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Insured not credible with respect to injuries caused by the car accident.

June 14, 2014, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Date of Decision Date: April 29, 2914

Heard Before: Adjudicator: J. R. Richards

 

 

Sikander Sediqyar was injured in a car accident on June 25, 2010. He applied for and received statutory accident benefits from Unica Insurance Inc. Unica subsequently terminated the benefits. After failed mediation Mr. Sediqyar applied for arbitration at the Financial Services Commission of Ontario.

 

The particular issues in this hearing are:

 

  1. Is Mr. Sediqyar entitled to a non-earner benefit in the amount of $185.00 per week from December 24, 2010 to date and ongoing?

  2. Is Mr. Sediqyar entitled to an attendant care benefit in the amount of $836.57 per month from June 25, 2010 to August 8, 2010 and January 19, 2011 to June 24, 2012?

  3. Is Mr. Sediqyar entitled to housekeeping and home maintenance benefits in the amount of $100.00 per week from June 25, 2010 to July 18, 2010 and $24.00 per week from September 13, 2010 to October 30, 2011 and $100.00 per week from October 31, 2011 to June 24, 2012?

  4. Is Mr. Sediqyar entitled to a Special Award?

  5. Is Mr. Sediqyar entitled to interest for the overdue payment of benefits?

 

Result:

 

  1. Mr. Sediqyar is not entitled to a non-earner benefit in the amount of $185.00 per week from December 24, 2010 to date and ongoing.

  2. Mr. Sediqyar is not entitled to an attendant care benefit in the amount of $836.57 per month from June 25, 2010 to August 8, 2010 and January 19, 2011 to June 24, 2012.

  3. Mr. Sediqyar is not entitled to housekeeping and home maintenance benefits in the amount of $100.00 per week from June 25, 2010 to July 18, 2010 and $24.00 per week from September 13, 2010 to October 30, 2011 and $100.00 per week from October 31, 2011 to June 24, 2012.

  4. Mr. Sediqyar is not entitled to a Special Award.

  5. Mr. Sediqyar is not entitled to interest for the overdue payment of benefits.

 

Unica’s position is that Mr. Sediqyar had chronic, low back pain prior to the motor vehicle accident and that the accident did not lead to a complete inability for Mr. Sediqyar to lead a normal life. Unica asserts there are serious credibility issues with Mr. Sediqyar’s case, and that it is impossible to conclude that Mr. Sediqyar cannot carry on a normal life because he has not presented enough evidence to give a clear picture of his pre-accident life. Furthermore, Mr. Sediqyar has not presented evidence substantiating his need for assistance to care for himself or to engage in his housekeeping and home maintenance.

 

Unica introduced surveillance videos of Mr. Sedigyar attending worksites and staying all day, casting Mr. Sedigyar’s claim into doubt.

 

Mr. Sediqyar who suffered chronic low back before the car accident claims he used to take care of his children and played sports regularly. His claim is that now he cannot spend time with his children, has required knee surgery and 3 hernia operations. He takes prescription medication for his knee and back. He claims even short walks cause him knee and back pain. He asserts that he needed assistance up to 104 weeks after the accident to care for himself and to carry out his housekeeping duties.

 

Medical records of Mr. Sedigyar prior to the accident showed a pre-existing meniscal tear and a disc problem in his back. He was given prescription medication and went to an orthopedic surgeon on referral, both of which Mr. Sedigyar claimed not to recall. His family doctor’s assessment was that Mr. Sedigyar was in good health before the accident. Post accident assessments indicate that physicians believe Mr. Sedigyar exaggerates his symptoms. The conclusion preferred by Arbitrator Richards was that that Mr. Sediqyar can function at a higher level than he demonstrated.

 

Arbitrator Richards was not convinced that Mr. Sedigyar’s back and knee pain were accident related. Arbitrator Richards found that Mr. Sediqyar did not present sufficient evidence to persuade him that Mr. Sedigyar is continuously prevented from engaging in substantially all of the activities in which he engaged before the accident. The threshold test for entitlement to a non-earner benefit is particularly strict and requires a significant degree of impairment and a marked, measurable impact on levels of function and consequent ability of the insured person to continue in his pre-accident activities.

 

In general Arbitrator Richards did not find Mr. Sedigyar’s claims to be consistent or reasonable. Mr. Sedigyar’s selective memory, failure to disclose his medical history fully. And the perception he tailored his evidence, brought his credibility into doubt. On the basis of this and the evidence presented Arbitrator Richards ruled against Mr. Sedigyar’s claims.

Posted under Accident Benefit News, Automobile Accident Benefits, Car Accidents, Catastrophic Injury, Chronic Pain, Pain and Suffering, Paraplegia

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About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us toll-free at 1-866-414-4878.

It is important that you review your accident benefit file with one of our experienced personal injury / car accident lawyers to ensure that you obtain access to all your benefits which include, but are limited to, things like physiotherapy, income replacement benefits, vocational retraining and home modifications.

Practice Areas

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