Dr. L.P. Tuff

The insurer appealed an arbitrator's decision awarding the insured, a minor who sustained a catastrophic brain injury, private school tuition as a rehabilitation benefit and a $28,000 special award for unreasonably withholding benefits.

The Director's Delegate upheld the tuition award, finding no error in the arbitrator's conclusion that the expense was reasonable, necessary, and 'incurred' under the Schedule despite not being paid upfront.

The Delegate also upheld the entitlement to a special award, noting the insurer unreasonably relied on preliminary and flawed expert reports to deny benefits.

However, the Delegate set aside the quantum of the special award and remitted it to arbitration, finding the arbitrator failed to provide sufficient reasons explaining how the $28,000 figure was calculated.