Andrea Genereux

The applicant, a taxi driver, was injured in a rear-end motor vehicle accident and sought statutory accident benefits.

The insurer terminated his income replacement benefits (IRBs) and denied certain medical and assessment treatment plans.

The arbitrator found that the applicant suffered from chronic pain syndrome and psychological impairments, entitling him to both pre-104-week and post-104-week IRBs.

The disputed medical and assessment plans were denied for lack of evidence of reasonableness and necessity at the time of submission.

The arbitrator awarded a maximum 50% special award against the insurer, finding it unreasonably withheld benefits by ignoring mounting medical evidence of the applicant's psychological and cognitive impairments and relying solely on outdated physical assessments.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and medical benefits.

The arbitrator found the applicant was entitled to pre-104 week IRBs because the insurer's own occupational therapy expert concluded she could not perform the essential tasks of her pre-accident employment.

However, post-104 week IRBs were denied as the applicant failed to prove a complete inability to engage in any suitable employment, given her ability to manage a household and work part-time as a house cleaner.

A claim for massage therapy was denied as not reasonable or necessary.

The arbitrator awarded a $1,000 special award against the insurer for unreasonably terminating the pre-104 week IRBs despite clear evidence of the applicant's inability to perform her pre-accident job.