Sandra Zilli

The applicant was injured in a motor vehicle accident and received income replacement benefits, which the insurer later terminated.

The applicant applied for arbitration.

The insurer subsequently requested that the applicant attend a medical examination with a respirologist.

The applicant refused, and a preliminary issue hearing was held to determine if the examination was reasonably necessary under section 42 of the Statutory Accident Benefits Schedule.

The arbitrator found that the examination was not reasonably necessary for claims adjustment, as the insurer had been aware of the applicant's medical condition for years and had already made its adjusting decision.

The arbitration was ordered to proceed as scheduled.

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

He subsequently returned to work intermittently, earning substantial post-accident income.

The insurer argued that 80% of all post-accident income should be deducted from benefits on a 'carry forward' basis, applying excess earnings against future benefits.

The arbitrator rejected this approach, finding it would act as a disincentive to rehabilitation and returning to work.

Instead, the arbitrator held that post-accident income must be matched directly to the specific weekly income benefit payable in the week it was earned, with no carry forward of any excess.