Orest H.T. Rudzik

The appellant appealed an arbitrator's decision upholding the termination of his weekly income benefits at the 156-week mark by the respondent insurer.

The central issue was whether the appellant met the disability test under section 12(5)(b) of the Statutory Accident Benefits Schedule, which requires that the injury continuously prevents the insured from engaging in any suitable occupation.

The appellant argued that the arbitrator erred in relying on the evidence of his treating physiatrist, who testified for the insurer, and in finding that suitable work was available.

The Director's Delegate dismissed the appeal, finding no error in the arbitrator's reliance on the physiatrist's evidence or the conclusion that the appellant was capable of light or sedentary work.

The appellant was awarded his reasonable appeal expenses.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them after 156 weeks.

The applicant sought reinstatement of benefits, while the insurer sought repayment of benefits, arguing that Canada Pension Plan (CPP) disability payments should have been deducted from the applicant's gross weekly income.

The arbitrator found that the applicant was not continuously prevented from engaging in a suitable alternative occupation, relying on surveillance video that contradicted the applicant's reported physical limitations.

The arbitrator also held that CPP benefits are non-indemnity payments and therefore not deductible from gross weekly income under the Schedule.

Both the claim for ongoing benefits and the claim for repayment were dismissed.