Income replacement benefits denied for subsequent work injury, but insurer penalized for unilaterally terminating medical benefits.
The applicant was injured in a motor vehicle accident and received income replacement benefits until returning to heavy physical work.
Ten months later, he stopped working due to back pain and sought reinstatement of benefits, claiming the disability resulted from the accident.
The insurer denied the claim, arguing the new disability was a work-related repetitive strain injury.
The arbitrator agreed with the insurer on causation, dismissing the claim for income replacement benefits.
However, because the insurer unilaterally terminated payment for medical and rehabilitation treatments without following the mandatory dispute resolution procedures under the Statutory Accident Benefits Schedule, the arbitrator ordered the insurer to pay for those treatments up to the date it formally notified the providers of the negative assessment results, plus a 25% special award for unreasonable withholding.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJan 7, 1999
