Dr. Tommy K. C. Chan

The insurer applied to vary or revoke an arbitration order that granted the insured ongoing income replacement benefits (IRBs).

The insurer argued that the transition from the 'own occupation' test to the stricter 'any occupation' test at the 104-week mark constituted a material change in circumstances under s. 284 of the Insurance Act, and relied on new insurer examinations to argue the insured did not meet the stricter test.

The Director's Delegate held that a change in the legal test alone does not automatically constitute a material change in circumstances where a final order for benefits has been made, noting the protection of benefits under s. 287 of the Insurance Act.

The Delegate found that the insurer's medical assessors failed to document any material change in the insured's condition, as they largely ignored the Arbitrator's previous findings of psychological disability.

The application for variation or revocation was dismissed.

The applicants, who were injured in a rear-end motor vehicle collision, sought arbitration after the insurer terminated their statutory accident benefits.

Mr. Narain claimed ongoing income replacement benefits, medical benefits, housekeeping expenses, and the cost of a medical assessment.

Ms. Mangroo claimed income replacement benefits, medical benefits, and housekeeping expenses.

The arbitrator found Mr. Narain credible regarding his ongoing back and knee pain, granting his claim for income replacement benefits and the cost of a physiatrist's report, but dismissed his claims for further medical treatment and housekeeping expenses.

Conversely, the arbitrator found Ms. Mangroo to be an unreliable witness due to numerous inconsistencies in her evidence and dismissed all of her claims, concluding she failed to prove a substantial inability to perform her pre-accident employment or housekeeping tasks.

The applicant was struck by a vehicle while walking home from work, sustaining injuries including to his right shoulder and lower back.

He applied for income replacement benefits, which the insurer terminated on the basis that he was no longer substantially unable to perform the essential tasks of his employment as a mattress builder.

The arbitrator found that the applicant's job required heavy physical labour, including frequently lifting mattresses weighing up to 115 lbs.

Relying on the medical evidence of the applicant's experts, the arbitrator concluded that the applicant suffered from accident-related bursitis in his right shoulder, which prevented him from performing these essential tasks.

The applicant was awarded ongoing income replacement benefits, and the insurer's claim for repayment of previously paid benefits was dismissed.