Section 64 of the SABS governs the process for stopping benefits but does not create substantive entitlement.
The appellant was injured in a motor vehicle accident and claimed caregiver benefits under the Statutory Accident Benefits Schedule.
The insurer paid a lower rate of disability benefits and later terminated them after an independent medical examination.
The appellant requested a Designated Assessment Centre (DAC) evaluation, which also concluded she was not disabled.
At arbitration, the arbitrator found the appellant was entitled to the higher caregiver benefit rate but only until the date of the first medical examination.
On appeal, the appellant argued that section 64 of the SABS required the insurer to pay benefits until the DAC report was issued.
The Director's Delegate dismissed the appeal, holding that section 64 governs the process for stopping benefits but does not create an absolute entitlement immune from a later finding that disability ended earlier.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJul 23, 1997
