Insurer ordered to pay ongoing income replacement benefits as applicant proved complete inability to work.
The applicant was injured in a motor vehicle accident and received income replacement benefits for 104 weeks.
The insurer terminated the benefits based on a Designated Assessment Centre (DAC) report concluding the applicant did not suffer a complete inability to engage in any employment for which he was reasonably suited.
The applicant disputed the termination, relying on a failed work trial and expert medical opinions indicating he could not sustain employment due to chronic pain.
The arbitrator rejected the DAC's conclusion, finding its process flawed and its functional abilities testing inadequate to measure the applicant's actual ability to work.
The arbitrator held that the applicant met the test for complete inability to engage in suitable employment and ordered the insurer to pay ongoing income replacement benefits and the expenses of the arbitration.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJul 12, 2001
