John J. Cardill

The insurer appealed two arbitration decisions regarding statutory accident benefits.

The insurer argued it should be allowed to set off an overpayment of benefits against future payments, and that it should be allowed to deduct post-accident income the insured reported from her husband's business.

The Director's Delegate dismissed these grounds, finding the insured did not materially contribute to the overpayment and the reported income was merely for income splitting.

However, the Director's Delegate allowed the appeal regarding a special award ordered against the insurer, finding that the arbitrator breached procedural fairness by raising the issue in her decision without giving the insurer a reasonable opportunity to present evidence in response.

The special award was revoked and a partial rehearing was ordered.

Following an arbitration decision awarding weekly income benefits to the applicant, the arbitrator considered whether the insurer was liable for a special award under s. 282(10) of the Insurance Act.

The arbitrator found that the insurer acted unreasonably and in bad faith by terminating the applicant's benefits based on a flimsy excuse and ignoring substantial medical evidence of her disability.

The insurer was ordered to pay a special award of $7,500 plus interest.

The applicant was seriously injured in a motor vehicle accident and received statutory accident benefits.

The insurer terminated her weekly income benefits after 156 weeks, arguing she was capable of returning to work.

The arbitrator found that the applicant suffered from chronic pain syndrome as a result of the accident and was continuously prevented from engaging in suitable employment.

The arbitrator ordered the insurer to pay ongoing weekly income benefits, denied the insurer's claim for repayment of an overpayment caused by its own error, and allowed the deduction of 80% of the applicant's actual post-accident earnings, but rejected the deduction of potential future income.