Insurer ordered to reinstate income replacement benefits after egregiously breaching statutory benefit stoppage procedures.
The applicant was injured in a motor vehicle accident and received income replacement benefits from the insurer.
The insurer terminated the benefits, and the applicant requested a Designated Assessment Centre (DAC) assessment.
The parties postponed the assessment for settlement discussions, but when those failed, the insurer refused to arrange the DAC assessment or reinstate benefits, arguing the applicant had waived his rights.
The arbitrator found that the insurer egregiously breached section 64 of the Statutory Accident Benefits Schedule by failing to continue benefits pending the DAC assessment.
The arbitrator ordered the insurer to reinstate the applicant's income replacement benefits with interest, finding the breach alone justified the interim award, and alternatively, that the applicant met the threshold criteria for interim benefits.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesDec 24, 1997
