Dr. Alcock

The applicant was injured in a motor vehicle accident in the United States and incurred significant hospital expenses.

The respondent insurer paid the hospital up to the $50,000 policy limit for non-catastrophic medical and rehabilitation benefits.

The applicant sought payment of the remaining hospital bill balance, chiropractic services, and an income replacement benefit (IRB).

The adjudicator dismissed the claims for medical expenses, finding that while the expenses were reasonable and necessary, the policy limits had been exhausted.

The adjudicator also dismissed the claim for an IRB, relying on surveillance evidence that showed the applicant working as a truck driver shortly after the accident, contradicting his testimony.

The respondent's request for costs due to the applicant's failure to attend case conferences was denied, as the high standard for awarding costs was not met.

The applicant was injured in a motor vehicle accident and sought income replacement benefits for intermittent days off work over a five-year period.

The insurer denied the claim, arguing the applicant had returned to work for more than 90 days and that an occasional disability did not constitute a substantial inability to perform essential tasks.

The arbitrator found the applicant was entitled to benefits for the days claimed, as he returned to work within 104 weeks and suffered a substantial inability on those specific days.

The arbitrator allowed the insurer to deduct sick leave benefits received.

A special award of $2,500 was ordered against the insurer for unreasonably withholding benefits despite compelling medical evidence.