Ms. E. Poon

The insurer appealed an arbitration order awarding the insured person ongoing income replacement benefits, attendant care benefits, medical benefits, and a special award following a motor vehicle accident.

The Director's Delegate upheld the award of income replacement benefits, finding no error in the arbitrator's conclusion that the insured person suffered a complete inability to engage in suitable employment due to chronic pain.

However, the Delegate reversed the award of attendant care benefits beyond the 104-week mark, holding that the transitional provisions of the SABS-1996 did not suspend the temporal limit.

The Delegate also reversed the award of medical benefits for a specific clinic, finding the arbitrator erred in ordering benefits solely because of a delay in obtaining a DAC report.

The special award was consequently reduced to reflect only those benefits that were unreasonably delayed and actually payable.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer terminated weekly income replacement benefits after 104 weeks.

The arbitrator found that the applicant suffered from a chronic pain disorder and met the test of a complete inability to engage in any employment for which he was reasonably suited.

The arbitrator awarded ongoing income replacement benefits, attendant care benefits, medical and rehabilitation expenses, and the costs of various medical reports.

Furthermore, the arbitrator granted a special award of $2,500 against the insurer for unreasonably withholding and delaying payments for medical and attendant care benefits recommended by its own experts.