Insured entitled to income replacement benefits for intermittent days off work; special award granted against insurer.
The applicant was injured in a motor vehicle accident and sought income replacement benefits for intermittent days off work over a five-year period.
The insurer denied the claim, arguing the applicant had returned to work for more than 90 days and that an occasional disability did not constitute a substantial inability to perform essential tasks.
The arbitrator found the applicant was entitled to benefits for the days claimed, as he returned to work within 104 weeks and suffered a substantial inability on those specific days.
The arbitrator allowed the insurer to deduct sick leave benefits received.
A special award of $2,500 was ordered against the insurer for unreasonably withholding benefits despite compelling medical evidence.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesSep 27, 2006
