Dr. Reda El-Sawy

The appellant appealed an Arbitrator's decision dismissing his claim for income replacement benefits following a motor vehicle accident.

The appellant argued the Arbitrator erred in assessing the evidence, admitting surveillance videotapes that post-dated the claim period, and finding that the insured bears the onus of proving ongoing entitlement to benefits after an insurer terminates them.

The Director's Delegate dismissed the appeal, holding that the Arbitrator's credibility findings and reliance on the insurer's medical experts were amply supported by the evidence.

The Delegate further held that the surveillance evidence was properly admitted to assess credibility and that the ultimate burden of proving entitlement to benefits remains on the insured person.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them at the three-year mark.

The applicant sought ongoing weekly income benefits, claiming total disability due to chronic pain and restricted neck movement.

The arbitrator found the applicant's subjective complaints of pain and limitation to be unreliable, noting significant discrepancies between her presentation to doctors and her fluid movements captured on video surveillance.

Relying on objective functional capacity evaluations, the arbitrator concluded the applicant was capable of returning to sedentary work and had unreasonably resisted rehabilitation efforts.

The claim for ongoing benefits was dismissed, save for a six-week period of benefits awarded for recovery following a related ear surgery.

The applicant, a self-employed real estate broker, was struck by a vehicle and claimed ongoing weekly income benefits and expenses under the Statutory Accident Benefits Schedule.

The insurer terminated benefits at the three-year mark, arguing she could return to work or engage in other suitable employment.

The arbitrator found that the alternative jobs proposed by the insurer were unsuitable given the applicant's age, lack of administrative skills, and pre-existing arthritis.

However, based on surveillance evidence showing the applicant working full days without apparent restriction by May 1995, the arbitrator concluded she was no longer substantially unable to perform her essential tasks after that date.

The arbitrator also calculated her pre-accident income to establish a maximum weekly benefit of $1,050, allowed deductions for post-accident income, and awarded partial housekeeping and full snow removal expenses.