The injuries also failed to meet the criteria for a catastrophic impairment designation: court
The Ontario Superior Court of Justice denied an appeal for various accident benefits, finding that the appellant's impairments were not caused by a motor vehicle accident and did not meet the criteria for a catastrophic impairment designation.
Following a motor vehicle accident in 2015, the appellant had sought various benefits from their insurer under the Statutory Accident Benefits Schedule (SABS). Disputes arose regarding his entitlement to these benefits, leading the appellant to file an application with the License Appeal Tribunal (LAT) in 2021. The application sought a catastrophic impairment designation, attendant care benefits, approval for nine treatment plans, interest, and a special award.
The LAT denied the application in its entirety. The tribunal found that the accident had exacerbated pre-existing physical impairments and caused new psychological impairments, but these issues were resolved by 2019. The tribunal concluded that the appellant did not meet the "but for" test of causation required to establish entitlement to a catastrophic impairment designation. Furthermore, the psychological state of the appellant deteriorated due to seizures and shoulder dislocations, which were not caused by the accident.
As the appellant was not suffering from accident-related impairments by 2019, the LAT determined that the appellant was not entitled to attendant care benefits from May 1, 2019, onwards. Additionally, the LAT found that the nine disputed treatment plans were not reasonable and necessary. Since the appellant was not entitled to benefits, the claims for interest and a special award were also denied.
The appellant subsequently appealed the LAT's decision and the reconsideration decision. The appeal raised several issues, including the correctness of the LAT’S findings on catastrophic impairment, attendant care benefits, and the disputed treatment plans.
The Ontario Superior Court of Justice reviewed the appeal, which was limited to questions of law as per the License Appeal Tribunal Act. The court upheld the LAT’s findings, noting there were no errors in the law regarding the weighing of evidence or the analysis of causation. The appellant had conceded that there were no errors in law in the determination that they were not catastrophically impaired. Furthermore, since the entitlement to non-catastrophic attendant care benefits expired before May 1, 2019, the court had no jurisdiction to consider these claims.
The court also agreed with the LAT’s dismissal of the claims for treatment plans, given the finding that the appellant had no accident-related impairments by 2019. The court deemed the LAT’s refusal to award treatment plans due to procedural issues proper. The court found the appellant's claim that the insurer denied treatment plans without adequate medical reasons to be improperly raised on appeal. Ultimately, the court denied the appeal.
