Dr. T. Schapira

The applicant sought interim income replacement benefits after the insurer terminated them.

The arbitrator found that the insurer's termination of benefits was based on a flawed Designated Assessment Centre (DAC) process, which failed to comply with section 64 of the Statutory Accident Benefits Schedule.

The arbitrator also found that the applicant established a strong prima facie case for entitlement to benefits and demonstrated financial urgency.

The insurer was ordered to pay interim benefits of $313.77 per week, with the issues of a special award and expenses reserved for the main arbitration hearing.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on an occupational medicine examination.

The applicant was subsequently involved in a second motor vehicle accident but only sought benefits related to the first.

The arbitrator found that the applicant's evidence was inconsistent and that multiple medical specialists noted exaggerated pain behaviour and illness behaviour.

The arbitrator concluded that the applicant did not suffer a physiological or anatomical impairment from the first accident that disabled her from working, and that her psychological impairment did not prevent her from performing the essential tasks of her employment.

The application for arbitration was dismissed.

The appellant was injured in a minor rear-end collision and received extensive rehabilitation services funded by the respondent insurer.

After the insurer terminated funding based on medical assessments indicating the appellant could return to pre-accident activities, the appellant sought funding for a holistic treatment program through Trauma Services.

The arbitrator dismissed the claim for these additional rehabilitation benefits, finding them neither necessary nor reasonable.

On appeal, the Director's Delegate confirmed the arbitrator's decision, finding no error in the arbitrator's evaluation of the evidence, including the reliance on expert testimony and the conclusion that the appellant's needs had been adequately met by the previously funded services.