Insurer ordered to pay death benefits, funeral benefits, and a special award for unreasonably denying claim.
The applicant sought death and funeral benefits after her 87-year-old husband fell backwards on a street, suffered a severe closed head injury, and died days later.
The insurer denied the claim, arguing there was insufficient evidence that its insured's van caused the fall.
The arbitrator found on a balance of probabilities that the van made contact with the deceased, causing him to fall and sustain the fatal injury.
The arbitrator awarded $25,000 in death benefits and $6,000 in funeral benefits, plus interest.
Furthermore, the arbitrator found the insurer unreasonably withheld benefits by failing to properly investigate, ignoring supportive evidence, and allowing a tort supervisor to influence the accident benefits decision, thereby justifying a special award under s. 282(10) of the Insurance Act.
