Asfaw Seife

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

She applied for arbitration, claiming a substantial inability to perform the essential tasks of her pre-accident employment as a cook.

The arbitrator reviewed medical evidence, including functional capacity assessments and expert reports, which indicated she was capable of returning to work with minor restrictions.

Finding the applicant's testimony regarding her limitations lacked credibility and was inconsistent with her activities, the arbitrator concluded she did not suffer a substantial inability to perform her essential tasks and dismissed the claim for further benefits, though awarded her arbitration expenses.

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

The insurer terminated benefits, arguing the applicant no longer met the stricter disability test under section 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator found that while the applicant suffered from chronic back pain and might be disabled from his pre-accident heavy manual job, he failed to prove that his injuries continuously prevented him from engaging in any occupation or employment for which he was reasonably suited by education, training, or experience.

The application for further weekly income benefits was dismissed, but the insurer was ordered to pay the applicant's arbitration expenses.

The applicant was injured in a rear-end motor vehicle accident while she was a full-time law student and pregnant.

She applied for statutory accident benefits, claiming weekly income benefits and housekeeping expenses.

The arbitrator found that while the applicant sustained soft tissue injuries, she did not suffer a substantial inability to perform her essential tasks as a student and homemaker, as she successfully completed her studies and her husband performed the household chores.

The claim for housekeeping expenses was also denied because the husband's services were provided out of love and duty, and did not constitute a compensable expense under the Schedule.

The Arbitrator issued a correction to a previous decision dated June 13, 1995.

A typographical error citing Section 227(5)(1) of the Act was deleted and replaced with the correct citation, Section 227(5).

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 but failed to attend the hearing or produce required medical and financial documentation.

The arbitrator dismissed the applicant's claim due to lack of evidence.

Finding the applicant's pursuit of the claim to be vexatious and an abuse of process, the arbitrator ordered the applicant to pay the insurer $1,000 for the arbitration assessment fee.

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

The insurer subsequently terminated the benefits and sought repayment, alleging the applicant had misrepresented his pre-accident employment and income.

The arbitrator found the applicant's evidence regarding his employment to be contradictory and unsubstantiated, determining his weekly income benefits should be based solely on his verifiable employment.

The arbitrator also accepted expert evidence that the applicant was malingering and feigning psychological injuries, concluding he was not entitled to ongoing benefits.

The applicant was ordered to repay $16,233.06 in overpaid benefits and $1,000 in arbitration expenses for advancing a frivolous claim.

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

A dispute arose regarding the correct method of calculating his gross weekly income under section 12(7) of the Statutory Accident Benefits Schedule, as he had only worked for part of the four weeks preceding the accident.

The arbitrator found that the legislation is ambiguous and should be interpreted to best reflect the applicant's actual employment income.

The arbitrator concluded that the applicant's income should be averaged only over the weeks he actually worked, resulting in a weekly benefit of $429.31.

The applicant was injured in a motor vehicle accident while driving a taxi.

He applied for statutory accident benefits from the insurer of the taxi, who denied the claim and referred him to the insurer of his personal vehicle.

A priority dispute arose between the two insurers regarding which was liable to pay the benefits.

The arbitrator determined that the applicant was an 'insured' under both policies, but was only a 'named insured' under his personal vehicle's policy for the purposes of section 268(5) of the Insurance Act.

Consequently, the insurer of the applicant's personal vehicle was held liable to pay the statutory accident benefits.

The applicant was injured in a motor vehicle accident and received weekly income benefits until January 1992.

The insurer raised a preliminary issue that the applicant's 1994 application for arbitration was time-barred under the Insurance Act, arguing a February 1992 letter constituted a valid notice of refusal.

The arbitrator found that the letter did not clearly and unequivocally communicate the insurer's refusal to pay benefits and the reasons for the refusal.

Therefore, the letter did not meet the requirements of subsection 24(8) of the Schedule, the limitation period was not triggered, and the applicant was not precluded from proceeding to arbitration.

The applicant was injured in a motor vehicle accident when she was struck by a car as a pedestrian, sustaining knee injuries.

The insurer terminated her weekly income benefits after approximately 20 months.

The applicant sought ongoing benefits, arguing she was substantially unable to perform the essential tasks of her pre-accident employment as a fast-food restaurant assistant manager.

The arbitrator found that while the applicant had some limitations with heavy lifting and repetitive crouching, she could perform the great majority of her essential tasks without difficulty.

The application for ongoing weekly income benefits and a special award was dismissed, though the applicant was awarded her arbitration expenses.

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

The Insurer raised a preliminary issue that the Applicant was no longer eligible for benefits under section 16(2) of the Schedule because she had returned to work for an aggregate of more than 90 days after the second anniversary of the accident.

The Arbitrator held that the phrase 'for periods of up to ninety days' in section 16(2) means one or more continuous periods of up to 90 days each, not an aggregate of shorter periods.

Since the Applicant had not worked for a continuous period of 90 days, she remained eligible for benefits.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

After mediation failed, she applied for arbitration regarding weekly income benefits and other expenses.

The Insurer raised a preliminary issue, arguing the Applicant was precluded from proceeding to arbitration because she had commenced a separate court action against the Insurer for different medical expenses arising from the same accident.

The arbitrator dismissed the preliminary objection, finding that the Insurance Act does not compel an insured to refer all disputes to a single forum, provided the specific matters referred to arbitration are distinct from those in the court action.

The applicant, a real estate agent, was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer disputed the calculation of her pre-accident income, arguing that commissions received after the accident for sales negotiated before the accident should not be included in her pre-accident income.

The arbitrator held that the commissions were earned prior to the accident when the work was performed, and should be included in the calculation of her pre-accident income.

The applicant was awarded weekly income benefits of $600.00, and the insurer's claim for repayment was dismissed.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits.

The Insurer terminated weekly income benefits, arguing she was no longer substantially unable to perform her essential tasks.

The Applicant sought ongoing benefits and a special award.

The arbitrator found the Applicant was entitled to weekly income benefits for a limited period following the termination, as her ongoing disabilities after that period were attributable to pre-existing medical conditions and subsequent slip and fall accidents, not the motor vehicle accident.

The claim for a special award was dismissed as the Insurer did not unreasonably withhold payments.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

A dispute over the amount of weekly income benefits went to mediation, where the Insurer claimed a settlement of $300 per week was reached.

The Applicant later applied for arbitration, arguing mediation had failed.

On a preliminary issue, the arbitrator found that the parties had indeed settled the issue at mediation, as evidenced by the mediator's report and the parties' subsequent conduct.

Consequently, the Applicant was precluded from referring the matter to arbitration under section 281(2) of the Insurance Act.

The arbitrator declined to award expenses to either party.

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

The parties mediated the issue of entitlement to benefits but not the amount.

At a pre-hearing discussion for arbitration, the Insurer sought to add the amount of benefits as an issue.

The arbitrator held that the amount of benefits could not be raised because it had not been mediated and did not reasonably and consequentially flow from the issue of entitlement.

The applicant was injured in a minor rear-end motor vehicle accident and received weekly income benefits until the insurer terminated them.

The applicant sought arbitration, claiming ongoing disability due to neck, shoulder, and back pain.

The arbitrator reviewed medical evidence and surveillance videotape showing the applicant performing physical tasks without apparent difficulty.

Finding the applicant's testimony evasive and lacking objective medical corroboration, the arbitrator concluded the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment.

The claim for ongoing weekly benefits was dismissed.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and claimed statutory accident benefits.

A dispute arose regarding the calculation of her pre-accident gross weekly income, as she operated on a cash basis and did not file tax returns.

The arbitrator found that the applicant's uncorroborated testimony and self-created trip sheets for only one week were insufficient to prove an income higher than the deemed minimum.

Consequently, her weekly income benefits were set at the minimum of $185.60.

The insurer's claim for repayment of benefits previously paid at a higher rate was dismissed, as the insurer failed to prove the payments were made through error or fraud.

The appellant submitted a request under the Freedom of Information and Protection of Privacy Act for notes made by panellists of a Health Disciplines Review Board hearing and a Ministry employee.

The Ministry informed the appellant that the notes had been destroyed after the review concluded.

The appellant appealed, maintaining the records existed.

The Inquiry Officer reviewed affidavits from the panellists and an explanatory note, concluding that the Ministry's search was reasonable and the records had been destroyed in accordance with established procedures.

The Ministry's decision was upheld.

The appellant requested access to the identities of individuals who responded to a municipal market survey regarding lot development.

The City of Elliot Lake denied access to the names, addresses, and telephone numbers under the personal privacy exemption of the Municipal Freedom of Information and Protection of Privacy Act.

The Information and Privacy Commissioner upheld the City's decision, finding that the records contained personal information, disclosure would constitute an unjustified invasion of personal privacy, and the public interest override did not apply.

The Commissioner also found that the City conducted a reasonable search for responsive records.