Insurer ordered to pay income replacement benefits and a $30,000 special award for unreasonable denial.
The applicant was injured in a rear-end motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits from his insurer.
The insurer denied the benefits, arguing that the applicant's inability to work was caused by pre-existing psychological issues and not the accident.
The arbitrator applied the 'material contribution' test for causation and found that the accident materially contributed to the applicant's post-concussion syndrome, depression, and resulting unemployability.
The arbitrator awarded IRBs for both the pre-104-week and post-104-week periods, relying heavily on undisputed vocational expert testimony that the applicant was completely unemployable.
The arbitrator also awarded the claimed medical benefits and ordered the insurer to pay a special award of $30,000, finding that the insurer acted unreasonably in continuing to deny benefits despite overwhelming evidence of the applicant's accident-related impairments.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesMar 7, 2016
