Insurer ordered to pay 40% special award for unreasonably terminating income replacement benefits based on flawed assessments.
The applicant was injured in a motor vehicle accident and received income replacement benefits.
The insurer terminated these benefits at the 104-week mark based on a multidisciplinary assessment suggesting the applicant could perform alternative employment.
The applicant sought a special award, arguing the termination was unreasonable.
The arbitrator found that the insurer failed to critically assess the expert reports, which contained significant inconsistencies and ignored the applicant's pre-accident income and limited education.
The insurer's reliance on a flawed assessment process and failure to consider credible evidence to the contrary constituted an unreasonable withholding of benefits.
A special award of 40% of the withheld benefits was ordered.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesOct 15, 2010
