April Belbeck

The insurer appealed an arbitration order regarding the calculation of income replacement benefits (IRBs), interest, and a special award under the SABS-1994.

The Director's Delegate held that the 75% deduction rate for post-accident income under s. 10(4) applies only to a single 26-week period, reversing the arbitrator's application of the lower rate to multiple jobs.

The Delegate upheld the finding that a lump sum lay-off payment was termination pay excluded from income under s. 87.

The Delegate reversed the interest award, finding interest was only payable from 14 days after the insured requested mediation, due to his four-year delay in seeking reinstatement of benefits.

Finally, the Delegate upheld a 15% special award, finding the insurer unreasonably relied on a deficient ergonomist report to terminate benefits.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them, relying on an ergonomist's report.

The applicant applied for arbitration, arguing he remained substantially unable to perform the essential tasks of his pre-accident job as a machine operator due to a shoulder injury and a traumatic brain injury.

The arbitrator found the ergonomist's report fundamentally flawed and accepted the evidence of the applicant's experts and an orthopaedic specialist retained by the insurer.

The arbitrator concluded the applicant was entitled to ongoing income replacement benefits, subject to deductions for post-accident earnings, and ordered a 15% special award against the insurer for unreasonably withholding benefits.