Dr. Emile Ramlochan

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the insurer, including income replacement benefits (IRBs) and medical benefits.

The insurer denied the benefits based on its assessors' reports, which concluded the applicant could return to his pre-accident employment as a heavy labourer.

The arbitrator found the applicant's evidence and his experts' reports more credible, noting the insurer's assessors lacked complete information and ignored the applicant's chronic pain.

The arbitrator held that the applicant met the test for IRBs both before and after the 104-week mark, as he suffered a complete inability to engage in suitable employment.

The requested medical benefits were also found to be reasonable and necessary.

However, the arbitrator dismissed the claim for a special award, finding the insurer did not act unreasonably in relying on its medical assessors, despite the flaws in their reports.

The applicant was injured in a motor vehicle accident while riding his bicycle.

The insurer paid income replacement benefits for 104 weeks but terminated them, arguing the applicant did not meet the more stringent test of complete inability to engage in suitable employment.

The arbitrator found the applicant, who was functionally illiterate in English and had a history of heavy physical labour, suffered from chronic pain and psychological impairments caused by the accident.

The arbitrator rejected the insurer's expert evidence that the applicant was malingering, finding instead that he was completely disabled from working.

The applicant was awarded ongoing income replacement benefits.

However, his claim for a multidisciplinary pain management program was dismissed as he failed to prove it was reasonable and necessary, given a previous similar program had not yielded further recovery.