Joseph Zayouna

The applicant was injured in a motor vehicle accident and sought post-104-week income replacement benefits (IRBs).

The respondent denied the benefits, arguing the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited.

The Tribunal found that the applicant's physical impairments, specifically complex regional pain syndrome (CRPS) in her right arm, along with psychological impairments, prevented her from engaging in suitable employment, even on a part-time basis.

The Tribunal ordered the respondent to pay IRBs of $400 per week from September 1, 2022, plus interest.

The applicant's claim for an award under s. 10 of Regulation 664 for unreasonable withholding of benefits was dismissed.

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

The Insurer terminated the IRBs and the Applicant elected to attend a Designated Assessment Centre (DAC) assessment.

After retaining counsel, the Applicant cancelled the DAC assessment and applied for mediation.

The Insurer argued the Applicant was precluded from proceeding to arbitration under s. 50(1)(c) of the Statutory Accident Benefits Schedule for failing to attend a required assessment.

The Arbitrator found that the Insurer failed to provide clear and straightforward information about the dispute resolution process, making the election invalid.

Alternatively, the Arbitrator held that the Applicant had a bona fide change of mind after receiving legal advice and was entitled to revoke her election.

The preliminary issue was resolved in favour of the Applicant.