Dr. Tucker

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for approximately 13 years before the respondent insurer terminated them.

The applicant sought post-104 week IRBs, arguing that his chronic pain, reliance on opioids, and resulting cognitive issues prevented him from working.

The respondent relied on independent medical examinations and video surveillance to argue the applicant could perform light duties.

The Tribunal found that the applicant's pain and medication use severely limited his functionality, rendering him unable to sustain competitive employment.

The Tribunal held that the applicant met the test for post-104 week IRBs and awarded the benefits with interest.

The respondent's request for costs was denied.

The applicant sought arbitration for a catastrophic impairment determination and medical benefits following a motor vehicle accident.

The insurer raised preliminary issues, arguing the applicant failed to attend and submit to a psychiatric insurer examination and that her claims were barred by issue estoppel due to a previous arbitral decision.

The arbitrator found the applicant's behaviour at the examination, while challenging, did not amount to a failure to attend and submit, as the examination was abruptly terminated by the assessor.

The arbitrator also declined to apply issue estoppel, noting catastrophic impairment was not decided in the previous proceeding.

The issue of res judicata for specific medical benefits was deferred to the hearing arbitrator.

The applicant was awarded her expenses for the preliminary hearing.