Applicant entitled to ongoing post-104 week IRBs due to physical and psychological impairments; award denied.
The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for nearly four years before the insurer terminated them based on insurer's examinations.
The applicant sought ongoing IRBs, arguing she suffered a complete inability to engage in suitable employment due to severe physical and psychological impairments, including chronic pain syndrome and PTSD.
The Tribunal found that the applicant met the post-104 week disability test, preferring the evidence of her treating practitioners and experts over the insurer's assessors, who failed to consider her psychological impairments.
The Tribunal ordered the insurer to pay IRBs of $400 per week from the date of termination, plus interest.
However, the Tribunal dismissed the applicant's claim for an award under O. Reg. 664, finding the insurer's reliance on its medical assessments was not unreasonable or immoderate.
OLATOntario Licence Appeal TribunalFeb 5, 2021
