Insurer unreasonably terminated benefits after 156 weeks; ongoing income benefits and $2,000 special award granted.
The applicant was seriously injured in a motor vehicle accident and received weekly income benefits for 156 weeks.
The insurer terminated the benefits, and the applicant sought ongoing benefits under s. 12(5)(b) of the Statutory Accident Benefits Schedule, arguing she was continuously prevented from engaging in any occupation or employment for which she was reasonably suited.
The arbitrator found that the applicant did not have the physical capacity or stamina to do reasonably suitable full-time work, and that part-time work would not be sufficiently remunerative.
The arbitrator concluded that the insurer acted unreasonably in terminating the benefits given the medical evidence of the applicant's ongoing hip problems and need for further surgery.
The applicant was awarded ongoing weekly income benefits and a special award of $2,000.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesApr 15, 1996
