Jing Wang

The applicant sought a special award under s. 10 of O. Reg. 664, alleging the respondent unreasonably delayed payment of an income replacement benefit (IRB).

The respondent argued the claim should be dismissed for procedural unfairness due to lack of particulars, which the Tribunal rejected.

The Tribunal found the respondent's conduct between February 29, 2024, and April 4, 2024, was excessive and imprudent, as the adjuster failed to actively review the file or address inconsistencies in the applicant's employment status until a complaint was lodged.

The Tribunal awarded the applicant $704.36, representing 50% of the IRB payable during the period of unreasonable delay, plus interest.

The applicant was injured in a motor vehicle accident and sought non-earner benefits and medical and rehabilitation benefits from the respondent insurer.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as her pain did not practically prevent her from engaging in her pre-accident activities, and dismissed the claim for non-earner benefits.

However, the Tribunal found that several of the disputed treatment plans for physiotherapy, chiropractic, acupuncture, and massage services were reasonable and necessary to treat her lingering pain.

The applicant was awarded the approved medical benefits along with interest on overdue amounts.