Dr. Stephen H. Gallay

The insurer appealed an arbitration decision awarding the claimant ongoing income replacement benefits, housekeeping benefits, assessment expenses, and a special award under the SABS-1996.

The Director's Delegate dismissed the appeal on the merits, finding no error in the arbitrator's preference for the claimant's medical and lay evidence over the insurer's experts.

The arbitrator's finding that the insurer unreasonably terminated benefits based on an incomplete functional abilities evaluation, justifying a special award, was also upheld.

The appeal was allowed in part only to revoke an inadvertent order regarding arbitration expenses.

The applicant, a self-employed hairstylist, was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer terminated his income replacement and housekeeping benefits.

The arbitrator found that the insurer's termination of the income replacement benefit was fatally flawed because it relied on a functional abilities evaluation that had not actually been conducted at the time of termination.

The applicant was awarded pre-104 week income replacement benefits, as his chronic pain substantially disabled him from performing the essential tasks of his employment, though he did not meet the post-104 week test of complete inability to engage in any suitable employment.

The arbitrator also awarded housekeeping and home maintenance benefits, the cost of an in-home assessment, and a special award of $2,000 against the insurer for unreasonably relying on the flawed termination notice.