Mr. D. Antflick

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 when she slipped and fell on a bus.

She applied for statutory accident benefits.

The insurer deducted amounts she received from a private disability policy from her pre 104-week income replacement benefits and denied her post 104-week benefits.

The arbitrator held that the private policy was a non-indemnity policy and its benefits were not deductible.

The arbitrator also found that the applicant suffered a complete inability to engage in suitable employment due to chronic pain and was entitled to post 104-week benefits.

A special award of $1,500 was granted due to the insurer's unreasonable delay in adjusting the claim.