The adjudicator's decision denying benefits is reasonable and supported by evidence: court
The Ontario Superior Court of Justice has upheld the denial of catastrophic impairment benefits following a motor vehicle accident, finding the decision reasonable and well-supported by evidence.
The claimant had exhausted the $65,000 in benefits from her insurer and sought a determination under section 45 of the Statutory Accident Benefits Schedule (SABS) that her impairment was catastrophic. The insurer denied her application, leading the claimant to appeal to the License Appeal Tribunal (LAT).
The LAT adjudicator ruled that the claimant had not sustained a catastrophic impairment and was not entitled to the attendant care, medical, and rehabilitation benefits in dispute. The adjudicator also dismissed the claimant's request for punitive damages and awarded $2,000 in costs to the insurer.
The claimant requested a reconsideration of the decision, alleging breaches of procedural fairness and errors of fact and law. The LAT denied her reconsideration request. The claimant then sought judicial review, arguing that the LAT unreasonably concluded she did not meet the “catastrophic impairment” definition under the SABS. She contested the adjudicator's findings on her social functioning impairment, whole person impairment (WPI) ratings, and the consideration of her mental or behavioural impairments.
The Superior Court found that the adjudicator's decision was reasonable and well-supported by evidence. The adjudicator preferred the assessments of the insurer's experts over the claimant's experts, who provided detailed explanations for his conclusions. The court noted that its role was not to reweigh the evidence or substitute its judgment for that of the tribunal.
The claimant also claimed procedural unfairness, arguing that the adjudicator had denied her access to relevant documents and failed to consider her motions adequately. The court found no merit in these claims, stating that the adjudicator had followed procedural rules and provided rational explanations for his decisions. The court emphasized that allegations of bias or procedural unfairness must be substantiated by substantial evidence, which the claimant failed to provide.
Additionally, the court addressed the claimant's assertion that the LAT lacked jurisdiction to award punitive damages, affirming that the LAT does not have such authority and referencing relevant case law.
The court concluded that the adjudicator had conducted a fair hearing and rendered a reasonable decision. It dismissed the claimant's application in its entirety and ordered her to pay $10,000 in costs to the insurer.
