A. Balaban

The appellant appealed an arbitrator's decision dismissing her claims for medical, caregiver, attendant care, and housekeeping benefits following a motor vehicle accident.

The appellant argued the arbitrator erred in law by excluding a witness and a document disclosed shortly before the hearing, applying an incorrect causation test, and improperly weighing the medical evidence.

The Director's Delegate rejected the appeal, finding the arbitrator properly exercised his discretion to exclude late evidence to prevent trial by ambush, made reasonable credibility findings, and provided adequate reasons for preferring the respondent's medical evidence.

The appeal was restricted to questions of law, and no such errors were found.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including income replacement benefits (IRBs), which the insurer terminated after approximately 21 months.

The applicant sought ongoing IRBs under both the pre-104 week 'own occupation' test and the post-104 week 'any occupation' test.

The arbitrator found that the applicant sustained significant orthopaedic injuries, particularly to his right hip and left hand, which prevented him from performing the heavy physical demands of his pre-accident employment as a welder.

Furthermore, given the applicant's limited English proficiency and lack of transferable skills, the arbitrator concluded he suffered a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience.

The applicant was awarded ongoing IRBs and interest, but his claim for a special award was dismissed as the insurer's reliance on its medical assessments was not unreasonable.

Arbitration under the Statutory Accident Benefits Schedule concerning ongoing income replacement benefits after a motor vehicle accident.

The arbitrator found that the applicant met the own-occupation disability test up to the two-year anniversary of the accident, largely on the strength of two functional capacity evaluations that were not effectively undermined by the insurer.

The insurer's orthopaedic expert was given little weight because his analysis focused unduly on objective findings and failed to address the functional demands of the pre-accident job.

The applicant failed, however, to prove the stricter post-104 week any-occupation test.

Issues of prejudgment interest, special award, and legal expenses were left for further submissions.

The applicant sought income replacement benefits following a motor vehicle accident, claiming he was substantially unable to perform his pre-accident job as a retail investigator.

The insurer terminated benefits and sought repayment of an overpayment.

The arbitrator dismissed the applicant's claim, finding he lacked credibility and had misrepresented his pre-accident medical condition, the nature of his injuries, and the reasons for leaving his employment.

The arbitrator concluded the applicant left his job due to poor performance rather than accident-related injuries.

The applicant was ordered to repay $1,140.30 in overpaid benefits.

The applicant sought interim weekly income replacement benefits (IRBs) and housekeeping benefits following two motor vehicle accidents.

The insurer had terminated benefits based on an insurer's medical examination which concluded the applicant could return to work.

The arbitrator found that the insurer's medical assessment improperly ignored the applicant's pain and relied on flawed heart rate testing to conclude a lack of effort.

Finding that the applicant established a very probable case for ongoing entitlement, the arbitrator ordered the insurer to pay interim IRBs of $400 per week for a 17-week period.

The claim for interim housekeeping benefits was dismissed for lack of evidence.