Category: Catastrophic Impairment

The claimant appealed the Tribunal’s decision that she did not suffer a catastrophic impairment. The Court held that the Tribunal came to an unreasonable conclusion with respect to the WPI ratings for double vision, peripheral neuropathy, and medications. The adjudicator took a rigid view of the AMA Guides and refused to provide any WPI for double vision when there was ample evidence with objective testing to support as much as a 24 percent WPI rating. The adjudicator was also unreasonable in refusing to rate WPI for peripheral neuropathy based on his own error in referencing the wrong tables and pages in the Guides, and then refusing to adjust the error on reconsideration. Similarly, the adjudicator’s refusal to rate WPI for medications was unreasonable when he was directed to an error in his factual findings regarding the medical evidence. The Court dismissed the other grounds of appeal, and remitted the matter to the Tribunal for a new hearing.

The applicant requested reconsideration of the Tribunal’s decision. The hearing adjudicator dismissed the request (2024 CanLII 102098). The adjudicator did not agree that s. 280(1) of the Insurance Act could be interpreted as providing jurisdiction to determine the rate to be paid for attendant care. The adjudicator also did not agree that it was an error of law to require a breakdown of what services were provided and for how long they were performed. Lastly, the adjudicator found that finding that Bulletin A-03/18 limited the Form 1 to calculating the amount of attendant care to be paid was not inconsistent with the principles in Malitskiy v. Unica Insurance, 2021 ONSC 4603 for the purpose of applying the ratio method for paying for attendant care.

The claimant appealed the Tribunal’s decision that she did not sustain a catastrophic impairment. Her primary argument was that the LAT erred in rejecting the evidence of her chiropractor in the ratings for Criterion 6, 7, and 8. The Tribunal rejected the chiropractor’s evidence insofar as the chiropractor gave opinion and diagnosis of psychological injury, and preferred the evidence of the insurer’s experts who were qualified to diagnose psychological conditions. The Court dismissed the appeal, holding that the Tribunal correctly applied the law in restricting the scope of the chiropractor’s admissible evidence. The SABS and AMA Guides permit a chiropractor to give certain opinions on catastrophic impairment when it comes to physical impairment ratings, but does not allow a chiropractor to give evidence outside of their qualified areas of expertise.

The claimant appealed the Tribunal’s decision that he did not suffer a catastrophic impairment as a result of the accident. The Court dismissed the appeal, holding that the claimant’s appeal was essentially a re-argument of the evidence. The Tribunal was entitled to weigh the evidence as it saw fit, and the adjudicator provided full and cogent reasons for the decision. There was no error of law or denial of procedural fairness to the claimant.

The claimant appealed and sought judicial review of the Tribunal’s decision that he did not suffer a catastrophic impairment as a result of a 2002 accident. The Tribunal concluded that the claimant’s impairments did not meet the necessary psychological injuries, and that a subsequent 2006 accident was a primary factor for the reported impairments. The Court dismissed the appeal and the judicial review, holding that there were no legal errors made by the Tribunal. The adjudicator applied the correct tests, and did not improperly weigh any evidence or improperly admit hearsay evidence.

The claimant appealed the Tribunal’s decision that she did not suffer a catastrophic impairment. She argued that the Tribunal erred in applying the “but for” causation test, and failing to properly weigh other issues that led to psychological impairment. The Court dismissed the appeal, holding that there was no basis to reversed the Tribunal. The adjudicator carefully considered the evidence relating to psychological impairment and concluded that the claimant failed to prove that she had sufficiently reduced impairment in three spheres of function. Further, the adjudicator’s conclusion that the accident was not a necessary cause of the claimant’s condition was fact driven, and was based on the evidence before the Tribunal.