Dr. Jonathan Siegel

The insurer appealed an arbitration decision ordering it to pay income replacement benefits beyond the 104-week mark, a maximum special award, and arbitration expenses.

The Director of Arbitrations upheld the ongoing entitlement to income replacement benefits, finding that the evidence supported the conclusion that the insured suffered a complete inability to engage in suitable employment.

However, the special award was reduced to $5,000 because the insurer's initial reliance on its experts was not unreasonable, and the arbitration expenses were slightly reduced to exclude pre-mediation legal work.

The insurer brought a motion to compel the insured to attend an independent medical examination by a psychiatrist under section 42 of the Statutory Accident Benefits Schedule.

The insured refused to attend, arguing the examination was for medical-legal purposes rather than determining entitlement to a benefit.

The arbitrator dismissed the motion, finding that arbitrators at the Financial Services Commission of Ontario lack jurisdiction to order an insured to attend a medical examination.

The arbitrator also noted that the insurer's delay in requesting the examination until the eve of the hearing would cause significant prejudice to the insured.

The applicant, a health care aide, was injured in a motor vehicle accident and received income replacement benefits for 104 weeks.

The insurer terminated benefits, arguing she could perform alternative employment.

The arbitrator found the insurer's vocational assessments relied on erroneous assumptions about the applicant's education and skills.

The arbitrator concluded the applicant suffered a complete inability to engage in suitable employment and awarded ongoing benefits.

Additionally, the arbitrator ordered a special award of 50 per cent of outstanding benefits, finding the insurer unreasonably withheld payments by ignoring credible evidence of the applicant's limitations.

The appellant was injured in a motor vehicle accident and received weekly income benefits for over 156 weeks.

The insurer terminated benefits, and an arbitrator upheld the termination, finding the appellant did not meet the post-156 week test of being continuously prevented from engaging in suitable employment.

On appeal, the appellant argued the arbitrator erred in law by focusing on whether she suffered a head injury, relying on hearsay evidence, and failing to properly analyze suitable employment options.

The Director's Delegate dismissed the appeal, finding the causation issue was properly before the arbitrator, the reliance on hearsay was permissible, and the arbitrator's conclusions were supported by the evidence.

The Applicant was injured in a motor vehicle accident and claimed ongoing income replacement benefits.

The Insurer argued his condition was not caused by the accident and he was not motivated to return to work.

The Arbitrator found that the Applicant suffered continuous depression, reduced cognitive skills, and chronic pain as a result of the accident.

Due to these cognitive and physical disabilities, the Applicant suffered a substantial inability to perform the essential tasks of his job as a welder.

The Arbitrator ordered the Insurer to pay ongoing income replacement benefits and the expenses of the arbitration.