Dr. E. English

The appellant was injured in a motor vehicle accident and applied for non-earner benefits.

The insurer denied the claim based on orthopaedic and neurological independent medical examinations, but failed to provide the neurological report with its denial notice.

The arbitrator held that the failure to provide the report did not invalidate the denial and that the appellant's claim was statute-barred by the two-year limitation period.

On appeal, the Director's Delegate found that the insurer's failure to provide the medical report upon which it relied meant the denial lacked sufficient reasons to permit the insured to decide whether to challenge it.

The limitation period did not commence until the report was finally provided, meaning the appellant's application for mediation was timely.

The applicant was injured in a motor vehicle accident in 2007 and sought ongoing income replacement and housekeeping benefits, claiming the accident exacerbated a pre-existing right knee injury.

The insurer terminated benefits in February 2008 based on medical assessments.

The arbitrator found the applicant's evidence lacked credibility due to inconsistencies and symptom magnification.

Relying on medical experts, the arbitrator concluded the 2007 accident only temporarily exacerbated the pre-existing knee condition, which resolved by April 18, 2008.

The applicant was awarded income replacement and housekeeping benefits up to that date, but the claim for a special award was dismissed as the insurer's termination was not unreasonable.

The applicant was injured in a motor vehicle accident and claimed ongoing income replacement benefits.

The insurer terminated benefits based on independent medical examinations and a DAC report suggesting the applicant could work.

The arbitrator found the applicant suffered significant cognitive impairments rendering him competitively unemployable, characterizing his post-accident work at his brother's video store as a sheltered workshop.

The arbitrator ordered the reinstatement of income replacement benefits at $340.53 per week and found the insurer liable for a special award for unreasonably withholding benefits by relying on flawed reports that ignored the overwhelming evidence of the applicant's disability.