original 9% rating was made in error and a correct rating based on the Guides and Mr. Haddad’s scar is 0%.

I find that the appropriate rating in respect of the scar is 0%.

Medication

I find that the correct rating for Mr. Haddad’s medication is 0%.

Since the accident, Mr. Haddad has been prescribed numerous medications.⁴³ Under the Guides, an assessor may choose to assign a percentage of impairment based on medication in certain instances.⁴⁴

Initially, Dr. Crawford assigned 3% for medication effects in his report. However, during his cross-examination he admitted that his rating was wrong and in fact, based on the Guides, he should have assigned 0% because the usage of medications in and out of itself does not entitle Mr. Haddad to an impairment rating for medication under the Guides.

I find that the correct rating for Mr. Haddad’s medication based on the Guides is 0%.

Back pain

I find that the correct rating for Mr. Haddad’s back pain in 0%.

The Guides allow for spine impairments in soft tissue injuries to be rated by the Diagnosis Related Estimates (DREs) and Range of Movement methods. Both Drs. Crawford and Paitich chose the DREs method. The DREs deals with lumbosacral spine impairments in Tables 70 and 72 of the Guides under eight designated classes that distinguish complaints of pain.⁴⁵

Dr. Paitich assigned 0% based on a DREs Lumbosacral Category I Impairment, which deals with complaints or symptoms without significant clinical findings or evidence of impairment. Dr. Crawford assigned 5% for Mr. Haddad’s back pain based on a DREs Lumbosacral Category II Impairment, which relates to minor impairments with some evidence. I agree with Dr. Paitich because I find that without objective diagnosis or evidence demonstrating a decrease in Mr. Haddad’s range of motion, Category I is an appropriate reflection of his back impairment.

In fact, Drs. Paitich and Archer who examined Mr. Haddad found a full range of motion with respect to his back. Dr. Crawford, who conducted his own measurements, also found that Mr. Haddad’s range of motion is “within normal limits”.⁴⁶ Other assessors do not assign a positive rating for Mr. Haddad’s back pain. Dr. Theodoropoulos, an orthopaedic surgeon, stated that “without radiographic evidence or investigations to corroborate this diagnosis, his current pain would be considered chronic myofascial pain.”⁴⁷

Without pathology to explain Mr. Haddad’s back pain, I agree with the opinions of the orthopaedic specialists that Mr. Haddad’s back pain is based on soft tissue injuries and is therefore, accurately rated at 0% WPI in accordance with the Guides.

Mr. Haddad’s WPI on account of his psychological impairments

I find that the correct rating for Mr. Haddad’s psychological impairments is 22% WPI.

The Guides do not provide a methodology for assigning a WPI rating for emotional and behavioural impairments in the same way that physical impairments are assessed. In addition, the court in Kusnierz did not endorse a particular or specific method for arriving at a percentage rating for emotional or behavioural impairments.⁴⁸

All of the assessors used Table 3 in Chapter 4 of the Guides to arrive at a WPI rating for Mr. Haddad’s psychological impairments, which is one of the accepted methodologies to determine a WPI rating on account of emotional and behavioural impairments.⁴⁹

Table 3 - Emotional or Behavioural Impairments:⁵⁰

Impairment description	% Impairment of the whole person
Mild limitation of daily social and interpersonal functioning	0 - 14
Moderate limitation of some but not all social and interpersonal daily living functions	15 - 29
Severe limitation impeding useful action in almost all social and interpersonal daily functions	30 - 49
Severe limitation of all daily functions requiring total dependence on another person	50 - 70

After reviewing the approaches and analyses of the various assessors in this case, the range of possible impairment scores for Mr. Haddad’s emotional or behavioural impairments in accordance with Table 3 spans from 14% to 38% but only Dr. Salmon assigns an impairment score beyond the 29% moderate range.

Dr. Reznek assigned 14%, the highest score possible in the mild range of the scale. Although I prefer Dr. Reznek’s opinion to Dr. Salmon’s for reasons already noted above, I do not find support for his 14% assessment in the mild level of the scale. In fact, Dr. Reznek testified that psychiatry is not an exact science and there should be a 5% margin of error in rating impairments.

In my opinion, Mr. Haddad’s emotional and behavioural impairments are more appropriately reflected in the mid-point level of the moderate scale in Table 3, which spans from 15% to 29% WPI. In this Table, the moderate range is described as limitation of some, but not all, social and interpersonal daily living functions. In Chapter 14 of the Guides, moderate impairment is defined as one that is compatible with some, but not all, useful functioning. In my view, the moderate range in Table 3 reflects the kind of impairment that we see with Mr. Haddad. I based this opinion on my previous analysis under section 2(1.2)(g) and my finding that Mr. Haddad suffers from an overall rating of moderate impairment in all the spheres of function.

Dr. Salmon assigned Mr. Haddad 38% WPI, which is a midpoint of the severe range in Table 3. Here, as noted before, I do not agree with Dr. Salmon’s rating because he did not have a full picture of Mr. Haddad’s problems and did not follow the assessment protocol outlined by the Guides.

Dr. Pilowsky assigned 25% - 29% WPI which is in the moderate range of Table 3 but did not provide any explanation for assigning a “moderate” as opposed to a “severe” impairment and, as noted previously in this decision, did not conduct a CAT assessment in accordance with the Guides. Dr. Cooper found an overall marked impairment under Chapter 14 of the Guides but did not provide a WPI rating in accordance with section 2(1.2)(f).

Generally, I find that Mr. Haddad’s assessors overemphasized the effect of psychological disorders on his function and impairment levels and ignored the physical reasons for his problems and pain. They did not follow the approach outlined in Pastore and failed to parcel out Mr. Haddad’s physical symptoms from the emotional ones in assessing psychological impairments and arriving at his WPI rating.⁵¹

I find it appropriate to rate Mr. Haddad’s WPI at the midway score of the moderate level, at 22% WPI, for his psychological impairments.

Mr. Haddad’s combined WPI on account of his physical and psychological impairments

Using the Combined Values Chart in the Guides⁵², the combination of 12% WPI for Mr. Haddad’s physical impairments and 22% WPI for his emotional and behavioural impairments amount to a total WPI of 31%, which is insufficient to meet the criteria in section 2(1.2)(f).

Consequently, Mr. Haddad is not catastrophically impaired as defined in section 2(1.2)(f) of the Schedule.

Issue 3 - Is Mr. Haddad entitled to housekeeping and home maintenance expenses?

Mr. Haddad clarified at the outset of the hearing that he was seeking entitlement to a housekeeping and home maintenance benefit at the rate of $100.00 per week from April 1, 2010 and ongoing, post the 104-week mark.

As per section 22(3) of the Schedule, “no payment is required under this section for expenses incurred more than 104 weeks after the onset of the disability.” Given my finding that Mr. Haddad is not catastrophically impaired as a result of the accident, I find that Mr. Haddad is not entitled to benefits for housekeeping and home maintenance expenses beyond April 1, 2010.

Issue 4 - Is Mr. Haddad entitled to attendant care benefits?

Given my finding that Mr. Haddad is not catastrophically impaired as a result of the accident, I find that Mr. Haddad is not entitled to attendant care benefits beyond April 1, 2010 because section 18(2) of the Schedule states that “no attendant care benefit is payable for expenses incurred more than 104 weeks after the accident,” unless the applicant sustains a catastrophic impairment as a result of the accident.

Attendant care benefits from April 1, 2008 to April 1, 2010

I find that Mr. Haddad is entitled to $933.31 per month from November 2008 to April 1, 2010, less amounts already paid by Economical, plus interest in accordance with the Schedule.

Mr. Haddad claims the following:

$3,000.00 per month from November 2008 to December 21, 2009⁵³
$933.31 per month from December 21, 2009 to March 20, 2010
$1,068.61 per month from March 20, 2010 to April 1, 2010

There was evidence that supported Mr. Haddad’s entitlement to attendant care services. In September of 2008, an OT, assessed Mr. Haddad on behalf of Economical and completed an Assessment of Attendant Care Needs (Form 1), in which she recommended he continue to be provided with assistance for various personal care services (including grooming, dressing, feeding and mobility) at the rate of $458.75 per month, based on 9.5 hours of Level 1 attendant care per week, which Economical paid until May 2009.⁵⁴

In November 2008, another OT found that Mr. Haddad requires assistance with 32.36 hours per week for his personal care with respect to Level 1 and 4.43 hours per week with respect to Level 3.⁵⁵When she examined him again in January of 2009, she found that he was still not independent with his personal care and continued to recommend 23.38 hours per week with respect to Level 1 and 3.96 hours per week with respect to Level 3.⁵⁶

I do not agree with the considerable level of care reported by Mr. Haddad’s service provider and suggested by his assessor with respect to supervisory care at Level 2, from November 2008 to December 2009⁵⁷, because no treating doctor recommended 24/7 supervisory care and his own assessor who completed an assessment of his attendant care needs in December 2009 and March 2010, did not recommend supervisory care.⁵⁸

Mr. Haddad testified that due to his injuries he could not do certain personal care activities following the accident and that his mother assisted in these activities but he was partially independent with some of his mobility, dressing, feeding, grooming, bathing and medication management, as well as completely independent with toileting. He was also capable of attending at the pharmacy, at medical appointments and at the grocery store on his own.

Mr. Haddad’s service provider, his mother, did not testify. Without her testimony to clarify what services she provided, I did not find support for those services related to supervisory care and was not persuaded that supervisory care is a reasonable claim.

However, based on the evidence, I agree that Mr. Haddad required assistance with his personal care. When you factor out the time assigned to supervisory care and those personal care activities that Mr. Haddad was partially able to perform, the level of care required by Mr. Haddad resembles the level of care suggested by his assessor, Ms. Havrylechko, in December 2009. She recommended that Mr. Haddad continue to be provided with assistance for various personal care services (including grooming, dressing, feeding, hygiene, skin care and bathing) at the rate of $933.31 per month, based on 9.5 hours at Level 1 with his personal care, as well as another 2.92 hours a week of Level 2 and 5.67 hours of Level 3 care.⁵⁹ In fact, Economical agreed with this assessment and paid this benefit from December 2009 to March 20, 2010.

Orthopaedic, functional, in-home and psychological assessments during the relevant time period confirmed that there were physical limitations that played a major role in Mr. Haddad’s condition and ability to function and continued to recommend help at home. Many assessors deemed Mr. Haddad to suffer a substantial inability to perform his housekeeping duties.⁶⁰

On April 1, 2010, two years after the accident, Dr. Langer examined Mr. Haddad and found that he continuous to suffer from a substantial inability to perform his housekeeping duties because his leg length discrepancy could not be easily corrected. He stated “Mr. Haddad has a disability for any activities that require sustained weight bearing, squatting, kneeling, etc.”⁶¹

However, several assessors found that Mr. Haddad was able to perform his personal care activities and did not require attendant care services.⁶² I disagree because I find that most of Mr. Haddad’s assessors underestimated his need for personal care assistance and premised their opinion on a normal course of healing from a broken femur. In reality, Mr. Haddad’s fracture had not healed and he continued to suffer from a non-union of the bone and a leg length discrepancy until he underwent another surgery in October 2011. Therefore, I do not accept that Mr. Haddad was able to perform all of his care activities for the period in question.

Based on the totality of the evidence, I accept that Mr. Haddad’s need for personal care assistance at the rate of $933.31 a month is reasonable and necessary and find that he is entitled to this attendant care benefit from November 2008 to April 1, 2010, less amounts already paid, plus interest in accordance with the Schedule.

EXPENSES

I encourage the parties to agree on expenses. If they are unable to do so, they may request an assessment of expenses in accordance with Rule 79 of the Dispute Resolution Practice Code (Fourth Edition).

July 5, 2012

Deborah Pressman Arbitrator

Date

ARBITRATION ORDER

Under section 282 of the Insurance Act, R.S.O. 1990, c. I.8, as amended, it is ordered that:

Mr. Haddad is not catastrophically impaired according to section 2(1.2)(g) of the Schedule.
Mr. Haddad is not catastrophically impaired according to section 2(1.2)(f) of the Schedule.
Mr. Haddad is not entitled to housekeeping and home maintenance expenses beyond the 104-week mark.
Mr. Haddad is entitled to an attendant care benefit at the rate of $933.31 per month from November 2008 to April 1, 2010, less any amounts already paid by Economical for this period.
Mr. Haddad is entitled to interest for the overdue payment of attendant care benefits pursuant to the Schedule.