Beth Allen

The applicant was injured in a motor vehicle accident and sought various supplementary medical and rehabilitation benefits, a special award, and arbitration expenses.

The arbitrator held that issues not previously mediated could not be raised without the insurer's consent.

The claims for transportation, medication, orthopaedic shoes, and home maintenance expenses were dismissed because the applicant failed to sufficiently substantiate that they were reasonably and necessarily required as a result of the accident.

The claims for a special award and arbitration expenses were also dismissed.

The applicant was struck by an automobile while riding his bicycle and claimed statutory accident benefits, including other disability benefits (ODBs), medication, and transportation expenses.

The insurer terminated ODBs and argued the arbitration was barred because the applicant had previously commenced a tort action.

The arbitrator held that the Insurance Act does not preclude concurrent arbitration and court actions.

On the merits, the arbitrator found the applicant failed to establish a partial or complete inability to carry on a normal life, denying ongoing ODBs.

Claims for medication expenses were denied for lack of proof, but $140 for transportation expenses to medical appointments was awarded.

The applicant was injured in a snowmobile accident and received income replacement benefits (IRBs) for 104 weeks.

The insurer then terminated IRBs and offered a 'nil' loss of earning capacity (LEC) benefit.

The applicant disputed the LEC benefit amount and claimed entitlement to ongoing IRBs pending the dispute's resolution.

The arbitrator held that the pre-1995 version of the Statutory Accident Benefits Schedule applied, entitling the applicant to ongoing IRBs pending resolution.

The arbitrator determined the applicant's pre-accident earning capacity based on his intermittent employment history and his residual earning capacity based on an electronics assembler position, resulting in a weekly LEC benefit of $153.41.

The insurer was ordered to pay the ongoing IRBs, the LEC benefit, and the applicant's arbitration expenses.

The applicant was injured in a motor vehicle accident and sought payment for rehabilitation services provided by Trauma Services.

The insurer refused to fund further services and raised a preliminary issue, arguing that the arbitrator lacked jurisdiction because the service provider, not the insured, was the real applicant.

The arbitrator found that the applicant had not assigned her right to commence arbitration but had merely authorized the service provider to represent her and deal directly with the insurer.

The arbitrator concluded she had jurisdiction to hear the claim.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for a rehabilitation case manager and attendant care services provided by her daughter.

The insurer disputed the need for a case manager and the extent of attendant care required.

The arbitrator found that the applicant's ongoing impairment and need for coordinated rehabilitation justified the services of a case manager.

Furthermore, relying on the applicant's credible testimony and supportive occupational therapy assessments, the arbitrator awarded attendant care benefits at the claimed rate of $10 per hour for four hours a day, five days a week.

The applicant sought an assessment of legal expenses incurred during an arbitration and the subsequent assessment hearing.

The insurer argued the legal bill exceeded the maximum hours allowable under the Legal Aid Act.

The arbitrator allowed the legal expenses for the arbitration period, finding them reasonable given the complexity and duration of the hearing.

However, the arbitrator denied the expenses for the assessment hearing itself, ruling that it is a separate proceeding not covered by the Expenses Schedule.

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

She subsequently missed two periods of work and claimed entitlement to weekly income benefits for those periods under section 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant failed to meet the burden of proving that her injuries continuously prevented her from engaging in any occupation or employment for which she was reasonably suited by education, training, or experience.

The claim for benefits was dismissed, but the applicant was awarded her arbitration expenses.

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

The insurer reduced her weekly income benefits to the minimum rate, and the applicant sought arbitration to claim a higher rate based on an alleged offer of employment.

The insurer raised a preliminary issue that the arbitration was barred by the two-year limitation period.

The arbitrator held that the limitation period was not triggered because the insurer's reduction of benefits was not a refusal to pay the benefit claimed.

On the substantive issue, the arbitrator found that the applicant was employed on an extended unpaid leave at the time of the accident and did not hold a legitimate offer of employment within the meaning of the Schedule.

The applicant was therefore entitled only to the minimum weekly benefit rate.

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

The applicant brought a motion for interim benefits, arguing the insurer failed to comply with the benefit stoppage provisions under section 64 of the Statutory Accident Benefits Schedule.

The arbitrator held that to obtain interim benefits, an applicant must establish a prima facie case for entitlement and a sense of urgency.

The arbitrator found that the medical evidence raised the possibility that the applicant's cognitive problems resulted from non-accident related causes, such as age-related dementia.

As the applicant failed to present sufficient evidence or legal arguments to establish a prima facie case for entitlement, the motion for interim benefits was dismissed.

The applicant was struck by a bus while walking to work and sustained a head injury resulting in chronic headaches, depression, anxiety, and cognitive difficulties.

The insurer terminated her weekly income benefits after 104 weeks, arguing she was not disabled from returning to reasonably suitable employment or that her disability was due to pre-existing conditions.

The arbitrator found the applicant credible and preferred the evidence of her treating medical practitioners over the insurer's assessors who only saw her once or twice.

The arbitrator concluded that the applicant's complex of psychological, emotional, and cognitive symptoms substantially disabled her from engaging in any employment for which she was reasonably suited.

The insurer was ordered to reinstate weekly income benefits with interest and pay the applicant's arbitration expenses.

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

The applicant applied for arbitration, claiming ongoing weekly income benefits on the basis that severe, unpredictable headaches caused by the accident continuously prevented him from engaging in any occupation for which he was reasonably suited.

The Arbitrator found the applicant credible and accepted medical evidence that his severe headaches were debilitating and unpredictable.

The Arbitrator concluded that the applicant was continuously prevented from engaging in suitable employment and ordered the insurer to pay ongoing weekly income benefits and arbitration expenses.

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

The parties attended mediation and signed a settlement agreement.

The applicant later applied for arbitration, arguing the settlement was invalid due to a language barrier, lack of education, and emotional problems (non est factum).

The arbitrator found the applicant understood the mediation process, as the mediator translated discussions and documents, and the applicant had prior business experience.

The arbitrator concluded the claims were validly settled and dismissed the application for arbitration.

The arbitrator declined to award expenses to the applicant and declined to order an award against the applicant for a frivolous proceeding.

The applicant, an 87-year-old woman, was injured in a motor vehicle accident and sought ongoing weekly and care benefits after the insurer terminated them.

The insurer raised a preliminary issue that the applicant failed to attend an independent medical examination.

The arbitrator found the applicant had a reasonable excuse for missing the examination and was not precluded from proceeding.

On the merits, the arbitrator found the applicant suffered a substantial inability to perform her essential tasks due to physical and psychological injuries from the accident, entitling her to ongoing weekly benefits.

The arbitrator also awarded ongoing care benefits at $250 per week and a $2,000 special award under section 282(10) of the Insurance Act, finding the insurer unreasonably terminated benefits without a sound basis.

The applicant sought statutory accident benefits (weekly income benefits) under the Insurance Act, claiming he suffered from post-traumatic stress disorder (PTSD) following a motor vehicle accident.

The arbitrator found the applicant's account of the accident to be exaggerated and unreliable, noting inconsistencies in medical records and post-accident conduct that contradicted a driving phobia.

The arbitrator rejected the expert evidence of both the applicant's psychiatrist and the insurer's psychologist.

The application for weekly income benefits was dismissed as the applicant failed to prove a disability resulting from the accident, though arbitration expenses were awarded to the applicant.

The applicant was injured in a motor vehicle accident and applied for weekly income benefits, claiming he had a legitimate offer of employment as a cook at the time of the accident.

The arbitrator found the applicant's evidence and that of his witnesses regarding the job offer to be untrustworthy and contradictory.

The arbitrator concluded that the applicant did not have a genuine offer of employment and dismissed the claim for income benefits.

Finding that the applicant advanced a dishonest claim and abused the arbitration process, the arbitrator denied the applicant's hearing expenses and ordered him to pay a $2,000 assessment to the insurer.

The applicant sought to arbitrate a claim for statutory accident benefits after her benefits were terminated.

The insurer raised a preliminary issue, arguing the application was barred by the two-year limitation period under s. 281(5) of the Insurance Act.

The arbitrator found that the insurer failed to provide clear and unequivocal written notice of its refusal to pay benefits as required by s. 24(8) of the Statutory Accident Benefits Schedule.

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

The Applicant was injured in a motor vehicle accident and received weekly income benefits of $185.60 based on her part-time employment.

She applied for arbitration, claiming her benefits should be $478.77 per week based on potential income from a street vending business she was attempting to start before the accident.

The arbitrator found that the statutory accident benefits scheme compensates for actual loss of income, not loss of potential or future business profits.

The Applicant's claim for higher benefits was dismissed, and her entitlement was confirmed at $185.60 per week.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, which were later terminated by the insurer.

She applied for arbitration seeking ongoing weekly benefits and housekeeping expenses.

The arbitrator found that the applicant failed to prove a substantial inability to perform her essential tasks, noting significant credibility issues, including video surveillance evidence that contradicted her claims of severe physical limitations.

The claims for weekly benefits and housekeeping expenses were dismissed, but the applicant was awarded her hearing expenses.