Insurer's appeal dismissed; Arbitrator's findings of catastrophic impairment, IRB entitlement, and special award upheld.
The insurer appealed an Arbitrator's decision finding the insured catastrophically impaired, entitled to post-104 week income replacement benefits (IRBs), and awarding a special award of 35% for unreasonably withholding benefits.
The insurer argued the Arbitrator reversed the onus of proof and failed to properly consider causation, specifically the insured's pre-existing psychological issues stemming from childhood abuse.
The Director's Delegate dismissed the appeal, finding the Arbitrator properly applied the 'but for' test, correctly weighed the medical evidence, and reasonably concluded the insurer's reliance on flawed and inconclusive reports justified the special award.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJun 14, 2019
