Insured entitled to EDBs and LEC offer at 104 weeks based on partial inability.
The applicant, who sustained a severe brain injury in a motor vehicle accident, sought Education Disability Benefits (EDBs) for the period of July 12 to July 15, 1996, which marked 104 weeks post-accident.
The insurer had terminated EDBs just prior to this date.
The arbitrator found that the applicant suffered a substantial inability to continue his specific pre-accident educational path, despite his efforts to attend university part-time with accommodations.
The arbitrator also found that the applicant suffered a partial inability to carry on a normal life.
Furthermore, the arbitrator ruled that under the Statutory Accident Benefits Schedule, an insured only needs to demonstrate a partial inability to carry on a normal life at the exact 104-week mark to be entitled to a Loss of Earning Capacity (LEC) benefits offer, rejecting the insurer's argument that complete inability was required.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJan 14, 1999
