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Insured with WAD II and psychological impairment not subject to 16-week cap on income replacement benefits.
The applicant was injured in a motor vehicle accident and diagnosed with a Grade II Whiplash-Associated Disorder (WAD II).
The insurer terminated her income replacement benefits after 16 weeks, relying on section 5(2)(e) of the Statutory Accident Benefits Schedule.
The arbitrator found that the applicant also suffered a psychological impairment resulting from the accident, which excluded her impairment from the Grade II Whiplash Guideline.
Consequently, section 5(2)(e) did not preclude her from receiving income replacement benefits beyond 16 weeks.
Application for ongoing accident benefits dismissed due to lack of credible evidence of substantial inability.
The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them based on a DAC assessment.
The applicant sought ongoing IRBs, supplementary medical and housekeeping expenses, and the cost of a medical report.
The insurer sought repayment of an overpaid benefit.
The arbitrator found the applicant was not a credible witness due to inconsistent pain behaviour, discrepancies between his testimony and medical records, and surveillance video showing him working.
The arbitrator concluded the applicant did not suffer a substantial inability to perform his essential tasks as an auto mechanic and dismissed the claims for ongoing IRBs, physiotherapy, and housekeeping expenses.
The claim for the medical report cost was also dismissed as it was obtained for litigation.
The insurer's claim for repayment was dismissed for failing to provide the required notice.
No linked lawyers found.
No linked judges found.
