Lyndon F. Mascarenhas

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them.

The applicant sought reinstatement of the benefits, claiming he was substantially unable to perform the essential tasks of his employment as a real estate agent.

The arbitrator found that the applicant failed to meet his burden of proof, relying on independent medical assessments and surveillance evidence showing he had returned to work.

The application for further income replacement benefits was dismissed.

The applicant was involved in two motor vehicle accidents and sought ongoing income replacement and supplementary medical benefits (chiropractic treatments) from the insurer.

The insurer terminated benefits, arguing the applicant was no longer disabled or that any disability was due to pre-existing conditions or the second accident.

The arbitrator found that the applicant's pre-existing back and shoulder injuries from prior workplace falls were the true cause of his inability to work as a carpenter, and the accidents did not significantly exacerbate his condition.

The claim for ongoing chiropractic expenses was also dismissed as the applicant failed to prove the treatments were reasonable or effective in light of a negative DAC assessment.

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

The insurer terminated benefits, arguing the applicant did not meet the stricter post-156 week test of being continuously prevented from engaging in any occupation for which he is reasonably suited by education, training, or experience.

The arbitrator found that while the applicant had chronic injuries preventing heavy physical work, he was capable of performing lighter or sedentary work consistent with his education and experience.

The arbitrator concluded the applicant's failure to pursue such work was due to a lifestyle choice rather than physical restrictions.

The application for ongoing benefits was dismissed, but the applicant was awarded expenses.

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

The insurer refused to pay for chiropractic treatments after July 30, 1993, arguing they were no longer reasonable or necessary.

The arbitrator found that the ongoing chiropractic care constituted therapeutically necessary supportive care rather than elective maintenance care, given the physical demands of the applicant's work.

The arbitrator also ruled that while the insurer had no statutory right to require a medical examination for a claim involving only medical and rehabilitation benefits, the resulting medical report was admissible because the applicant attended voluntarily.

The insurer was ordered to pay the outstanding chiropractic and transportation expenses, plus the costs of the arbitration.

The applicant, a taxi driver, was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, alleging overpayment based on fraudulent income records.

The arbitrator found that the applicant remained substantially unable to perform the essential tasks of her employment and was therefore entitled to ongoing weekly income benefits.

However, the arbitrator accepted the insurer's accounting evidence that the applicant's pre-accident financial records were not genuine.

Consequently, her benefits were reduced to the statutory minimum of $185.60 per week, and she was ordered to repay the overpayment to the insurer pursuant to section 27 of the Schedule.

The applicant was injured in a motor vehicle accident and received weekly, childcare, and housekeeping benefits until the insurer terminated them, claiming an overpayment.

The insurer relied on a medical report and a nurse's assessment to conclude the applicant was no longer disabled.

The arbitrator found the nurse was not qualified as an expert and her assessment lacked an objective basis, while the treating orthopaedic surgeon's testimony was contradictory and unreliable.

Relying on the applicant's credible testimony regarding her ongoing physical limitations, the arbitrator ordered the reinstatement of all benefits and dismissed the insurer's claim for repayment.