Kalk v Intact Insurance Company

2022 CanLII 45275

Ontario Licence Appeal Tribunal

Another catastrophic impairment WIN for one of our clients following a successful hearing as against Intact insurance company. This VICTORY allows our client to have access to an additional $1.95 Million towards medical, rehabilitation and attendant care benefits for her lifetime.

Our client sustained significant injuries, including a traumatic brain injury, multiple fractures, and a collapsed lung due to a motor vehicle accident. Her injuries required multiple surgeries where she spent two months between hospital.

At the time of the accident, our client was an active 24 year-old who completed a three-year Registered Massage Therapist diploma. She was also a very active person who enjoyed rock climbing, sky diving, and water sports with her friends and boyfriend.

Our client applied for a variety of benefits, which were denied by her insurer. The issue at this hearing was whether she was catastrophically impaired and entitled to these corresponding benefits.

Adjudicator Shapiro accepted that our client met the criteria for catastrophic impairment. Notably, he dismissed the arguments of the accident benefit insurer’s experts who did not sufficiently examine our client and rate her impairments. For example, the adjudicator noted that the insurer’s expert neurologist, Dr. Yahmad, did not provide any impairment ratings for our client’s documented issues with sleep and arousal, vertigo, and hearing. In addition, Dr. Yahmad did not offer any meaningful basis as to why he did not rate these areas.

Further, the adjudicator accorded less weight to Dr. Yahmad’s conclusion that our client did not suffer from any neurocognitive changes because his expertise was limited to neurology strictly from a physical perspective. In contrast, the adjudicator preferred the evidence of our client’s expert neurologist, Dr. Basile, who specialized in head trauma and concussions. Dr. Basile opined that our client met the criteria for post-concussive syndrome associated with traumatic brain injury. His conclusion was supported by several other medical specialists and health-care providers.

Finally, the adjudicator also found that our client was entitled to a housekeeping benefit, physiotherapy and occupational therapy services.

Have you suffered a serious injury or have been denied long-term disability? Contact us for a free consultation. Call us at (905) 286-0050 or fill out our form on this page.

Get Started