Applicant entitled to ongoing income replacement benefits for chronic pain, but must repay overpayment.
The applicant was injured in a rear-end motor vehicle accident and claimed statutory accident benefits, including income replacement benefits (IRBs) and medical rehabilitation expenses.
The insurer terminated IRBs based on medical assessments suggesting the applicant was not disabled.
The arbitrator found the applicant was substantially disabled from his pre-accident employment as a limousine driver due to chronic pain syndrome and fibromyalgia, entitling him to ongoing IRBs and a Loss of Earning Capacity (LEC) offer.
However, the arbitrator dismissed the claim for ongoing physical therapy expenses, finding them no longer reasonable or necessary.
Furthermore, the arbitrator determined the correct quantum of the IRB was $185 per week, not the previously paid $273.20, and ordered the applicant to repay the $9,387 overpayment due to his material misrepresentation regarding his income tax filings.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesApr 10, 2000
