Beth Allen

The applicant sought to withdraw his application for arbitration of statutory accident benefits in order to proceed by court action.

The insurer consented to the withdrawal on the condition that the applicant pay its assessment fee and arbitration expenses.

The arbitrator permitted the withdrawal and ordered the applicant to pay $500 towards the insurer's arbitration expenses, recognizing that the applicant's change of process caused wasted expenses.

However, the arbitrator declined to order the applicant to pay the insurer's $3,000 assessment fee, finding that the decision to withdraw and proceed in court did not constitute an abuse of process.

The applicant, a self-employed taxi driver, sought income replacement benefits following a motor vehicle accident.

The insurer denied the claim on the basis that the applicant failed to provide sufficient financial and medical information to determine entitlement.

The arbitrator found that the applicant failed to comply with his obligations under section 33 of the Statutory Accident Benefits Schedule by providing inadequate financial records and refusing to authorize the release of clinical notes from his treating physicians.

Consequently, the applicant was disentitled to benefits.

The arbitrator also found that the applicant failed to prove a substantial inability to perform the essential tasks of his employment.

The claim for a special award was dismissed.

The applicant sought expenses following an arbitration decision that awarded her income replacement benefits.

The insurer disputed the amounts claimed for legal fees and accountants' services as excessive.

The arbitrator assessed the legal fees based on a reasonable ratio of preparation time to hearing time, allowing 24 hours at $125 per hour for the original bill.

The supplementary legal bill was reduced as excessive.

The arbitrator also reduced the claimed disbursements for two accounting firms, noting that one accountant did not testify and part of their report dealt with matters not in dispute.

The applicant was awarded a total of $6,427.07 in expenses.

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

The applicant sought reinstatement of the benefits, claiming he was substantially unable to perform the essential tasks of his employment as a real estate agent.

The arbitrator found that the applicant failed to meet his burden of proof, relying on independent medical assessments and surveillance evidence showing he had returned to work.

The application for further income replacement benefits was dismissed.

The applicant sought income replacement benefits following a motor vehicle accident but failed to produce required financial documents.

She subsequently failed to attend pre-hearing discussions and the arbitration hearing itself, and her counsel withdrew due to lack of instructions.

The arbitrator dismissed the application due to a lack of evidence.

The arbitrator denied the applicant's expenses, awarded the insurer a portion of its expenses to be assessed, and ordered the applicant to pay $1,000 to the insurer for abuse of process under subsection 282(11.2) of the Insurance Act.

The applicant, who sustained a closed head injury in a motor vehicle accident, sought accident benefits for 'non-legal' support services provided by a law clerk at his counsel's firm.

The law clerk spent significant time providing emotional support and dealing with the applicant's personal problems.

The arbitrator dismissed the claim, finding that while the expense was incurred as a result of the accident, it was not reasonable because the law clerk's services duplicated and overlapped with the services already provided by the applicant's funded case manager.

The arbitrator issued a correction to a previous decision regarding the applicant's entitlement to an income replacement benefit.

The original decision incorrectly stated the entitlement period began on October 8, 1999 and continued onwards.

The decision and order were corrected to reflect that the applicant is entitled to an income replacement benefit of $81.30 per week, based solely on employment income, from October 8, 1998 to the 104-week point after the accident.

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

The parties agreed on the quantum of his employment income but disputed the amount of his self-employment income from home renovations.

The applicant claimed his memory of the self-employment work was affected by a head injury sustained in the accident.

The arbitrator found that the applicant failed to provide reliable evidence or documentation to prove the amount of self-employment income he earned in the 52 weeks before the accident.

The arbitrator concluded that the applicant's Income Replacement Benefit should be calculated based solely on his employment income at the agreed rate of $81.30 per week.

The applicant was injured in a minor rear-end motor vehicle accident and received income replacement benefits until they were terminated following a DAC assessment.

He applied for arbitration seeking reinstatement of IRBs, a loss of earning capacity benefit offer, and transportation expenses, claiming severe psychological and physical impairments.

The arbitrator dismissed the claims, finding that the applicant exaggerated his symptoms and was malingering.

The arbitrator concluded that the applicant's physical complaints were related to pre-existing conditions, including post-polio syndrome and degenerative disc disease, and that the minor impact of the collision could not account for his extreme clinical presentation.

Video surveillance showing the applicant walking normally without a cane further undermined his credibility.

The applicant sought various statutory accident benefits following a motor vehicle accident, including income replacement benefits, an education benefit, medical expenses, dependant care, and housekeeping expenses.

The insurer denied the claims.

The arbitrator found that while the applicant was not procedurally barred from claiming income replacement benefits, she failed to prove that her accident-related injuries substantially prevented her from performing the essential tasks of her employment.

The arbitrator also dismissed the claims for education, medical, dependant care, and housekeeping benefits due to a lack of credible evidence and documentary proof that the expenses were incurred or were reasonable and necessary as a result of the accident.

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

The insurer paid income replacement benefits, but the applicant claimed entitlement to higher education disability benefits (EDBs) because she was a hairstylist apprentice at the time of the accident.

The insurer argued she was employed and thus only entitled to income replacement benefits, and alternatively, that her claim for EDBs was barred by the two-year limitation period.

The arbitrator found that the applicant's apprenticeship constituted full-time enrollment in post-secondary education, qualifying her for EDBs.

The arbitrator also held that the insurer's explanation of assessment did not constitute a clear and unequivocal refusal of benefits, so the limitation period was not triggered and the claim was not statute-barred.

The applicant was injured in two motor vehicle accidents and received income replacement benefits from the insurer.

The insurer terminated the benefits, and the applicant brought a preliminary motion requesting that the insurer arrange a Designated Assessment Centre (DAC) assessment and pay interim benefits pending the assessment.

The arbitrator dismissed the motion, finding that the applicant had delayed raising the issue for over three years and that a DAC assessment would not be useful given the passage of time.

The arbitrator also declined to order interim benefits, noting that the applicant failed to establish a minimal level of disability or urgency.

The applicant sought to withdraw her application for arbitration regarding a $330 physiotherapy assessment bill, claiming the arbitration was commenced by her former legal representatives and the clinic without her knowledge or consent.

The insurer did not oppose the withdrawal but sought its arbitration expenses against the clinic and the legal representatives, arguing they abused the Commission's process.

The arbitrator permitted the withdrawal without conditions.

The arbitrator found that the clinic and representatives had indeed abused the process by commencing the arbitration without the applicant's knowledge, but concluded she had no statutory jurisdiction under the Insurance Act or the Statutory Powers Procedure Act to order non-parties to pay expenses or to make orders against them to prevent future abuse of process.

The applicant was assaulted and his car was stolen in the underground parking garage of his apartment building.

He applied for statutory accident benefits, claiming the incident was an 'accident' under the Schedule.

The arbitrator found that the applicant was approaching his car when he was attacked, but had not yet reached it or begun to use it.

Applying the Amos test, the arbitrator concluded that the vehicle was not instrumental in causing the injuries and the incident did not arise out of the ordinary use or operation of an automobile.

The application for accident benefits was dismissed.

The applicant was injured in two motor vehicle accidents and received weekly income benefits.

The insurer reduced the benefits after the applicant began receiving CPP disability benefits, and later refused to restore the higher rate following court decisions holding that CPP benefits were not deductible.

The insurer argued the applicant was barred from arbitrating the issue by the two-year limitation period.

The arbitrator found that the insurer's notice of benefit reduction did not constitute a proper refusal to pay, as the applicant had already agreed to a reduction and proposed a repayment method.

Therefore, the limitation period had not commenced, and the applicant was not time-barred.

The arbitrator declined to order a special award, finding the insurer's position was based on an honestly-held error rather than bad faith, but awarded interest on overdue amounts and expenses to the applicant.

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

The insurer terminated benefits and the applicant applied for arbitration.

The insurer argued the application was barred by the two-year limitation period under subsection 281(5) of the Insurance Act.

The applicant's representative claimed to have filed two previous applications within the limitation period that were allegedly misplaced by the Commission.

The arbitrator rejected the representative's evidence as fabricated and unreliable, finding the application was filed out of time.

The arbitration was dismissed, and the applicant was ordered to pay $1,000 of the insurer's expenses due to the manifestly unfounded claims regarding the limitation period.

The applicant was injured in a motor vehicle accident and claimed income replacement benefits, alleging he was employed as a mechanic.

The arbitrator found that while the applicant was employed at the time of the accident, he failed to provide reliable evidence to substantiate the amount of his income, as the employment documents were created after the fact and contained inconsistencies.

Consequently, the applicant did not establish the amount of his income replacement benefits.

The insurer was granted an interim order for repayment of $3,239.34 for benefits previously paid in excess of the minimum rate, due to the applicant's wilful misrepresentation of his income.

The applicant was injured in a motor vehicle accident while a passenger in a car.

The insurer denied income replacement benefits, arguing the applicant was excluded under s. 30(2)(b) of the Statutory Accident Benefits Schedule because he knew or ought reasonably to have known the driver was operating the vehicle without the owner's consent.

The arbitrator found that the driver's father was the owner of the vehicle and had not consented to the driver's use.

However, the insurer failed to prove that the applicant knew or ought reasonably to have known of the lack of consent.

The exclusion did not apply, and the insurer was ordered to pay interim income replacement benefits.

The applicants sought statutory accident benefits, including income replacement, education, rehabilitation, and medical benefits, following a motor vehicle accident.

The insurer terminated benefits and the matter proceeded to arbitration.

The arbitrator dismissed the applicants' claims, finding significant inconsistencies and credibility issues in their evidence regarding the accident and their injuries.

The arbitrator also found the medical and rehabilitation evidence unreliable.

The insurer's request for expenses and a special award for frivolous claims was also dismissed, as the arbitrator accepted an accident occurred and did not find the claims to be an abuse of process.

The applicant was injured in a motorcycle accident and applied for income replacement benefits (IRBs).

He argued that the proceeds from the sale of a property he renovated should be treated as business income from self-employment and included in the calculation of his IRBs.

The insurer argued the proceeds were a capital gain and should be excluded.

The arbitrator found that the applicant was not self-employed in a business related to the property, as he did not have an established business location, did not register a business, and the transaction was not obviously commercial in nature.

The proceeds were determined to be a capital gain and excluded from the IRB calculation.

The applicant was awarded his expenses for the arbitration proceeding due to the complexity of the issues.