Monique R. Bennett

The insurer appealed an arbitration order that reinstated the insured's caregiver benefits and imposed a special award at the maximum rate.

The insurer had suspended benefits after the insured refused to attend two sets of multi-disciplinary medical examinations.

The Director's Delegate dismissed the appeal, upholding the arbitrator's finding that the requested examinations were not reasonably necessary given the extensive medical information already available, including Designated Assessment Centre (DAC) reports supporting the insured's disability.

The Director's Delegate also confirmed the special award, finding that the insurer acted unreasonably in ignoring the medical evidence and the concerns of the insured's treating practitioners regarding the excessive assessments.

The applicant was injured in a motor vehicle accident and was previously awarded statutory accident benefits and a special award following a preliminary issues hearing.

The arbitrator rescinded the initial order for expenses on consent and held a further hearing to determine the applicant's entitlement to and quantum of expenses.

The arbitrator found the applicant was entirely successful and entitled to her expenses.

The arbitrator set aside the 30-day time limit for requesting an assessment and awarded the applicant's counsel the maximum hourly rate of $150, allowing a 3:1 ratio for preparation to attendance time.

The insurer was ordered to pay $15,150 in legal fees and $9,103.41 in disbursements.

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

The insurer terminated her caregiver and housekeeping benefits after she refused to attend multiple insurer examinations.

The applicant sought arbitration, arguing the requests for examinations were unreasonable and excessive.

The arbitrator found that the insurer failed to comply with section 65 of the Statutory Accident Benefits Schedule, as the number and length of the requested assessments were excessive and failed to consider the applicant's convenience or provide reasonable notice.

The arbitrator also found that the insurer unreasonably withheld and delayed benefits, ordering a special award of 50 per cent of the outstanding benefits plus interest, and awarded expenses to the applicant.

The applicant was injured in a rear-end motor vehicle accident and claimed ongoing statutory accident benefits after the insurer terminated them.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a waitress for the first 156 weeks, rejecting the insurer's medical assessments that she could work part-time.

However, the applicant failed to prove she was continuously prevented from engaging in any suitable employment after the 156-week mark, as she was capable of attending school full-time and could perform suitable minimum-wage jobs.

The arbitrator also awarded supplementary rehabilitation benefits for school transportation and alternative therapy.