Insurer ordered to pay ongoing accident benefits and a special award for unreasonably denying treatment plans.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, and housekeeping benefits.
The insurer terminated benefits, arguing the applicant's pain responses were exaggerated and his psychological issues stemmed from pre-existing childhood trauma rather than the accident.
The arbitrator found the applicant credible and concluded that the accident was a material contributing factor to his chronic pain syndrome, fibromyalgia, and depression.
The arbitrator awarded ongoing income replacement benefits, medical benefits for various treatments, and housekeeping benefits.
Furthermore, the arbitrator found the insurer acted unreasonably in denying certain treatment plans without a designated assessment, and ordered the insurer to pay a special award under section 282(10) of the Insurance Act.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJan 23, 2008
