Roger Raymond Foisy

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.

The parties disputed the correct calculation of the IRB, specifically whether a $120,000 lump sum settlement the applicant received from her long-term disability (LTD) carrier should be deducted from her IRBs.

The Tribunal found that the LTD settlement encompassed all claims against the LTD carrier, including extracontractual damages, and could not be broken down to satisfy the requirements of the Schedule.

Therefore, the LTD settlement was not deductible from the IRBs.

The Tribunal ordered the respondent to pay IRBs at $400 per week plus interest, denied the respondent's claim for repayment, and declined to make an award for unreasonable withholding of benefits.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the treatment plans for physiotherapy, assistive devices, psychological treatment, and chiropractic treatment based on its insurer's examinations.

The Licence Appeal Tribunal found the respondent's expert opinions unpersuasive and insufficiently explained, preferring the evidence of the applicant and her treating practitioners.

The Tribunal ordered the respondent to pay all disputed treatment plans and overdue interest.

Furthermore, the Tribunal granted a maximum special award of 50% under Regulation 664, finding that the respondent unreasonably delayed or withheld payments by providing reasons for denial inconsistent with its actual reasons and failing to consider medical records on file.

The appellant appealed an arbitrator's decision denying his claim for an Income Replacement Benefit (IRB) following a motor vehicle accident.

The arbitrator had found that the appellant failed to produce requested financial documents regarding a corporation he controlled, making it impossible to calculate his income and resulting in an adverse inference.

On appeal, the Director's Delegate found no error of law in the arbitrator's credibility assessments, evidentiary rulings, or conclusion that the appellant failed to meet his burden of proof.

The appeal was dismissed.