Applicant with catastrophic brain injury awarded ongoing income replacement benefits; DAC assessment found inherently flawed.
The applicant, who suffered a catastrophic brain injury when struck by a car as a pedestrian, applied for ongoing income replacement benefits beyond the 104-week mark.
The insurer terminated benefits based on a DAC assessment concluding the applicant could work.
The arbitrator found the DAC assessment inherently flawed and preferred the evidence of the applicant's treating practitioners, which demonstrated that despite numerous attempts to work, the applicant's cognitive, behavioural, and physical deficits rendered him completely unable to engage in suitable employment.
The arbitrator ordered the insurer to pay ongoing income replacement benefits with interest, declined to reopen the hearing for new evidence, and gave notice that a special award for unreasonably withholding benefits was being considered.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesNov 5, 2003
