Insurer ordered to pay medical, transportation, and housekeeping benefits, plus a $5,000 special award.
The applicant was injured in a motor vehicle accident and sought various statutory accident benefits that the insurer had terminated or denied.
The arbitrator found that the applicant's ongoing chiropractic and massage therapy treatments were reasonable for pain relief, and that her physical and cognitive limitations justified the cost of taxi transportation to treatment sessions and ongoing housekeeping expenses.
However, the claim for opioid prescription medication was denied, as the weight of medical opinion indicated it was not beneficial and potentially harmful.
The arbitrator rejected the applicant's argument that her income replacement benefits should include the indexation percentage for the first year following the onset of disability, finding the statutory language clear.
Finally, the arbitrator ordered the insurer to pay a $5,000 special award for unreasonably withholding payment for treatments and medication in blatant disregard of the pay-pending-dispute provisions of the Schedule.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesOct 4, 2001
