Insurer precluded from raising causation defence after paying IRBs to 104-week mark and transitioning to LECBs.
The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the insurer.
After two years, the insurer transitioned the applicant to loss of earning capacity benefits (LECBs).
The insurer later attempted to argue that the applicant's disability was unrelated to the accident.
The arbitrator held that the insurer was precluded from raising a causation defence because it had paid IRBs to the 104-week mark without protest and had already begun paying LECBs.
The arbitrator determined the applicant's residual earning capacity at various stages, awarding LECBs based on a 30-hour work week initially, and a 20-hour work week after the three-year review.
The arbitrator also awarded supplementary medical expenses and a $3,000 special award for the insurer's unreasonable refusal to fund psychological counselling.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJul 4, 2001
