Ms. Sivananthan suffered from claustrophobia and extreme anxiety attacks after a car accident. These problems prevented her from taking the elevator out of her apartment by herself, using public transit and getting to job interviews. State Farm argued that she was capable of sitting, typing, talking on the phone, filing, and other physical aspects of an office job and therefore not entitled to further benefits. The arbitrator agreed with Moira Gracey that in examining a person’s ability to work, factors the ability to arrive reliably, be punctual, concentrate on her job tasks, such as respond competently to stressful situations, deal appropriately with co-workers and customers and other basic requirements of any job must be considered. Thus, Ms. Sivananthan was entitled to continue Income Replacement Benefits.
State Farm then refused to pay interest on the Income Replacement Benefits. It had stopped paying Ms. Sivananthan Income replacement Benefits after a Designated Assessment Centre report said that she could return to work, and argued that since was allowed to stop payment after a DAC report in its favour, the benefits were not ‘overdue’ until the Arbitrator ordered them paid. Joseph Campisi and Moira Gracey successfully argued that the insurer is responsible for paying interest on any benefits paid for a period when the injured person met the test of entitlement.
Insurance companies have recognized that because of our success on appeal in this case, they will have to carefully evaluate the strength and quality of doctors’ reports before relying on them to terminate benefits something we feel has always been their duty to their injured customers.
Case and Appeals Synopsis