Dr. Rashid

The applicant sought income replacement benefits and medical benefits following a minor motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant did not suffer a complete inability to engage in employment.

The Tribunal relied on surveillance evidence showing the applicant socializing, driving, and taking vacations, which contradicted his claims of severe impairment.

The Tribunal also found the claimed medical benefits were not reasonable and necessary, as previous treatments had not improved his condition and independent medical examinations found him capable of working.

The applicant sought a special award under s. 282(10) of the Insurance Act, arguing the insurer unreasonably withheld and delayed payment of income replacement benefits (IRB) and catastrophic impairment benefits following a motor vehicle accident.

The arbitrator found that while a special award could not be based solely on the catastrophic impairment determination, the insurer's handling of the IRB claim justified an award.

The insurer had relied on incomplete and inconclusive reports to terminate benefits, ignoring a multitude of conclusive medical reports, including from its own assessors, that supported the applicant's inability to work.

The arbitrator concluded this demonstrated stubborn, inflexible, and unreasonable behaviour, and ordered the insurer to pay a special award of 35% of the owing IRB total, plus 2% compound interest.

The applicant was receiving income replacement benefits following a motor vehicle accident.

The insurer terminated these benefits based on a revised section 42 psychological report.

The applicant brought a preliminary issue arguing the insurer breached procedural requirements under sections 35, 37, and 42 of the Statutory Accident Benefits Schedule, and that this non-compliance entitled her to ongoing benefits.

The arbitrator found that the insurer did breach the procedural requirements by failing to provide timely notice and failing to request a new disability certificate.

However, applying appellate jurisprudence, the arbitrator held that these procedural flaws did not invalidate the clear and unequivocal notice of termination, nor did they automatically entitle the applicant to ongoing benefits.

The preliminary issue was dismissed, and the matter was ordered to proceed to a full hearing on the merits.

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

A preliminary issue hearing was held to determine whether the applicant had the mental capacity to proceed in the dispute resolution process.

Based on medical reports and direct questioning of the applicant, the arbitrator found that the applicant lacked the mental capacity to proceed.

The arbitrator appointed the applicant's daughter to act on his behalf pursuant to Rule 10.5 of the Dispute Resolution Practice Code.