OFSCDRS 2000

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, including income replacement, rehabilitation, housekeeping, and dependant care benefits.

The insurer terminated benefits based on a disability DAC assessment by a chiropractor.

The arbitrator found that the applicant suffered from a severe TMJ disorder, chronic pain, and depression, rendering her substantially unable to perform the essential tasks of her pre-accident employment as a travel consultant.

The arbitrator awarded the claimed benefits and ordered the insurer to pay a $30,000 special award for unreasonably withholding benefits, noting the insurer's reliance on an assessor lacking expertise in TMJ disorders and its failure to re-evaluate its position in light of overwhelming medical evidence.

The appellant was injured in a motor vehicle accident and claimed income replacement benefits.

The insurer terminated benefits based on medical assessments indicating the appellant could return to work.

The arbitrator dismissed the appellant's claim for ongoing benefits, finding he was not substantially unable to perform the essential tasks of his self-employment in construction, and calculated a reduced benefit rate based on estimated business expenses.

On appeal, the Director's Delegate upheld the arbitrator's decision, finding no error in the assessment of the expert medical evidence or the pragmatic calculation of the appellant's self-employment income.

The appellant appealed an arbitration order finding that the insurer was not required to pay him further income replacement benefits because he was knowingly operating an uninsured motor vehicle at the time of the accident.

The appellant sought to introduce fresh evidence and raise a new waiver argument on appeal.

The Director's Delegate admitted part of the fresh evidence but refused the waiver argument.

On the merits, the Director's Delegate upheld the arbitrator's findings that the vehicle's coverage had been deleted at the spouse's request, that the appellant knew of the deletion, and that the insurer was not estopped from denying coverage.

The appeal was dismissed.

The applicant sought statutory accident benefits for physiotherapy expenses after allegedly being struck by a slow-moving vehicle while walking on a sidewalk.

The insurer denied the claim, arguing there was no contact between the vehicle and the applicant.

The arbitrator found the applicant's version of events credible, supported by her immediate actions and her family doctor's evidence, despite her misrepresentations regarding her employment status.

The arbitrator concluded the applicant sustained an impairment from the accident and awarded the physiotherapy expenses, but dismissed claims for a special award and the insurer's assessment fee.