2 total
Applicant entitled to IRBs and interest based on tax records; special award for unreasonable delay denied.
The applicant, a self-employed handyman, sought income replacement benefits (IRBs) and medical benefits following a motor vehicle accident.
The insurer conceded entitlement to IRBs but disputed the quantum, arguing the applicant failed to provide adequate proof of income.
The Tribunal found the applicant proved the quantum of IRBs based on his income tax records, though the insurer was entitled to withhold payments during a specific period of non-compliance when updated tax documents were delayed.
The Tribunal also awarded interest on the overdue IRBs and medical benefits but declined to grant a special award, finding the insurer did not unreasonably withhold payments.
Interlocutory appeal of catastrophic impairment finding rejected; arbitrator correctly applied binding GCS score test.
The appellant insurer sought to appeal an arbitrator's preliminary decision which found that the respondent insured had sustained a catastrophic impairment following a motor vehicle accident.
The arbitrator based this finding on the respondent's Glasgow Coma Scale scores of 9 and a diagnosis of concussion, applying the binding legal test that the severity of the brain injury is irrelevant if the statutory GCS criteria are met.
The Director's Delegate rejected the interlocutory appeal, finding no strong grounds to depart from established case law and concluding that the most efficient resolution was to defer any appeal until all issues in the arbitration were finally decided.
The Delegate also refused to stay the arbitrator's order, noting the hardship a stay would cause the respondent whose minor injury benefits had been exhausted.
