Dr. G.S. Conn

The appellant insurer appealed an arbitration decision awarding the respondent insured various statutory accident benefits, including attendant care, a hot tub, massage therapy, psychological counseling, and ergonomic equipment, as well as a special award and legal expenses.

The Director's Delegate dismissed most of the appeal, finding no errors of law in the Arbitrator's awards for the benefits, interest, and the special award, noting the insurer unreasonably withheld payments by relying on flawed medical assessments that applied incorrect legal tests.

The Delegate found the Arbitrator erred by failing to provide reasons for allowing an increased claim for ergonomic equipment and for awarding legal expenses.

With the parties' consent, the Delegate redetermined these issues, denying the increased equipment costs but awarding the original amount plus HST, and fixing the respondent's arbitration legal expenses at $95,633.79 and appeal legal expenses at $24,179.67.

The applicant, a visiting homemaker, was struck by a motor vehicle and received income replacement benefits until the insurer terminated them, claiming she could return to work.

The applicant sought reinstatement of benefits, arguing she suffered from benign paroxysmal positional vertigo and soft tissue injuries preventing her from working.

The arbitrator found that while the soft tissue injuries did not prevent her from working, the vertigo caused a substantial inability to perform the essential tasks of her pre-accident employment.

The applicant was awarded ongoing income replacement benefits but denied the cost of a multidisciplinary assessment.