Insurer ordered to pay medical benefits, examination costs, and a $5,000 special award for unreasonable delay.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).
The arbitrator found that the applicant's injuries, which included chronic pain, a head injury resulting in hearing impairment, and psychological impairments, took him outside the MIG.
The arbitrator ordered the insurer to pay for the disputed medical benefits and the costs of various examinations.
Although the applicant established an entitlement to attendant care benefits, the claim was dismissed because the quantum could not be proven under section 19(3)4 of the Schedule.
The arbitrator also ordered the insurer to pay a $5,000 special award for unreasonably delaying and withholding benefits, noting the insurer's failure to properly investigate the applicant's head injury and chronic pain.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesOct 12, 2017
