Insurer ordered to pay accident benefits and a $30,000 special award for unreasonably withholding payments.
The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, including income replacement, rehabilitation, housekeeping, and dependant care benefits.
The insurer terminated benefits based on a disability DAC assessment by a chiropractor.
The arbitrator found that the applicant suffered from a severe TMJ disorder, chronic pain, and depression, rendering her substantially unable to perform the essential tasks of her pre-accident employment as a travel consultant.
The arbitrator awarded the claimed benefits and ordered the insurer to pay a $30,000 special award for unreasonably withholding benefits, noting the insurer's reliance on an assessor lacking expertise in TMJ disorders and its failure to re-evaluate its position in light of overwhelming medical evidence.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJan 11, 2000
