Sven Mascarenhas

The applicant requested a reconsideration of a Tribunal decision that dismissed her second application for a catastrophic impairment determination on the basis of res judicata.

The applicant argued the Tribunal breached procedural fairness by failing to address her arguments regarding the insurer's statutory obligations under Roy and the fairness exception to res judicata under CUPE.

The Adjudicator granted the reconsideration, finding that the original decision lacked adequate reasons on these central arguments, constituting a material breach of procedural fairness.

The original decision was cancelled and a written rehearing before a different adjudicator was ordered.

The applicant sought a determination that she sustained a catastrophic impairment under criterion 8 of the SABS following a motor vehicle accident.

The dispute centered on whether she had marked impairments in Activities of Daily Living and Concentration, Persistence, and Pace.

The Tribunal found that while the applicant suffered moderate impairments, she retained significant useful functioning, such as driving, caring for her autistic son, and attending the gym regularly.

The Tribunal concluded the applicant did not suffer a catastrophic impairment and dismissed the claims for an award and interest.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent argued the application was barred because the applicant had entered into a full and final settlement agreement for $20,000, negotiated by his mother.

The applicant contended the settlement only covered medical and rehabilitation benefits, not income replacement benefits, and alternatively argued the agreement was unconscionable.

The Tribunal found there was a meeting of the minds on all benefits, no capacity or duress issues existed, and the Tribunal lacked equitable jurisdiction to set aside the agreement.

Furthermore, the applicant failed to comply with O. Reg. 664 by not rescinding within two days or returning the settlement funds.

The application was barred, and the respondent's request for costs was dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued she was exempt from the MIG due to chronic pain and a pre-existing condition of sciatica.

The Tribunal found insufficient evidence of chronic pain and concluded that the applicant failed to prove her pre-existing sciatica prevented her from achieving maximal recovery within the minor injury limits.

The application for benefits, interest, and a special award was dismissed.

The Applicant sought expenses following a successful motion for interim income replacement benefits.

The Insurer argued for mixed success because the arbitrator declined to order an interim special award or interest.

The arbitrator rejected this argument, finding the Applicant was successful in obtaining the interim benefits requested.

The arbitrator awarded the Applicant his reasonable expenses, deducting 4 hours of counsel's time spent researching interim benefits, fixing the total expenses payable by the Insurer at $6,790.50.