Dr. Marek J. Celinski

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, housekeeping, and assessment costs.

The insurer terminated benefits based on an assessment by a general practitioner and a Disability DAC report.

The arbitrator found that the applicant suffered a substantial inability to perform her pre-accident employment as a sewing machine operator for the first 104 weeks, relying on the chronic pain diagnosis of her treating physiatrist and psychologist.

However, the applicant failed to meet the stricter "complete inability" test for post-104 week benefits.

The arbitrator awarded the claimed medical, housekeeping, and assessment expenses.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award under s. 282(10) of the Insurance Act, finding that the insurer unreasonably withheld benefits by relying on flawed assessments, ignoring substantial medical evidence, and improperly requesting a supplementary report from a neutral DAC assessor.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, including income replacement and housekeeping expenses, arguing she could no longer work as a live-in housekeeper.

The arbitrator found that while the applicant sustained genuine injuries, including vertigo and cervicogenic pain, she exaggerated her limitations and was only disabled from working until her employer returned from Florida on February 21, 1996.

Income replacement benefits were awarded up to that date, along with a 50% special award because the insurer unreasonably withheld payment despite having uncontradicted medical evidence of disability for that initial period.

Claims for ongoing income replacement, housekeeping, and a case manager were dismissed.