David R. Draper

The Applicant was injured in a motor vehicle accident and claimed expenses for a Health Care Aide to assist her at home, arguing these were 'nursing services' under section 6(1)(a) of the Statutory Accident Benefits Schedule, which has no monthly limit.

The Insurer argued the services were 'care' benefits under section 7, subject to a $3,000 monthly limit.

The Arbitrator held that the services provided by the Health Care Aide were best described as 'care' rather than 'nursing services,' as they were primarily focused on assisting with daily tasks rather than active treatment or rehabilitation.

Therefore, the benefits were limited to $3,000 per month under section 7.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, claiming she was no longer substantially unable to perform the essential tasks of her pre-accident employment as a server and cashier.

The arbitrator found that the applicant remained substantially unable to perform the heavy aspects of her work as a server and was therefore entitled to ongoing weekly income benefits.

The arbitrator also determined the proper calculation of her pre-accident income, including an estimate of her tip income, and awarded a special award of $1,500 against the insurer for unreasonably handling the tips issue.

The applicant, a taxi driver, was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, alleging overpayment based on fraudulent income records.

The arbitrator found that the applicant remained substantially unable to perform the essential tasks of her employment and was therefore entitled to ongoing weekly income benefits.

However, the arbitrator accepted the insurer's accounting evidence that the applicant's pre-accident financial records were not genuine.

Consequently, her benefits were reduced to the statutory minimum of $185.60 per week, and she was ordered to repay the overpayment to the insurer pursuant to section 27 of the Schedule.

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

The insurer deducted Canada Pension Plan disability benefits from the weekly income benefits, arguing they were payments for loss of income.

The applicant disputed this and applied for arbitration.

On the date of the hearing, the applicant conceded the claim would fail but sought arbitration expenses.

The arbitrator found it was reasonable for the applicant to have applied for arbitration to test the legal issue, but noted the claim was unreasonably prolonged before being conceded.

The arbitrator awarded the applicant $750 in expenses.

The applicant sought death and care benefits following the death of her uncle in a motor vehicle accident.

The applicant claimed her uncle was her dependant and that she lost business income while caring for him.

The arbitrator dismissed the claims, finding that the uncle was financially independent and therefore not a dependant under the Schedule.

The arbitrator also found insufficient evidence that the applicant's business lost income as a result of her caregiving duties.

However, the applicant was awarded her arbitration expenses.

The applicant sought ongoing weekly income benefits and a special award following a motor vehicle accident.

The insurer terminated benefits after an independent medical examination concluded the applicant's complaints were not genuine and he was fit to return to work.

The arbitrator dismissed the claim for ongoing benefits, finding the applicant's evidence lacked credibility due to his active concealment of a prior similar accident and exaggeration of his symptoms.

The claim for a special award was also dismissed, but the applicant was awarded his arbitration expenses because the claim was not manifestly frivolous.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including weekly income benefits, which the insurer terminated on the basis that she was no longer substantially unable to perform the essential tasks of her pre-accident employment as a dental assistant.

The insurer relied on surveillance evidence and an independent medical examination suggesting she could return to work.

The arbitrator preferred the evidence of the applicant's treating professionals, finding that she remained unable to perform the specific, sustained physical tasks required of a dental assistant.

The applicant was awarded ongoing weekly income benefits, outstanding housekeeping expenses, and arbitration expenses.

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

The insurer terminated the weekly benefits, arguing the applicant was no longer substantially unable to perform the essential tasks of her pre-accident employment as a sales clerk.

The arbitrator found that the medical evidence, including the insurer's own medical examination, supported the applicant's ongoing inability to work due to chronic pain and fibromyalgia.

The arbitrator ordered the insurer to pay ongoing weekly income benefits and outstanding rehabilitation expenses.

Furthermore, the arbitrator awarded a special award of $3,000 against the insurer for unreasonably withholding and delaying the payment of benefits, noting the insurer's refusal to share medical reports and its inappropriate reliance on a medical report that actually recommended further rehabilitation.

At a pre-hearing discussion, the parties disagreed on the issues to be included in the arbitration hearing.

The applicant sought to exclude her eligibility for supplementary medical and rehabilitation benefits, which she had not raised in her current application, while the insurer argued all outstanding disputes should be heard together.

The arbitrator held that, following the Director's decision in DeCicco, an insurer cannot raise a new matter (benefit category) not included in the applicant's application without consent.

Therefore, the supplementary medical and rehabilitation benefits were excluded from the arbitration.

The applicant was injured in a motor vehicle accident and initially received workers' compensation benefits.

The Workers' Compensation Board later determined he was an executive officer, not a worker, and assessed an overpayment.

The insurer brought a preliminary issue arguing it was relieved of responsibility to pay statutory accident benefits under section 20 of the Schedule because the applicant was entitled to workers' compensation benefits.

The arbitrator dismissed the preliminary issue, finding that the Board's exclusive jurisdiction to determine eligibility meant the insurer could not rely on section 20 to avoid liability at this stage.

The applicant sought to preclude the insurer from participating in the arbitration hearing, arguing that the insurer failed to serve its Response within the required 14-day period.

The arbitrator found that the insurer had attempted to serve its Response within the time period and was therefore not precluded from participating.

In the alternative, the arbitrator noted that he would have extended the time limit under section 42.3 of the Dispute Resolution Practice Code, as there was no indication of delay caused by the insurer.

The insurer was permitted to participate as a party in the arbitration hearing.

The applicant was involved in two motor vehicle accidents in October 1990 and received weekly income benefits until April 1991.

He applied for arbitration after the insurer terminated his benefits, claiming he remained substantially unable to perform the essential tasks of his pre-accident employment as a security guard due to chronic pain.

The arbitrator found that the applicant's job was not physically demanding and that the medical evidence, including surveillance video, did not support a finding of substantial inability to work.

The claim for ongoing weekly income benefits was dismissed, but the applicant was awarded his arbitration expenses.

In a supplementary arbitration decision, the applicant sought statutory accident benefits for child care and housekeeping services provided by her mother, as well as expenses for her husband's lost income while attending the hearing.

The arbitrator found that the applicant was not entitled to benefits for the period prior to her back surgery, but awarded $1,344.00 for heavy housekeeping assistance required post-surgery.

The claim for the husband's lost income as an expense was denied.

The Applicant was injured when struck by a car while riding her bicycle.

The Insurer paid weekly income benefits but terminated them, arguing the Applicant failed to mitigate her damages by finding alternative part-time employment.

The Arbitrator found the Applicant had not acted inappropriately, given her significant job barriers, physical limitations, and ongoing education and physiotherapy.

The Arbitrator ordered the Insurer to pay ongoing weekly income benefits and awarded a $2,500 special award because the Insurer unreasonably withheld benefits.

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

The insurer terminated the benefits on the basis that the applicant was capable of performing the essential tasks of his pre-accident occupation.

The applicant sought arbitration to reinstate benefits and increase the weekly quantum, claiming he was an employee earning a higher wage.

The arbitrator found the applicant's evidence regarding his employment and income lacked credibility, determining he was a partner in a business that lost money, entitling him only to the minimum weekly benefit.

The arbitrator also found the applicant failed to prove he suffered a substantial inability to perform his essential tasks during the disputed period.

The application was dismissed, the applicant was ordered to repay the overpayment, and his claim for expenses was denied.

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

The insurer terminated benefits based on surveillance evidence showing the applicant working at a doughnut shop and a supermarket.

The applicant sought arbitration for ongoing benefits and a higher weekly rate based on alleged pre-accident income.

The arbitrator dismissed the applicant's claims, finding his evidence and financial documents lacked credibility.

The arbitrator ordered the applicant to repay an overpayment of $2,243.96 to the insurer and denied the applicant's request for expenses.

The applicant was struck by a motor vehicle and applied for no-fault benefits from the insurer.

After a dispute arose, the applicant commenced a court action against the insurer and the at-fault driver.

The applicant subsequently applied for arbitration at the Ontario Insurance Commission regarding unpaid medical invoices.

The insurer brought a preliminary motion to prevent the arbitration from proceeding, arguing the applicant had elected to proceed in court.

The arbitrator held that the applicant is not entitled to proceed in both forums for issues that significantly overlap, and granted the insurer's motion to dismiss the arbitration to avoid duplicative proceedings.

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

He returned to work for over 90 days after the two-year anniversary of the accident.

When he subsequently missed work due to the injury, the insurer denied benefits under s. 16(2) of the No-Fault Benefits Schedule.

The arbitrator held that the applicant lost his eligibility for weekly income benefits because he worked for more than 90 days after the two-year anniversary.

The application for benefits was dismissed, but the applicant was awarded his $50 filing fee for raising a novel issue of interpretation.

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

The insurer terminated benefits on the basis that the applicant was able to perform the essential tasks of his employment as a machinist.

The applicant sought reinstatement of benefits and a special award for unreasonable delay.

The arbitrator found that medical and surveillance evidence demonstrated the applicant was not substantially unable to perform his pre-accident employment duties.

The claims for weekly income benefits and a special award were dismissed, but the applicant was awarded his arbitration expenses.

The applicant was injured in a motor vehicle accident and received no-fault benefits as a student for eight weeks.

He applied for arbitration, claiming he was a self-employed renovator entitled to higher weekly income benefits.

The applicant failed to attend the arbitration hearing.

In the absence of contradictory evidence, the arbitrator accepted the insurer's documentary evidence and dismissed the applicant's claims.

The arbitrator also denied the insurer's request for a refund of its filing fee.