Insurer ordered to pay ongoing accident benefits and a $3,000 special award for unreasonable delay.
The applicant was injured in a motor vehicle accident and received weekly income benefits and rehabilitation benefits from the insurer.
The insurer terminated the weekly benefits, arguing the applicant was no longer substantially unable to perform the essential tasks of her pre-accident employment as a sales clerk.
The arbitrator found that the medical evidence, including the insurer's own medical examination, supported the applicant's ongoing inability to work due to chronic pain and fibromyalgia.
The arbitrator ordered the insurer to pay ongoing weekly income benefits and outstanding rehabilitation expenses.
Furthermore, the arbitrator awarded a special award of $3,000 against the insurer for unreasonably withholding and delaying the payment of benefits, noting the insurer's refusal to share medical reports and its inappropriate reliance on a medical report that actually recommended further rehabilitation.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesApr 15, 1994
