David A. Di Lella

The applicant sought a determination of catastrophic impairment following a motor vehicle accident.

The respondent denied the designation but failed to request an insurer examination (IE) within the 10-day timeline required by section 45(3)(b) of the Schedule.

The applicant argued he was not required to attend an IE requested months later.

The Tribunal held that the Schedule does not prescribe a consequence for non-compliance with section 45 timelines.

Citing procedural fairness and the respondent's ongoing duty to adjust the claim, the Tribunal ordered the applicant to attend the IE and stayed the appeal application for four months to allow the assessment to be completed.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the insurer.

The insurer sought to reduce the IRBs by the amount of benefits the applicant received under a private disability insurance policy, arguing it was an 'income continuation benefit plan' under section 7(1)1i of the Statutory Accident Benefits Schedule.

The arbitrator held that the disability policy did not constitute an income continuation benefit plan because it had a 60-day elimination period, did not require the insured to be employed at the time of disability to qualify for benefits, and only coincidentally tied benefits to pre-disability income.

Therefore, the disability benefits were not deductible from the applicant's IRBs.

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

The insurer requested multiple insurer examinations, which the applicant refused to attend, leading the insurer to suspend benefits.

On a preliminary issue, the arbitrator found that the insurer failed to establish that the requested examinations were reasonable.

Consequently, the applicant was not precluded from proceeding to mediation and arbitration, nor was he disentitled to benefits for failing to attend the examinations.