Scott Densem

The appellant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until they were terminated by the insurer prior to the 104-week mark.

At arbitration, the arbitrator ordered IRBs to be paid for an additional period but found the appellant was no longer substantially disabled from her employment thereafter.

The arbitrator did not address the insurer's obligation to make a loss of earning capacity benefit (LECB) offer.

On appeal, the Director's Delegate held that because the appellant qualified for IRBs at the 104-week mark, the insurer was statutorily required to promptly deliver an LECB offer, even if the ultimate benefit amount might be zero.

However, the Delegate declined to order the continuation of IRBs pending the LECB offer, finding no statutory authority for such an extension once the procedural requirements for termination had been met.

The applicant was severely injured in a motor vehicle accident and received statutory accident benefits for 156 weeks.

The insurer terminated non-earner and childcare benefits at the three-year mark, arguing she did not meet the stricter post-156 week test of being continuously prevented from engaging in substantially all of her normal activities.

The arbitrator found that the applicant's permanent pelvic malalignment caused constant pain that drastically reduced her ability to engage in her pre-accident focus on outdoor activities and active childcare.

The arbitrator concluded the applicant met the test and ordered the insurer to pay ongoing non-earner and childcare benefits, plus arbitration expenses.