Insured entitled to ongoing weekly income benefits for psychological disability; insurer's fraud and repayment claims dismissed.
The applicant was injured in a motor vehicle accident and received weekly income benefits for five years before the insurer terminated them.
The applicant sought ongoing benefits under subsection 12(5) of the Statutory Accident Benefits Schedule, claiming she was continuously prevented from engaging in any suitable employment due to a psychological disability.
The arbitrator found the applicant credible and rejected the insurer's argument, based on video surveillance and one psychiatric opinion, that she was feigning her disability.
The arbitrator concluded the accident significantly contributed to her post-traumatic stress disorder and major depression, rendering her totally disabled.
The arbitrator also fixed the weekly benefit amount at $311.66 based on the insurer's own accountant's report, and dismissed the insurer's claims for repayment and post-accident income deductions.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJun 17, 1999
