Dr. H. Schutz

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

The insurer terminated income replacement benefits and, over four years later, requested that the applicant undergo a medical examination by an orthopaedic surgeon under section 42 of the Statutory Accident Benefits Schedule.

The applicant refused, arguing the examination was not reasonably necessary.

The arbitrator found that the insurer had already conducted multiple assessments by other specialists, including a neurosurgeon and an occupational medicine physician, none of whom recommended an orthopaedic evaluation.

The insurer failed to establish that the proposed examination was reasonably necessary or that its previous assessments were not meaningful evaluations of the applicant's physical condition.

The insurer's request was denied, and the applicant was awarded the expenses of the preliminary issue hearing.

The applicant was involved in three motor vehicle accidents in 1995 and 1996.

He sought income replacement benefits and loss of earning capacity benefits (LECB) for the second and third accidents, arguing he was entitled to multiple LECB offers.

The arbitrator found that the applicant was substantially disabled by the first accident and that the subsequent accidents did not materially contribute to his disability.

The arbitrator also interpreted the Statutory Accident Benefits Schedule to mean that an insured is only entitled to one LECB offer for a qualifying disability, even if multiple accidents contributed to it.

The applicant's claims for additional benefits and a special award were dismissed, but he was awarded his arbitration expenses due to the novelty of the legal issues raised.

The Applicant was injured in a motor vehicle accident and claimed statutory accident benefits, including income replacement benefits (IRBs) and housekeeping expenses.

The Arbitrator found that the Applicant suffered impairments preventing him from performing pre-accident housekeeping tasks and awarded $4,451 for housekeeping and home maintenance, subject to the $100 weekly maximum.

However, the claim for IRBs was dismissed because the Applicant, who was developing a country property for potential capital gain and rental income, was not considered employed or self-employed within the meaning of the Schedule.

The Arbitrator also awarded interest on a late-paid medical assessment account.

The applicant sought interim income replacement benefits after the insurer terminated them.

The arbitrator found that the insurer's termination of benefits was based on a flawed Designated Assessment Centre (DAC) process, which failed to comply with section 64 of the Statutory Accident Benefits Schedule.

The arbitrator also found that the applicant established a strong prima facie case for entitlement to benefits and demonstrated financial urgency.

The insurer was ordered to pay interim benefits of $313.77 per week, with the issues of a special award and expenses reserved for the main arbitration hearing.