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The test for post-104-week income replacement benefits requires a contextual analysis of suitable employment without imposing stand-alone requirements for competitive real-world settings or comparable status.
The appellant sought income replacement benefits (IRBs) under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The central issue was the correct interpretation of the test for post-104-week IRBs under section 6(2)(b) of the Schedule.
The appellant argued that the test requires consideration of employment in a competitive, real-world setting comparable in nature, status, and remuneration to the insured's former employment.
The respondent insurer argued that the statutory test does not include such requirements.
The Court of Appeal upheld the lower courts' decisions, holding that while factors such as competitive real-world setting, status, and remuneration are relevant considerations in the evidence-based analysis, they are not stand-alone requirements of the test.
The appellant failed to prove a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience, particularly given evidence that wedding planning remained a viable option.
Pre-104 week IRB granted but post-104 week IRB denied due to capacity for alternative employment.
The applicant sought income replacement benefits (IRBs) following a 2014 motor vehicle accident.
The Tribunal found the applicant met the test for a pre-104 week IRB, as her physical and psychological impairments caused a substantial inability to perform the essential tasks of her pre-accident employment as an educational assistant.
However, the claim for a post-104 week IRB was dismissed.
The Tribunal concluded the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited, noting her volunteer work in a retail setting, her training as a wedding planner, and medical evidence indicating improvement in her condition.
Claims for a special award were dismissed, but interest was awarded on overdue pre-104 week benefits.
