Asfaw Seife

The applicant was injured in a motor vehicle accident and claimed ongoing weekly and lump sum education disability benefits under the Statutory Accident Benefits Schedule.

She argued that her back injuries prevented her from pursuing her intended career as a nurse, constituting a substantial inability to continue her education.

The arbitrator held that the Schedule does not compensate for loss of future career opportunity and found she was able to continue her post-secondary education in other fields.

However, the arbitrator found she suffered a partial inability to carry on a normal life for a limited period due to restrictions on her mobility activities, awarding weekly benefits for that closed period.

The applicant was injured in a motor vehicle accident and received weekly income benefits until August 1994.

The insurer argued the applicant's request for arbitration was time-barred under subsection 281(5) of the Insurance Act, relying on an Assessment of Claim form dated July 26, 1994 as its notice of refusal.

The arbitrator found the form did not satisfy the requirements of subsection 24(8) of the Statutory Accident Benefits Schedule because it was self-contradictory, stating the claim was 'accepted in its entirety' while also referencing a final settlement, and failed to provide clear reasons for refusal.

Consequently, the limitation period was not triggered, and the applicant was permitted to proceed to arbitration.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

A dispute arose over the calculation of his Income Replacement Benefits (IRB), specifically whether he was an employee or self-employed at the time of the accident.

The arbitrator found that the applicant had structured his financial affairs to be an independent contractor for tax purposes, and therefore must be treated as self-employed under the Schedule, resulting in a lower IRB.

Although the insurer had overpaid the applicant based on his initial claim of employment, the arbitrator held the applicant was not required to repay the overpayment because there was no wilful misrepresentation.

Claims for dependent care expenses, medical/accounting reports, and a special award were dismissed.

The applicant was awarded the expenses of the arbitration.

The applicant was injured in a motor vehicle accident and received weekly income benefits until they were terminated by the insurer.

The applicant applied for arbitration.

Prior to the hearing, the applicant's counsel was removed from the record after losing contact with her.

The applicant failed to attend the scheduled arbitration hearing.

The arbitrator proceeded in her absence pursuant to Rule 34.5 of the Dispute Resolution Practice Code.

As the applicant failed to present evidence or discharge her onus of proof, the application for ongoing weekly income benefits was dismissed.

The Applicant claimed she sustained neck and back injuries when her bicycle collided with a cube van insured by the Respondent.

The Insurer denied that an accident occurred.

Following a hearing on the preliminary issue of whether an 'accident' occurred within the meaning of the Statutory Accident Benefits Schedule, the Arbitrator found the Applicant's testimony implausible and preferred the evidence of the van driver and two independent witnesses who testified there was no contact between the van and the bicycle.

The Arbitrator concluded that the Applicant was not involved in an accident and did not sustain an impairment caused by the use or operation of an automobile.

The application for statutory accident benefits was dismissed.

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

The insurer terminated benefits, arguing the applicant did not meet the stricter disability test under section 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator determined that the 156-week period refers to 156 weeks of disability, not 156 weeks from the accident date.

On the merits, the arbitrator found that while the applicant could not return to his heavy pre-accident work as a millwright, he had transferrable skills and was capable of engaging in suitable light-duty employment.

The claim for ongoing weekly income benefits was dismissed.

The arbitrator also denied the applicant's claim for a special award, finding the insurer did not unreasonably withhold payments, but awarded the applicant his arbitration expenses.

The applicant was injured in a motor vehicle accident and received weekly disability benefits until they were terminated by the insurer.

She applied for arbitration, claiming entitlement to further benefits under section 19 of the Statutory Accident Benefits Schedule on the basis that she suffered a partial inability to carry on a normal life.

The arbitrator found inconsistencies in the applicant's reporting of her functional abilities and preferred the medical evidence indicating she could still perform the majority of her pre-accident mobility and household activities.

The claim for further benefits was dismissed, but the applicant was awarded her arbitration expenses as the claim was not totally without merit.

The applicant, a self-employed farmer, was injured in a motor vehicle accident and received weekly income benefits from the insurer.

The insurer terminated benefits after 156 weeks, arguing the applicant did not meet the stricter test of disability under section 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator found the applicant was continuously prevented from engaging in suitable employment and remained entitled to benefits.

The arbitrator also accepted the applicant's accountant's calculation of gross weekly income, which treated the value of exchanged family labour as a ceasing business expense.

Finally, the arbitrator held that the insurer was not entitled to repayment of an initial overpayment, as the error resulted from the insurer's interpretation of the legislation rather than any material act or omission by the applicant.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer refused to pay, and the applicant applied for arbitration.

The insurer raised preliminary issues regarding whether the applicant was precluded from arbitration for failing to submit a completed application for benefits (s. 59) and failing to attend insurer's examinations (s. 65).

The arbitrator found that the applicant substantially complied with the application requirement but failed to make himself reasonably available for the scheduled medical examinations without a reasonable explanation.

As a result, the applicant was precluded from commencing an arbitration proceeding.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated his weekly income replacement benefits.

The applicant sought arbitration for ongoing income replacement benefits and the cost of an orthopaedic mattress.

The arbitrator found the applicant lacked credibility, noting significant inconsistencies between his reported disability and surveillance evidence showing him working and performing physical tasks.

Relying on independent medical assessments, the arbitrator concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The claims for ongoing benefits, the mattress, and arbitration expenses were dismissed.

The applicant sought maximum death benefits of $200,000 following her husband's death in a motor vehicle accident, arguing he was self-employed as a securities trader.

The insurer paid the minimum $50,000, contending he was retired and living off investments.

The arbitrator found that the deceased's investment activities did not constitute self-employment or a business, as he was not an aggressive trader and his portfolio consisted largely of secure, fixed-income investments.

Consequently, the deceased was not employed at the time of the accident, and the applicant was entitled only to the minimum death benefit of $50,000.

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

The insurer refused to pay certain invoices for rehabilitation services, and mediation failed.

The applicant subsequently signed a full and final release settling her claims for a lump sum.

She later applied for arbitration to claim the disputed rehabilitation expenses.

The arbitrator held that the release was a valid agreement that finally disposed of the claim, precluding the applicant from commencing arbitration.

Finding the arbitration to be an abuse of process, the arbitrator denied the applicant's expenses and ordered her to pay the insurer's assessment fee.

The applicant was injured when a storage tank in the back of a pick-up truck exploded while a neighbour was welding bolts to it.

The applicant applied for statutory accident benefits, but the insurer denied the claim, arguing the injury was not caused by the 'use or operation' of an automobile.

The arbitrator applied the two-part test from Amos, finding that repairing equipment permanently installed on a commercial vehicle is an ordinary and well-known activity to which such vehicles are put.

The arbitrator also found a direct causal relationship between the repair work and the explosion.

The arbitrator concluded the applicant was injured in an accident and awarded expenses.

The applicant applied for arbitration after the insurer terminated his weekly income benefits following a motor vehicle accident.

The applicant failed to attend the pre-hearing and the hearing, despite receiving proper notice.

The arbitrator dismissed the applicant's claim due to his failure to pursue it and present evidence.

The arbitrator found the applicant's conduct to be vexatious and an abuse of process, ordering him to pay the insurer's $2,000 assessment fee.

The insurer's request for repayment of benefits was dismissed, as a counterclaim cannot stand alone once the main application is dismissed.

The applicant was injured in a motor vehicle accident and received weekly income benefits from the insurer for 156 weeks.

The insurer terminated benefits, arguing the applicant did not meet the test for disability under section 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant was continuously prevented from engaging in any suitable employment due to physical and psychological impairments caused by the accident.

The arbitrator also found the insurer acted unreasonably in terminating benefits without sufficient medical evidence or providing vocational retraining, and awarded a special lump sum of $5,000.

Finally, the arbitrator ruled that the insurer is entitled to deduct 100 per cent of collateral benefits received by the applicant.

The insurer brought a motion to dismiss the insured's application for arbitration and for payment of its $1,000 assessment, arguing the insured's conduct constituted an abuse of process.

The insured's counsel had requested an adjournment but subsequently failed to coordinate a new hearing date or respond to numerous communications from the Commission and the insurer over a six-month period.

The arbitrator found that the unexplained failure to respect the Commission's procedures and respond to inquiries constituted an abuse of process.

However, the arbitrator declined to dismiss the arbitration, instead ordering the insured to pay the insurer's $1,000 assessment as a condition of proceeding with a rescheduled hearing.

The Applicant was injured while operating a stock car during a race and applied for statutory accident benefits.

The Insurer denied the claim, arguing that a stock car is not an 'automobile' under the Schedule.

The Arbitrator found that the stock car qualifies as an automobile under the broad definition in section 1 of the Insurance Act, as it is a self-propelled vehicle not specifically excluded.

The Applicant was therefore injured in an 'accident' and is entitled to proceed with his claim for benefits.

The applicant was injured in a motor vehicle accident and received weekly income benefits until they were terminated by the insurer.

The applicant sought arbitration, claiming ongoing physical and psychological disability preventing him from working as a taxi driver.

The arbitrator found the applicant lacked credibility due to inconsistencies in his testimony and reliable medical records indicating pre-existing conditions.

The medical evidence did not establish an objective physical basis for his ongoing pain complaints, nor did it prove his psychological issues were caused by the accident.

The claim for ongoing weekly income benefits was dismissed, though the arbitrator confirmed the correct quantum of benefits was $540.00 per week and awarded the applicant his arbitration expenses.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits until the Insurer terminated them.

She applied for arbitration, claiming ongoing entitlement to weekly benefits, a special award, and expenses.

The arbitrator found the Applicant lacked credibility, noting inconsistencies in her testimony and medical evidence that contradicted her claims of ongoing disability.

The arbitrator concluded she was substantially able to perform her essential tasks by the time benefits were terminated.

The claims for weekly benefits, a special award, and expenses were dismissed.

The Arbitrator issued a correction to a previous decision dated January 24, 1996, to amend the name of the insurer's representative from Harry P. Brown to Mark W. Sones.