Licence Appeal Tribunal

File Number: 20-005424/AABS

In the matter of an application per subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.

Between:

Ronald Lanzon Applicant

and

Economical Insurance Company Respondent

DECISION

ADJUDICATOR: Michael Beauchesne

APPEARANCES:

For the Applicant: Satwant Merwar, Counsel

For the Respondent: Earl Murtha, Counsel

Court Reporter: Alyssa Scott

HEARD: by Videoconference: October 26-28, 2022

OVERVIEW

1Ronald Lanzon, the applicant, was involved in an automobile accident on October 4, 2012, and sought benefits per the Statutory Accident Benefits Schedule¹ (the “Schedule”). The applicant was denied benefits and catastrophic designation by the Economical Insurance Company, the respondent, and applied to the Licence Appeal Tribunal—Automobile Accident Benefits Service (the “Tribunal”)—for resolution of the dispute.

ISSUES

2The issues in dispute are:

i. Has the applicant sustained a catastrophic impairment as defined by the Schedule?

ii. Is the applicant entitled to $33,335.00 for catastrophic impairment assessments, recommended by Omega Medical in a treatment plan dated April 20, 2020?

iii. Is the respondent liable to pay an award under Regulation 664 because it unreasonably withheld or delayed payments to the applicant?

iv. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

3The applicant is not catastrophically impaired.

4The applicant is entitled to up to $2,000 for a neuropsychological and psychological assessment and report, produced as part of a multidisciplinary catastrophic impairment determination by Omega Medical Associates.

5The applicant is entitled to up to $2,000 for an occupational therapy assessment and report, produced as part of a multidisciplinary catastrophic impairment determination by Omega Medical Associates.

6The respondent is not liable to pay an award under Section 10 of O. Reg 664.

7The applicant is entitled to interest on the neuropsychological and psychological assessment and report, as well as the occupational therapy assessment and report, both listed above.

ANALYSIS

The applicant is not catastrophically impaired

8The applicant’s Application for Determination of Catastrophic Impairment (dated April 13, 2017) indicates two criteria at issue: Criterion 7 and Criterion 8. However, a more recent (July 2019) multidis