Insurer ordered to pay ongoing IRBs and a 50% special award for unreasonably withholding benefits.
The applicant, a taxi driver, was injured in a rear-end motor vehicle accident and sought statutory accident benefits.
The insurer terminated his income replacement benefits (IRBs) and denied certain medical and assessment treatment plans.
The arbitrator found that the applicant suffered from chronic pain syndrome and psychological impairments, entitling him to both pre-104-week and post-104-week IRBs.
The disputed medical and assessment plans were denied for lack of evidence of reasonableness and necessity at the time of submission.
The arbitrator awarded a maximum 50% special award against the insurer, finding it unreasonably withheld benefits by ignoring mounting medical evidence of the applicant's psychological and cognitive impairments and relying solely on outdated physical assessments.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJan 29, 2018
