Appeal allowed in part; post-104-week attendant care and certain medical benefits reversed.
The insurer appealed an arbitration order awarding the insured person ongoing income replacement benefits, attendant care benefits, medical benefits, and a special award following a motor vehicle accident.
The Director's Delegate upheld the award of income replacement benefits, finding no error in the arbitrator's conclusion that the insured person suffered a complete inability to engage in suitable employment due to chronic pain.
However, the Delegate reversed the award of attendant care benefits beyond the 104-week mark, holding that the transitional provisions of the SABS-1996 did not suspend the temporal limit.
The Delegate also reversed the award of medical benefits for a specific clinic, finding the arbitrator erred in ordering benefits solely because of a delay in obtaining a DAC report.
The special award was consequently reduced to reflect only those benefits that were unreasonably delayed and actually payable.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJun 3, 2004
