Insurer ordered to pay homemaker benefits and a $4,000 special award for unreasonably terminating benefits.
The applicant was injured in a minor rear-end motor vehicle accident and claimed weekly accident benefits as a homemaker.
The insurer paid benefits until January 3, 1991, and then terminated them based on surveillance and an adjuster's lay observations, despite medical evidence supporting ongoing disability.
The arbitrator found that the applicant's part-time sales work from home did not disqualify her from claiming homemaker benefits under section 13 of the Statutory Accident Benefits Schedule.
The arbitrator concluded that the applicant suffered a somatoform pain disorder triggered by the accident and remained substantially unable to perform her essential homemaking tasks until December 1, 1991.
The arbitrator awarded weekly benefits of $285 for the disputed period and ordered a $4,000 special award against the insurer for unreasonably terminating and withholding benefits without medical evidence.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesFeb 22, 1994
