Alex Nikolaev

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits and medical benefits for chronic pain.

The insurer had paid benefits up to the Minor Injury Guideline (MIG) limit and terminated income replacement benefits based on insurer examinations.

The arbitrator found that the applicant's injuries fell within the MIG, rejecting the chronic pain diagnosis due to credibility issues, positive Waddell signs, and invalid psychometric testing results.

The arbitrator also concluded that the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The claims for income replacement and medical benefits were dismissed, though the cost of a disability certificate was allowed.

The appellant appealed an arbitrator's decision dismissing her claims for non-earner and attendant care benefits under section 55 of the SABS.

The Director's Delegate found that the arbitrator did not err in proceeding with the hearing in the absence of the appellant's written submissions, as she had been given notice and an extension.

However, the Director's Delegate held that the arbitrator erred in law by requiring the OCF-3s to confirm entitlement to the non-earner benefit and by concluding that no valid claim for attendant care benefits had been made because no Form 1 had been filed.

The appeal was granted, the arbitrator's order was rescinded, and the matter was remitted for a hearing on the merits.

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits, including an Income Replacement Benefit (IRB) beyond the 104-week mark and a Medical Treatment Plan.

The Insurer denied the benefits.

The Arbitrator found that the Applicant did not meet the "complete inability" test required for post-104 week IRBs, noting her history of working in a sedentary position and the availability of suitable alternative employment that would provide a higher income than her pre-accident earnings.

The Arbitrator also dismissed the claim for the Medical Treatment Plan, finding that the Applicant failed to prove it was reasonable and necessary, and did not contradict the Insurer's medical evidence that she had reached maximum therapeutic benefit.

The application was dismissed.