Dr. B. Alpert

The appellant sought leave to appeal a preliminary arbitration order requiring him to attend two insurer medical examinations (IMEs) to assess his entitlement to post-104 week income replacement benefits.

The Director's Delegate declined to exercise discretion under Rule 50.2 of the Dispute Resolution Practice Code to accept the appeal.

The Delegate found that the arbitrator's decision was a preliminary procedural order, and accepting the appeal would add expense and delay rather than facilitate a cost-effective resolution.

The arbitrator had properly considered the relevant criteria for IME requests, including the change in the disability test and procedural fairness, and the appeal did not raise novel or important issues warranting intervention.

The applicant was injured in a rear-end motor vehicle accident and received income replacement benefits until the insurer terminated them at the 104-week mark.

The insurer argued the applicant was capable of returning to work, relying on assessments suggesting symptom magnification and a lack of organic basis for his pain.

The arbitrator found the applicant credible and accepted medical evidence that he suffered from chronic pain syndrome, depression, and adjustment disorder as a result of the accident.

The arbitrator concluded that the combination of the applicant's physical and psychological impairments rendered him completely unable to engage in any employment for which he was reasonably suited by education, training, or experience.

The applicant was awarded ongoing income replacement benefits.

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 was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement and medical benefits.

The arbitrator found that the applicant was substantially disabled from his pre-accident employment as a vacuum installer due to an exacerbation of a pre-existing back condition, entitling him to income replacement benefits for the 104-week period.

However, he did not meet the test for a complete inability to engage in any employment thereafter.

The arbitrator also awarded partial medical benefits, noting the insurer failed to comply with the Schedule's procedures for denying treatment plans, but denied other medical benefits as not reasonable or necessary.

Interest and arbitration expenses were awarded to the applicant.

The insurer appealed an arbitration decision reinstating the insured's income replacement benefits, arguing the Arbitrator failed to apply the 'crumbling skull' rule to the insured's pre-existing heart condition.

The Director's Delegate dismissed the appeal, finding the Arbitrator correctly applied the 'significant or material contribution' test from Athey v. Leonati.

The Arbitrator's factual finding that the insured's heart condition did not deteriorate significantly after the accident and did not impact his functional ability was supported by the evidence and not reviewable as an error of law.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on a disability assessment.

The applicant sought ongoing benefits, arguing that accident-related headaches, neck, and back pain prevented him from working full-time as a travel agent.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment due to chronic pain from soft-tissue injuries and aggravated pre-existing conditions.

The arbitrator ordered the insurer to pay ongoing income replacement benefits but denied the applicant's claim for a special award, finding the insurer's termination of benefits was not unreasonable.

The applicant, a self-employed baker and greenhouse operator, was injured in a head-on motor vehicle collision.

The insurer terminated her income replacement benefits at the 104-week mark, arguing she was no longer disabled and seeking repayment for allegedly overstated pre-accident income.

The arbitrator found the applicant remained substantially disabled from the essential tasks of her pre-accident employment, relying heavily on compelling lay witness testimony regarding her post-accident cognitive and physical decline.

The arbitrator also accepted the applicant's evidence regarding her pre-accident earnings, setting the ongoing benefit at $634.82 weekly and ordering the insurer to pay $34,233 in arrears.