Most supplementary medical and rehabilitation benefits denied due to pre-existing conditions and lack of evidence.
The applicant was injured in a motor vehicle accident and sought various supplementary medical, rehabilitation, and housekeeping benefits after the insurer terminated weekly benefits.
The arbitrator found that the applicant had a significant pre-accident history of chronic pain and had largely recovered from the accident-related soft tissue injuries by December 1995.
Most of the claimed expenses, including physiotherapy, massage therapy, and trips to India, were denied for lack of evidence connecting them to the accident.
However, the arbitrator allowed expenses for a dental bite plane and related travel, finding they were reasonably incurred for a temporomandibular joint impairment caused by the accident.
Insurer ordered to pay accident benefits and a $30,000 special award for unreasonably withholding payments.
The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, including income replacement, rehabilitation, housekeeping, and dependant care benefits.
The insurer terminated benefits based on a disability DAC assessment by a chiropractor.
The arbitrator found that the applicant suffered from a severe TMJ disorder, chronic pain, and depression, rendering her substantially unable to perform the essential tasks of her pre-accident employment as a travel consultant.
The arbitrator awarded the claimed benefits and ordered the insurer to pay a $30,000 special award for unreasonably withholding benefits, noting the insurer's reliance on an assessor lacking expertise in TMJ disorders and its failure to re-evaluate its position in light of overwhelming medical evidence.
Insurer's failure to provide proper notice of election under SABS allowed applicant to elect income replacement benefits.
The applicant was injured in a motor vehicle accident and received weekly caregiver benefits from the insurer.
The insurer terminated the benefits, and the applicant sought to elect to receive income replacement benefits instead.
The insurer argued that the applicant was deemed to have elected caregiver benefits under section 61(5) of the Statutory Accident Benefits Schedule because she failed to make an election within 30 days of receiving notice.
The arbitrator found that the insurer's letter did not constitute proper notice under section 61(2) because it did not advise the applicant of the requirement to choose between benefits or the consequences of failing to do so.
Therefore, the deemed election provision was not triggered, and the applicant was entitled to elect income replacement benefits.
Arbitrator awards caregiver and housekeeping benefits, finding applicant substantially unable to perform pre-accident household activities.
The applicant was injured in a motor vehicle accident and sought weekly caregiver benefits and housekeeping expenses after the insurer terminated them.
The arbitrator found that the applicant suffered a partial inability to carry on a normal life due to her substantial inability to engage in pre-accident household activities, including cooking, heavy laundry, and cleaning.
The arbitrator awarded the claimed caregiver benefits, housekeeping expenses, interest, and arbitration expenses, noting that the insurer's surveillance and medical evidence did not sufficiently contradict the applicant's credible testimony regarding her impairments.
Applicant awarded ongoing weekly income benefits after 156 weeks due to continuous disability from accident.
The applicant was injured in a motor vehicle accident and received weekly income benefits for 156 weeks.
The insurer terminated benefits, arguing the applicant was no longer disabled and could return to work.
The applicant applied for arbitration, claiming ongoing disability due to chronic pain, depression, and cognitive difficulties.
The arbitrator found the applicant credible and preferred the medical evidence supporting her disability over the insurer's medical examinations.
The arbitrator concluded that the applicant was continuously prevented from engaging in any occupation for which she was reasonably suited by education, training, or experience.
The applicant was awarded ongoing weekly income benefits and interest on overdue payments.