The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them, alleging failure to cooperate with a Residual Earning Capacity Designated Assessment Centre (REC DAC).
The applicant applied for arbitration, seeking ongoing IRBs and attendant care benefits.
The arbitrator found that the REC DAC did not report a failure to cooperate, meaning the insurer improperly stopped the IRBs.
On the merits, the arbitrator preferred the evidence of the applicant's medical experts, finding that the applicant suffered from a psychotic disorder and post-concussion syndrome caused by the accident, rendering him substantially unable to perform his pre-accident employment.
The insurer's allegations of malingering were rejected.
However, the claim for attendant care benefits was dismissed due to insufficient evidence of need, particularly given surveillance showing the applicant driving and taking public transit independently.
