Mr. Salituri

The insurer appealed an arbitrator's decision awarding the insured income replacement benefits and a $2,500 special award following a minor car wash collision.

The insurer argued the arbitrator erred procedurally by allowing a key medical expert to testify by telephone and substantively by misapprehending the medical evidence regarding the insured's pre-existing conditions.

The Director's Delegate dismissed the appeal regarding income replacement benefits, finding no procedural unfairness and sufficient evidentiary basis for the arbitrator's causation findings.

However, the Director's Delegate rescinded the special award, concluding the arbitrator erred by raising it on his own initiative without providing the insurer adequate notice or opportunity to respond, and by failing to properly assess whether the insurer's withholding of specific medical expenses was unreasonable.

The applicant was involved in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs), medical expenses, and housekeeping expenses.

The insurer denied the claims, arguing the applicant was not employed and did not suffer a substantial inability to perform her essential tasks.

The arbitrator found that the applicant's work as an in-home caregiver for disabled adults constituted employment and that the accident materially contributed to her ongoing low back complaints, rendering her substantially unable to perform the heavy physical demands of her job.

The arbitrator awarded ongoing IRBs, various medical and travel expenses, and housekeeping costs.

Additionally, the arbitrator ordered a $2,500 special award against the insurer for unreasonably withholding payments under the 'pay now, dispute later' provisions of the Schedule.