Dr. A. Margulies

The applicant sought income replacement benefits (IRBs) and other expenses following a 1995 motor vehicle accident.

The insurer reduced and then terminated the IRBs, and sought repayment of all benefits paid, alleging fraud.

The arbitrator found that the applicant had fabricated his employment history, concealed a previous disabling car accident, and grossly exaggerated his injuries, with medical evidence suggesting malingering.

The applicant's claims were dismissed in their entirety.

The arbitrator ordered the applicant to repay $37,879 in IRBs and rehabilitation expenses obtained through fraudulent misrepresentation, and awarded the insurer its arbitration expenses and assessment fee, finding the application frivolous and an abuse of process.

The applicant, a pedestrian, was struck by a car and sustained physical injuries and a traumatic brain injury.

He subsequently developed bipolar affective disorder.

The insurer terminated his weekly non-income benefits.

The arbitrator found that the applicant's psychiatric illness was caused by the accident and that he was substantially unable to perform his essential tasks for the period up to 156 weeks post-accident, entitling him to benefits under s. 13(1) of the Schedule.

However, the arbitrator concluded the applicant did not meet the stricter test under s. 13(8) for benefits beyond 156 weeks, as he was not continuously prevented from engaging in substantially all of his normal activities.

The claim for a special award was dismissed as the insurer's termination of benefits was not unreasonable.