Insured entitled to ongoing post-156 week income benefits as chronic pain prevented return to suitable employment.
The applicant was injured in a motor vehicle accident and received weekly income benefits from the insurer.
After 156 weeks, the insurer terminated the benefits, arguing the applicant did not meet the stricter test under section 12(5)(b) of the Statutory Accident Benefits Schedule, which requires that the injury continuously prevents the insured from engaging in any occupation or employment for which they are reasonably suited by education, training, or experience.
The applicant, a former nurse, argued she suffered from chronic pain syndrome and was retraining as a counsellor.
The arbitrator found the applicant's decision to retrain was reasonable and supported by her treating physicians.
The arbitrator concluded that the applicant's injuries continuously prevented her from engaging in suitable employment and ordered the insurer to pay ongoing weekly income benefits from the date of termination, along with arbitration expenses.
Judy Spicer v. State Farm Mutual Automobile Insurance Company, 1995 ONICDRG 56
