David J. Levy

AXA Insurance Company appealed an arbitration order awarding Mario Rocca income replacement benefits beyond the 104-week mark and a $10,000 special award.

Rocca cross-appealed the calculation of his benefits regarding commission income.

The Director's Delegate found that despite the arbitrator's adverse credibility findings against Rocca, there was sufficient objective medical evidence, including an MRI showing a large disc herniation, to support the conclusion that he was disabled from the physical aspects of his pre-accident job.

The Director's Delegate also upheld the special award, finding the insurer unreasonably reduced benefits to the minimum level without an objective basis.

Both the appeal and cross-appeal were dismissed.

The insured person was injured in a motor vehicle accident and commenced both a court action and an arbitration proceeding for statutory accident benefits.

The insurer appealed an arbitration order that allowed the arbitration to proceed despite the concurrent court action.

The Director's Delegate allowed the appeal, finding that the arbitrator erred by focusing only on whether the specific benefits claimed were different, rather than considering the substantial factual overlap between the two proceedings.

Applying the criteria for avoiding multiple proceedings, the Director's Delegate stayed the arbitration pending the outcome of the court action, noting that the court action was broader in scope and involved overlapping medical evidence and causation issues.