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Applicant v. TTC Insurance Company Limited (17-002561)

  • January 19, 2018

The claimant sought a declaration that she suffered a catastrophic impairment as a result of the accident, and entitlement to a psychological paper review. The claimant had submitted two OCF-19s – the first alleged a catastrophic impairment due to a 55 percent Whole Person Impairment; the second alleged a catastrophic impairment due to a Class 4 marked impairment. Adjudicator Bickley held that the claimant suffered a catastrophic impairment due to two Class 4 marked impairments, in social functioning and adaptation. She rejected the arguments regarding a 55 percent WPI, and held that the claimant’s injuries amounted to a maximum of 46 percent. In terms of the Class 4 marked impairments, Adjudicator Bickley preferred the evidence of the claimant’s experts due to the consistency and explanation in the report, and the expert’s consultation with the claimant’s family members. She also found that the surveillance tended to support the claimant’s submissions regarding social isolation and lack of independence. The claimed treatment plan was not awarded because it appeared to be proposed for the purpose of supporting the tort claim rather than the accident benefits claim.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Catastrophic Impairment
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