Dr. J. Pilowsky

The applicant sought non-earner benefits (NEBs) following a motor vehicle accident.

The arbitrator found that the applicant did not qualify for an income replacement benefit as he was not employed at the time of the accident.

Applying the test for NEBs, the arbitrator concluded that the applicant did not suffer a complete inability to carry on a normal life, as he remained independent in self-care and was not completely unable to engage in housekeeping and home maintenance.

The application for NEBs, a special award, and interest was dismissed.

The insurer applied to vary or revoke an arbitration order that granted the insured ongoing income replacement benefits (IRBs).

The insurer argued that the transition from the 'own occupation' test to the stricter 'any occupation' test at the 104-week mark constituted a material change in circumstances under s. 284 of the Insurance Act, and relied on new insurer examinations to argue the insured did not meet the stricter test.

The Director's Delegate held that a change in the legal test alone does not automatically constitute a material change in circumstances where a final order for benefits has been made, noting the protection of benefits under s. 287 of the Insurance Act.

The Delegate found that the insurer's medical assessors failed to document any material change in the insured's condition, as they largely ignored the Arbitrator's previous findings of psychological disability.

The application for variation or revocation was dismissed.

The respondent was injured in an automobile accident and, three weeks later, suffered severe burn injuries after attempting suicide by setting himself on fire.

He claimed psychological treatment expenses, which the insurer denied on the basis that the treatment related to the suicide attempt and pre-existing problems, not the accident.

An arbitrator ordered the insurer to pay, finding the accident triggered the suicide attempt.

On appeal, the Director's Delegate found no error in the arbitrator's legal analysis that a suicide attempt due to accident-related depression could be covered.

However, the appeal was allowed and the matter remitted for rehearing because the arbitrator failed to address critical gaps and contradictions in the evidence regarding the causal link between the accident and the suicide attempt.

The applicant was injured in two motor vehicle accidents and claimed caregiver, housekeeping, and medical benefits following the second accident.

The insurer terminated caregiver and housekeeping benefits in December 2000.

The arbitrator found that the applicant was entitled to caregiver and housekeeping benefits up to February 23, 2001, based on DAC assessments indicating she had substantially recovered to her pre-second-accident baseline by that date.

The arbitrator also awarded $600 for a massage therapy treatment plan to address an exacerbation of her fibromyalgia, rejecting the insurer's reliance on an outdated orthopaedic assessment.

The applicant was struck by a motor vehicle and sustained minor physical injuries.

Three weeks later, he attempted suicide by setting himself on fire, resulting in severe burns.

He applied for statutory accident benefits, claiming the suicide attempt was psychologically triggered by the motor vehicle accident.

The insurer denied the claims, arguing the suicide attempt was an intervening act caused by pre-existing psychological and social issues.

The arbitrator applied the direct causation test and the thin skull rule, finding that the motor vehicle accident was a direct cause of the suicide attempt.

The arbitrator ordered the insurer to pay for the proposed psychological treatment plan, the costs of related medical examinations, and interest on overdue payments.