Alec Fadel

The applicants were injured in a motor vehicle accident and sought statutory accident benefits.

The insurer capped their medical benefits under the Minor Injury Guideline (MIG) and terminated the husband's income replacement benefits (IRB).

The arbitrator found that both applicants developed chronic pain, which is an aberrant physiology not contemplated by the MIG, thus removing them from the $3,500 cap.

However, the claims for specific medical benefits were dismissed for lack of evidence proving they were reasonable and necessary.

The husband was awarded his claimed IRB as his injuries caused a substantial inability to perform his pre-accident employment as a truck driver.

Expenses were awarded to the applicants.

The applicant's son was catastrophically injured in a motor vehicle accident, requiring 24-hour attendant care.

The applicant provided this care and received $6,000 monthly from her son's attendant care benefit.

The insurer reduced the applicant's income replacement benefit to zero, arguing the attendant care payments constituted post-accident income from self-employment under section 7(3) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant was not engaged in a business and did not provide care with a view to profit.

The payments were not considered income from self-employment.

The insurer was ordered to pay the withheld benefits with interest, but no special award was granted as the insurer's position was not unreasonable.

The applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment based on a mental or behavioural disorder.

The insurer's psychiatric assessor concluded she had a moderate impairment, while the applicant's assessors found a marked impairment in adaptation to work or work-like settings.

The arbitrator preferred the evidence of the applicant's assessors, finding their conclusions consistent with her real-world functioning and psychometric testing.

The arbitrator held that the applicant suffered a marked impairment in adaptation and therefore met the definition of catastrophic impairment.

The applicant sought her expenses of the arbitration hearing following a mixed result where she was successful on her claims for income replacement and attendant care benefits, but unsuccessful on the issue of catastrophic impairment.

The insurer also sought its expenses.

The arbitrator considered the criteria under section 12(2) of Ontario Regulation 664, noting that while success was mixed, the applicant had made a reasonable offer to settle the income replacement and attendant care claims which the insurer rejected.

The applicant achieved greater success on those issues at the hearing than her offer.

The arbitrator awarded the applicant a portion of her expenses, fixed at $10,000.00, and dismissed the insurer's claim for expenses.

The applicant sought statutory accident benefits, including non-earner, housekeeping, and medical benefits, following a 2009 motor vehicle accident.

The insurer denied the claims, arguing the accident was minor and the applicant's impairments stemmed from severe pre-existing workplace injuries.

The arbitrator dismissed the application, finding overwhelming evidence that the applicant's physical and psychological conditions pre-dated the accident.

The arbitrator concluded the applicant sustained only minor soft-tissue injuries in the 2009 accident and failed to prove entitlement to the claimed benefits.

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 applicant sought statutory accident benefits following a motor vehicle accident.

The matter proceeded to an arbitration hearing, but the applicant failed to attend.

The arbitrator noted that the applicant's former representative had been removed from the record due to a complete breakdown in communication and inability to locate the applicant.

Finding that the applicant had received proper notice of the hearing, the arbitrator proceeded in his absence and dismissed the claims for failure to establish entitlement.

The insurer was awarded its expenses of the arbitration in the amount of $2,281.00.

The applicant sought statutory accident benefits, including income replacement and housekeeping benefits, following a motor vehicle accident.

The insurer denied the claims, and the applicant applied for arbitration.

The arbitrator dismissed the application, finding the applicant lacked credibility regarding his pre-accident job duties and a pre-existing wrist injury.

The arbitrator preferred the evidence of the applicant's employer, who testified that the applicant's job was sedentary and did not involve the heavy tasks he claimed he could no longer perform.

The claims for income replacement, housekeeping benefits, and a special award were denied.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from the insurer.

The insurer terminated income replacement and housekeeping benefits, arguing that the applicant's ongoing impairments were related to pre-existing conditions rather than the accident.

The arbitrator found that the accident materially contributed to the applicant's development of chronic pain syndrome and depression.

The arbitrator concluded that the applicant suffered a complete inability to engage in any employment for which he was reasonably suited and awarded ongoing income replacement benefits, housekeeping benefits, and various medical and rehabilitation benefits.

The claim for a special award was dismissed as the insurer's reliance on incorrectly completed disability certificates was not unreasonable.

The applicant sought statutory accident benefits following an alleged motor vehicle collision where he claimed to be a passenger in a BMW struck by a Nissan.

The insurer denied the claim, arguing the accident did not occur.

At a preliminary issue hearing, the insurer presented uncontroverted expert evidence from a collision reconstructionist demonstrating that the physical damage to the vehicles was entirely inconsistent with a collision between them.

The arbitrator accepted the expert's findings, concluded the applicant was not involved in an accident as defined by the Schedule, and found that the applicant had wilfully misrepresented material facts in his application for benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an orthopaedic mattress and retraining expenses.

The insurer denied the claims because the applicant incurred the expenses before submitting a treatment plan, contrary to section 38(1.1) of the Statutory Accident Benefits Schedule.

The applicant argued for relief from forfeiture under section 129 of the Insurance Act and section 31 of the Schedule.

The arbitrator held that the insurer was not liable to pay for the expenses because the treatment plans were not submitted prior to the expenses being incurred.

The arbitrator also found that section 129 of the Insurance Act and section 31 of the Schedule did not apply to relieve the applicant from the requirement to submit a treatment plan before incurring an expense.

The application was dismissed.

The applicant was injured in a motor vehicle accident in August 2005.

Nine months later, she suffered severe disc herniations resulting in a cauda equina-like syndrome and a conversion disorder.

The insurer denied ongoing income replacement and attendant care benefits, arguing the disc herniations were not causally related to the accident.

The arbitrator found that the accident materially contributed to the disc herniations and the subsequent conversion disorder.

However, the arbitrator concluded the applicant was not catastrophically impaired, as her combined physical (21%) and mental/behavioural (28%) whole person impairment rating was 43%, falling short of the 55% threshold.

The applicant was awarded an ongoing income replacement benefit and attendant care benefits capped at $3,000 per month for the 104-week period following the accident.

The applicant sought statutory accident benefits following a motor vehicle accident.

After her representative was removed from the record, the applicant failed to attend a pre-hearing and the scheduled arbitration hearing.

The arbitrator proceeded in her absence and dismissed the application, finding there was no evidence presented and no case for the insurer to meet.

The insurer was awarded $750 in expenses for its preparation and attendance.

The applicant applied for statutory accident benefits following a motor vehicle accident.

The insurer denied the claims, and the matter proceeded to arbitration.

The applicant failed to attend the pre-hearing and the hearing.

The arbitrator dismissed the application for arbitration due to the applicant's failure to attend and lack of evidence.

The insurer was awarded $750 in expenses.

The applicant was struck by an uninsured driver and applied for accident benefits from the Motor Vehicle Accident Claims Fund (MVAC Fund).

The applicant had previously settled a lawsuit against her long-term disability carrier, Great West Life (GWL), for a lump sum of $150,000.

The MVAC Fund brought a motion to determine whether the GWL settlement was deductible from any accident benefits owing under s. 267.8 of the Insurance Act or s. 22 of the Motor Vehicle Accident Claims Act.

The arbitrator found that the settlement funds were paid to settle a legal obligation rather than as a payment under an income continuation benefit plan.

As there was no evidence breaking down the settlement funds to past benefits owing, the arbitrator concluded the settlement was not deductible under either statute.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After his solicitor was removed from the record, the applicant failed to attend a pre-hearing discussion and the scheduled arbitration hearing.

The arbitrator dismissed the application for arbitration due to the applicant's failure to participate in the dispute resolution process.

The applicant was ordered to pay the insurer's expenses in the amount of $500.

The applicant filed an application for arbitration following a motor vehicle accident to claim statutory accident benefits.

The applicant's solicitors were removed from the record at a motion prior to the hearing.

The applicant failed to attend the pre-hearing and the scheduled arbitration hearing despite receiving notice.

The arbitrator dismissed the application for arbitration due to the applicant's failure to participate and ordered the applicant to pay $500 in expenses to the insurer.

The applicant sought an income replacement benefit following a motor vehicle accident.

The insurer denied the claim on the basis that the applicant was not employed at the time of the accident and that the application for mediation was filed beyond the two-year limitation period.

The Arbitrator found that the applicant had only completed a training period and was not employed at the time of the accident.

Furthermore, the Arbitrator held that the applicant failed to file an application for mediation within the two-year limitation period following a clear denial by the insurer.

The preliminary issues were resolved in favour of the insurer.

The applicant and the insurer both sought their expenses following an arbitration hearing regarding statutory accident benefits.

The arbitrator had previously awarded the applicant income replacement and housekeeping benefits for a limited duration, finding that the insurer relied on an equivocal medical report to stop benefits.

However, the arbitrator also found the applicant lacked credibility and had manufactured evidence.

Applying section 282(11) of the Insurance Act and the criteria in section 12(2) of Ontario Regulation 664, the arbitrator exercised his discretion to order that each party bear their own expenses due to divided success and the applicant's credibility issues.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including an income replacement benefit.

She also received a monthly disability benefit of $6,175.00 from a private RBC insurance policy.

The insurer sought to deduct the RBC benefit from the income replacement benefit under section 7 of the SABS.

The arbitrator held that the RBC policy met the criteria of an 'income continuation benefit plan' under section 2(9) of the SABS, as it was offered only to employed persons and the maximum benefit was calculated with reference to employment income.

Therefore, the RBC benefit was deductible.