Insurer ordered to pay retroactive personal assistance benefits and a special award for unreasonably withholding payments.
The applicant, an Ontario resident, was injured in a motor vehicle accident in Quebec and elected to receive personal assistance and care expenses under the Quebec Automobile Insurance Act.
The insurer paid benefits initially but terminated them in November 2003 based on an occupational therapy assessment.
The applicant sought retroactive and ongoing benefits, arguing the assessment failed to account for her cognitive deficits.
The arbitrator found the initial assessment flawed and accepted a later assessment that properly scored the applicant's need for assistance with complex tasks due to her brain injury.
The arbitrator awarded retroactive benefits of $70 per week for the period from November 2003 to January 2010, and ongoing benefits at a higher rate thereafter.
Furthermore, the arbitrator found the insurer unreasonably withheld benefits by failing to reassess the applicant upon receiving new information about her cognitive challenges, and ordered the insurer to pay a special award and interest.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesSep 16, 2011
