Dr. S. W. Joeseph Wong

The parties cross-appealed an Arbitrator's decision awarding the insured person all claimed accident benefits, interest, expenses, and a special award.

The Director's Delegate found that the Arbitrator correctly ordered payment of medical benefits and income replacement benefits (IRBs) where the insurer completely failed to respond to the claims, pursuant to the plain meaning of the Statutory Accident Benefits Schedule.

However, the Arbitrator erred in ordering payment where the insurer's response was merely deemed improper, and in failing to calculate the net amount of IRBs payable after deducting post-accident income.

The Delegate also found that while a special award was justified due to the insurer's unreasonable delay, the Arbitrator erred by failing to fix the amount of the award with precision.

Several issues, including the quantum of IRBs and the special award, were remitted for re-hearing.

The applicant was injured in two motor vehicle accidents and applied for statutory accident benefits.

The insurer placed her in the Minor Injury Guideline (MIG) and denied various medical benefits, income replacement benefits (IRBs), and non-earner benefits (NEBs).

The arbitrator found that the insurer consistently failed to comply with the notice requirements under the Statutory Accident Benefits Schedule.

As a result, the insurer was prohibited from taking the position that the MIG applied and was ordered to pay the claimed medical benefits, IRBs, and NEBs.

The arbitrator also found that the insurer unreasonably withheld or delayed payments and ordered a special award of 50 per cent of the amounts owed, plus interest.