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Arbitrator limits income benefits but orders insurer to pay for functional interdisciplinary rehabilitation program.
The applicant, a self-employed driving instructor, was injured in a rear-end motor vehicle collision and claimed ongoing weekly income benefits and rehabilitation expenses.
The insurer terminated income benefits in May 1991, arguing the applicant could return to work.
The arbitrator found the applicant was capable of returning to work by early June 1991, granting only three additional weeks of income benefits and ordering the applicant to repay a significant overpayment resulting from collateral benefits.
However, the arbitrator ordered the insurer to pay for a functional interdisciplinary rehabilitation program, finding the expense reasonable and necessary to support the applicant's return to the workforce.
Legal fees for completing no-fault benefit applications are not reimbursable expenses under the No-Fault Benefits Schedule.
The appellant appealed an arbitrator's decision denying reimbursement for $200 in legal fees incurred to complete an application for no-fault accident benefits.
The Director's Delegate upheld the arbitrator's finding that legal fees do not qualify as 'other goods and services' under section 6(1)(f) of the No-Fault Benefits Schedule.
The Delegate agreed that the Schedule requires such expenses to be of a nature that a medical practitioner could validly opine on their necessity, which does not apply to legal fees.
The appeal was dismissed.
