4 total
Non-earner benefit denied; one occupational therapy treatment plan approved to address psychological impairments.
The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and various medical and rehabilitation benefits.
The adjudicator found that the applicant did not suffer a complete inability to carry on a normal life, as the applicant was able to live independently, care for a child, and maintain relationships.
The claims for most of the medical and rehabilitation benefits were dismissed because they were not reasonable and necessary, largely due to a lack of evidence of cognitive impairment.
However, one treatment plan for occupational therapy services to address psychological impairments and assist the applicant in obtaining a GED was approved.
Arbitration application deemed withdrawn for abandonment; applicant ordered to pay insurer's assessment fee and expenses.
The applicant failed to attend his scheduled arbitration hearing for statutory accident benefits, and his counsel was granted leave to withdraw.
The arbitrator found that the applicant had abandoned the proceeding and that his failure to pursue the application or provide notice constituted an abuse of process.
The application was deemed withdrawn, and the applicant was ordered to pay the insurer's assessment fee of $3,000 and arbitration expenses of $750.
Private disability insurance benefits are not deductible from statutory income replacement benefits.
The appellant insurer appealed an arbitration decision finding that monthly benefits received by the respondent under a private disability insurance policy were not deductible from income replacement benefits and loss of earning capacity benefits payable under the SABS-1994.
The Director's Delegate reviewed the history of the deductibility of collateral benefits and concluded that the private disability benefits were not 'payments for loss of income' under an 'income continuation plan' within the meaning of section 75(1) of the SABS-1994.
The appeal was dismissed.
Private disability benefits with fixed monthly amounts are not deductible from statutory accident benefits.
The applicant was injured in a motor vehicle accident and received statutory accident benefits.
The insurer deducted $1,200 per month that the applicant received from a private disability policy with Great West Life, arguing it was a payment for loss of income under an income continuation plan pursuant to section 75(1)1 of the Schedule.
The arbitrator applied the reasoning from Cugliari v. White and found that the Great West Life policy was primarily a policy to compensate for general disability, not to insure a continuation of income, because the benefit amount was fixed and not dependent on employment at the time of disability.
The deduction was not permitted.
The applicant's claim for a special award was dismissed as the insurer's position was not unreasonable.
