Dr. Peter Parker

The insurer appealed an arbitration decision ordering it to pay income replacement benefits beyond the 104-week mark, a maximum special award, and arbitration expenses.

The Director of Arbitrations upheld the ongoing entitlement to income replacement benefits, finding that the evidence supported the conclusion that the insured suffered a complete inability to engage in suitable employment.

However, the special award was reduced to $5,000 because the insurer's initial reliance on its experts was not unreasonable, and the arbitration expenses were slightly reduced to exclude pre-mediation legal work.

The applicant, a health care aide, was injured in a motor vehicle accident and received income replacement benefits for 104 weeks.

The insurer terminated benefits, arguing she could perform alternative employment.

The arbitrator found the insurer's vocational assessments relied on erroneous assumptions about the applicant's education and skills.

The arbitrator concluded the applicant suffered a complete inability to engage in suitable employment and awarded ongoing benefits.

Additionally, the arbitrator ordered a special award of 50 per cent of outstanding benefits, finding the insurer unreasonably withheld payments by ignoring credible evidence of the applicant's limitations.

The applicant was injured in a motor vehicle accident and received income replacement benefits for 104 weeks.

The insurer terminated benefits, and the applicant sought ongoing income replacement, attendant care, and housekeeping benefits.

The arbitrator found that the applicant did not suffer a complete inability to engage in suitable employment due to physical injuries, but did suffer such an inability due to psychological complications (severe depression and anxiety) until her condition stabilized.

The arbitrator awarded income replacement benefits for a closed period.

The claims for attendant care and housekeeping expenses were dismissed because the applicant failed to prove she incurred a cost or obligation to pay her husband for those services.

The appellant appealed an arbitration decision dismissing her claim for income replacement benefits following a motor vehicle accident.

The arbitrator had rejected her claim on the basis that she was not employed at the time of the accident, relying in part on hearsay statements made by her alleged employer and a co-worker to an investigator.

On appeal, the Director's Delegate found that the arbitrator erred in relying on the hearsay evidence without the witnesses being called to testify.

However, the appeal was dismissed because the arbitrator's rejection of the appellant's employment evidence was supportable based on other significant inconsistencies and gaps in her own testimony.

The applicant was struck by a tow-truck after a motor vehicle accident and claimed statutory accident benefits.

The insurer terminated his weekly income replacement benefits in September 1995.

The applicant applied for arbitration, arguing he remained substantially disabled from his pre-accident employment as a gas station attendant due to physical and psychological injuries.

The arbitrator found that while the applicant was not physically disabled from working, he required psychological treatment to facilitate his return to the workplace.

The arbitrator concluded the applicant remained substantially disabled until his psychotherapy sessions concluded in March 1996, after which any residual restrictions were self-imposed or could be accommodated.

The applicant was awarded income replacement benefits for the closed period from September 1995 to March 1996.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, arguing he was no longer disabled.

The applicant sought benefits for an additional five months.

The insurer sought repayment of nearly $30,000, arguing the applicant failed to apply for available long-term disability (LTD) benefits through his employer.

The arbitrator dismissed the applicant's claim, finding insufficient evidence of ongoing disability.

The arbitrator also dismissed the insurer's claim for repayment, finding the applicant did not act fraudulently or in error by failing to apply for LTD benefits after his employment was terminated, and that the LTD benefits were not clearly available to him.