Insured who returned to work for over 90 days rebutted presumption of ineligibility for benefits.
The applicant, a truck driver, was injured in a motor vehicle accident and received statutory accident benefits.
He returned to work full-time for nearly six months before stopping due to chronic pain, and sought reinstatement of his weekly income benefits and vocational retraining.
The insurer argued that returning to work for more than 90 days after the two-year anniversary of the accident precluded further benefits under section 16(2) of the Schedule.
The arbitrator held that section 16(2) creates a rebuttable presumption of ineligibility, which the applicant successfully rebutted with medical evidence showing he was substantially disabled from his essential tasks.
The applicant was awarded weekly income benefits up to the 156-week mark and vocational retraining costs, but was denied benefits beyond 156 weeks as he failed to prove he was continuously prevented from engaging in any suitable occupation.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJan 1, 1995
