Insurer ordered to provide loss of earning capacity offer after paying benefits past 104 weeks.
The applicant was injured in a motor vehicle accident and received income replacement benefits from the insurer.
The insurer terminated the benefits after 104 weeks but did not provide a loss of earning capacity offer.
The applicant sought an order for a loss of earning capacity offer and ongoing income replacement benefits pending the offer.
The arbitrator held that because the insurer paid benefits past the 104-week mark without invoking stoppage provisions, it was estopped from arguing the applicant did not qualify for a loss of earning capacity offer.
However, based on medical and DAC assessments, the applicant did not suffer a substantial inability to perform the essential tasks of his employment after February 1997, so he was not entitled to ongoing income replacement benefits.
The insurer's claim for repayment of an overpayment was dismissed as it was out of time.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesSep 29, 2000
