Insurer's request for further neuropsychological assessment denied; payment of 104 weeks of benefits triggered LECB entitlement.
The applicant, who sustained a brain injury as a seven-year-old pedestrian in a motor vehicle accident, sought loss of earning capacity benefits (LECB).
The insurer brought a motion to compel a new neuropsychological assessment.
The arbitrator dismissed the insurer's motion, finding that the applicant had already undergone numerous neuropsychological assessments, her cognitive function had plateaued, and a new in-person assessment was not reasonably required.
On the preliminary issue, the arbitrator held that the insurer was precluded from disputing the applicant's entitlement to an offer for LECB because it had paid 104 weeks of education disability benefits based on a partial inability to carry on a normal life, thereby triggering entitlement under the Schedule.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJun 17, 2008
