Sara Jones

The applicant was injured in a motor vehicle accident and claimed attendant care benefits for services provided by his spouse, a stay-at-home parent.

The insurer denied the claim because the spouse did not sustain an economic loss.

The arbitrator held that under the 2010 Statutory Accident Benefits Schedule, a family member providing care must either sustain an economic loss or provide the services in the course of their employment, occupation, or profession.

A stay-at-home parent does not meet the definition of providing care in the course of an occupation.

The application for attendant care benefits was dismissed.

The Appellant was injured in a motorcycle accident and sought ongoing post-104 week income replacement benefits (IRBs) and a special award from his insurer.

The Arbitrator awarded IRBs for a limited period and denied the special award.

On appeal, the Appellant argued he was entitled to ongoing IRBs due to the insurer's procedural non-compliance with termination requirements and that he met the post-104 week disability test.

The Director's Delegate dismissed the IRB appeal, finding no error of law and affirming that procedural errors do not grant benefits in perpetuity.

However, the Delegate rescinded the denial of the special award, finding the Arbitrator failed to provide adequate reasons addressing whether the insurer's continued refusal to pay IRBs was reasonable in light of new medical evidence provided.

The special award issue was remitted for redetermination.

The applicant was seriously injured in a motorcycle accident and received income replacement benefits until the insurer terminated them in March 2010.

The applicant sought ongoing benefits, arguing he was completely unable to engage in suitable employment until he completed computer repair training.

The insurer relied on surveillance and medical assessments to argue he could return to light sedentary work.

The arbitrator found that the applicant's completion of high school equivalency and demonstrated ability to sit for extended periods during commutes and classes indicated he was capable of resuming sedentary office work by September 2012.

Income replacement benefits were awarded for the closed period from March 2010 to September 2012.

The claim for a special award was dismissed, as the insurer's reliance on surveillance to terminate benefits was reasonable.