Dr. Sam Ozersky

The insurer appealed an arbitrator's decision awarding the insured non-earner benefits, prescription costs, and the cost of a medical report following a motor vehicle accident.

The insurer argued the arbitrator erred by relying on the evidence of the insured's husband, who had previously assisted the insured in providing inaccurate histories to medical assessors.

The Director's Delegate dismissed the appeal, finding that the arbitrator's credibility assessments and weighing of the evidence were fact-driven determinations entitled to deference.

The arbitrator had a sufficient evidentiary basis, including evidence from the treating psychologist and the insurer's own examining psychiatrist, to conclude that the accident significantly exacerbated the insured's pre-existing depression and prevented her from engaging in substantially all of her pre-accident activities.

The applicant, a 62-year-old homemaker with a history of pre-existing depression and anxiety, was injured in a pedestrian knockdown.

She sought statutory accident benefits, including non-earner benefits, attendant care, housekeeping, prescription medication, and costs of examinations.

The arbitrator found that the accident significantly exacerbated her psychological condition, profoundly compromising her ability to engage in rewarding pre-accident activities such as babysitting, reading, and taking long walks.

Applying a qualitative approach to the non-earner benefit test, the arbitrator concluded she suffered a complete inability to carry on a normal life and awarded ongoing non-earner benefits and prescription medication costs.

Claims for attendant care and housekeeping were dismissed due to insufficient evidence.

The cost of a neurological assessment was allowed, but an orthopaedic assessment was denied as it did not address accident benefits.

A claim for a special award was also dismissed.

The applicant was injured in a minor rear-end motor vehicle accident and received income replacement benefits until they were terminated following a DAC assessment.

He applied for arbitration seeking reinstatement of IRBs, a loss of earning capacity benefit offer, and transportation expenses, claiming severe psychological and physical impairments.

The arbitrator dismissed the claims, finding that the applicant exaggerated his symptoms and was malingering.

The arbitrator concluded that the applicant's physical complaints were related to pre-existing conditions, including post-polio syndrome and degenerative disc disease, and that the minor impact of the collision could not account for his extreme clinical presentation.

Video surveillance showing the applicant walking normally without a cane further undermined his credibility.