Dr. Rafaela Davila

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, housekeeping, and assessment costs.

The insurer terminated benefits based on an assessment by a general practitioner and a Disability DAC report.

The arbitrator found that the applicant suffered a substantial inability to perform her pre-accident employment as a sewing machine operator for the first 104 weeks, relying on the chronic pain diagnosis of her treating physiatrist and psychologist.

However, the applicant failed to meet the stricter "complete inability" test for post-104 week benefits.

The arbitrator awarded the claimed medical, housekeeping, and assessment expenses.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award under s. 282(10) of the Insurance Act, finding that the insurer unreasonably withheld benefits by relying on flawed assessments, ignoring substantial medical evidence, and improperly requesting a supplementary report from a neutral DAC assessor.

The applicant was injured in a motor vehicle accident and received caregiver benefits.

The insurer terminated these benefits and made a loss of earning capacity (LEC) offer of zero.

The applicant claimed a higher LEC benefit, transportation expenses, housekeeping expenses, and a special award.

The arbitrator found that the applicant was not entitled to a LEC offer because she did not have the functional capacity to earn income at the time of the accident due to severe pre-existing psychiatric problems.

The arbitrator awarded the claimed transportation and housekeeping expenses, but denied the special award.