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Insurer ordered to pay past and ongoing accident benefits and an $18,000 special award for bad faith.
The applicant was injured in a 1994 motor vehicle accident and received statutory accident benefits from the insurer for ten years.
In 2004, the insurer abruptly terminated or reduced her housekeeping, home maintenance, and transportation benefits, and later denied a treatment plan for acupuncture.
The arbitrator found that the applicant's pre-existing fibromyalgia and arthritis were significantly aggravated by the accident, entitling her to the claimed benefits.
The arbitrator awarded past and ongoing housekeeping, home maintenance, and transportation expenses, as well as the acupuncture treatment.
Furthermore, the arbitrator found that the insurer breached its duty of good faith by arbitrarily reducing benefits without proper assessment or consideration of its legal obligations, and ordered a special award of $18,000 against the insurer.
Insurer ordered to pay treatment costs until DAC report receipt, but income replacement benefits denied.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including medical/rehabilitation benefits and income replacement benefits.
The insurer terminated treatment payments and income replacement benefits based on medical assessments.
At arbitration, the tribunal ordered the insurer to pay for physiotherapy treatment up to the date the applicant received the Designated Assessment Centre (DAC) reports, at the rates charged by the clinic.
However, the tribunal dismissed the claim for ongoing income replacement benefits, finding that the medical evidence, including psychiatric and orthopaedic assessments, did not establish a substantial inability to perform the essential tasks of her pre-accident employment as a sewing machine operator.
Claim for ongoing weekly income benefits dismissed; insurer's claim for repayment of medical benefits also dismissed.
The applicant was injured while a passenger on a bus and received statutory accident benefits.
The insurer terminated weekly income benefits and supplementary medical benefits in 1995.
The applicant sought reinstatement of weekly income benefits, and the insurer sought repayment of medical benefits paid for psychological treatment.
The arbitrator found that the applicant was physically and psychologically capable of returning to work by April 1995, dismissing the claim for ongoing weekly income benefits.
The arbitrator also dismissed the insurer's claim for repayment, finding the psychological treatment received prior to termination was reasonable and beneficial.
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