Dr. Keith Hayes

The insurer appealed an arbitration decision that found the insured met the post-156 week test for weekly income benefits and ordered the insurer to pay ongoing benefits and certain medical and rehabilitation accounts.

The insurer argued the arbitrator failed to properly analyze surveillance evidence and conflicting medical opinions regarding the insured's pain-based limitations.

The Director's Delegate dismissed the appeal, finding that the arbitrator provided an adequate explanation for her conclusions, properly considered the surveillance evidence, and reasonably determined that the disputed accounts were necessary expenses.

The applicant was injured in a motor vehicle accident and received weekly income benefits for 156 weeks.

The insurer terminated benefits, arguing she was capable of returning to work.

The arbitrator found that while the applicant suffered from chronic pain and was disabled from full-time work commensurate with her background, she was capable of part-time employment.

The arbitrator ordered the resumption of weekly income benefits but allowed the insurer to deduct 80% of the income available from part-time employment under section 15 of the Schedule.

The applicant was also awarded certain rehabilitation expenses, but her claim for a special award was dismissed.