Dr. G. D'Angelo

The insurer appealed an arbitration order regarding the calculation of income replacement benefits (IRBs), interest, and a special award under the SABS-1994.

The Director's Delegate held that the 75% deduction rate for post-accident income under s. 10(4) applies only to a single 26-week period, reversing the arbitrator's application of the lower rate to multiple jobs.

The Delegate upheld the finding that a lump sum lay-off payment was termination pay excluded from income under s. 87.

The Delegate reversed the interest award, finding interest was only payable from 14 days after the insured requested mediation, due to his four-year delay in seeking reinstatement of benefits.

Finally, the Delegate upheld a 15% special award, finding the insurer unreasonably relied on a deficient ergonomist report to terminate benefits.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them, relying on an ergonomist's report.

The applicant applied for arbitration, arguing he remained substantially unable to perform the essential tasks of his pre-accident job as a machine operator due to a shoulder injury and a traumatic brain injury.

The arbitrator found the ergonomist's report fundamentally flawed and accepted the evidence of the applicant's experts and an orthopaedic specialist retained by the insurer.

The arbitrator concluded the applicant was entitled to ongoing income replacement benefits, subject to deductions for post-accident earnings, and ordered a 15% special award against the insurer for unreasonably withholding benefits.

The applicant sought ongoing weekly income benefits and medical and rehabilitation benefits following a motor vehicle accident.

The insurer terminated benefits and sought repayment, alleging the applicant was involved in an insurance fraud scheme and had misrepresented his pre-accident and post-accident employment.

The arbitrator found the applicant entirely unreliable, noting he had pleaded guilty to fraud in relation to false employment confirmation forms.

The arbitrator concluded the applicant sustained only minor soft tissue injuries, was not disabled, and had been actively employed in auto body shops during the benefit period.

The application was dismissed, and the applicant was ordered to repay $27,600 in benefits obtained by fraud, plus interest, and to pay the insurer's $2,000 arbitration assessment.

The applicant was injured in a motor vehicle accident in December 1990 and received weekly income benefits until June 1991.

He applied for arbitration, seeking ongoing weekly income benefits and supplementary medical and rehabilitation expenses, claiming he was substantially unable to perform his essential tasks as a home day care provider due to continuing back and leg pain.

The arbitrator found that the applicant's ongoing pain and disability after June 1991 were the result of a pre-existing degenerative disc disease process rather than the motor vehicle accident.

The claims for ongoing weekly income benefits and rehabilitation expenses were dismissed, though the applicant was awarded his arbitration expenses.