Dr. Frank Deegan

The insurer appealed an arbitration decision that excluded the evidence of a replacement medical expert and ordered a $40,000 special award for unreasonably delaying and withholding income replacement benefits.

The Director's Delegate upheld the exclusion of the replacement expert's evidence, finding no error of law.

While the Delegate agreed that the insurer unreasonably delayed and withheld benefits, he found the arbitrator erred in calculating the special award by applying it to post-104 week benefits based on a late-filed medical report the insurer had no time to consider.

The Delegate also found the arbitrator failed to consider mitigating factors and proportionality.

The special award was reduced to $10,000.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer terminated his weekly income replacement benefits on October 24, 2000.

The applicant applied for arbitration, seeking ongoing income replacement benefits and a special award.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of his employment for the first 104 weeks, and a complete inability to engage in any suitable employment thereafter due to chronic pain and depression.

The arbitrator also found that the insurer unreasonably withheld the benefits despite having sufficient medical and employment information, and awarded a special award of $40,000 inclusive of interest.

In a preliminary issue hearing for a statutory accident benefits arbitration, the insurer sought to admit the medical report of an expert who died before the hearing, as well as a critique report by a different doctor to stand in his place.

The arbitrator admitted the deceased doctor's report, noting it was prepared at a crucial time when benefits were terminated and no other examination could be obtained, though its weight would be adjusted since he could not be cross-examined.

However, the arbitrator refused to admit the second doctor's report or allow him to testify, as there was no evidence he shared the same medical specialty as the deceased expert.

The applicant, a 69-year-old woman, was injured when the city bus she was riding stopped suddenly.

She applied for statutory accident benefits, but the insurer terminated medical benefits and refused to pay for housekeeping.

The arbitrator found that the applicant suffered physical and psychological impairments as a result of the accident, aggravating pre-existing conditions.

The arbitrator ordered the insurer to pay for physiotherapy, psychological treatment, medical assessments, and housekeeping expenses.

The insurer's argument that the applicant was disentitled to benefits for failing to attend a DAC assessment was rejected due to defective notice.

The applicant was awarded her arbitration expenses.