David R. Draper

The appellant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The insurer denied coverage shortly after the accident, asserting the policy had been cancelled.

The appellant failed to submit a formal application for benefits within the two-year limitation period under section 22 of the Statutory Accident Benefits Schedule.

The Director's Delegate upheld the arbitrator's decision that the insurer was not estopped from relying on the limitation period, as its denial of coverage did not constitute a waiver of the application requirement.

Furthermore, the Director's Delegate confirmed that arbitrators lack the jurisdiction to grant equitable relief from forfeiture under section 129 of the Insurance Act.

The appellants appealed an arbitrator's order that they could not arbitrate their claim for death benefits because they failed to file an adequate application within the 90-day time limit under subsection 59(3) of the Statutory Accident Benefits Schedule.

The Director's Delegate found that the initial application filed by the appellants' former counsel was for funeral and travel expenses, not death benefits, and that the appellants did not attempt to argue a reasonable excuse for the delay under subsection 59(4).

The appeal was dismissed, but the appellants were awarded $500 in appeal expenses because the appeal raised novel issues of significance regarding the insurer's obligations.

The insurer appealed an arbitration order that allowed the insured to withdraw his application for arbitration shortly before the hearing date without ordering him to pay an assessment for abuse of process.

The Director's Delegate dismissed the appeal, finding that the arbitrator properly exercised his discretion in allowing the withdrawal and correctly concluded that the insured's conduct did not amount to an abuse of process.

The appellant appealed an arbitration decision that denied his claim for ongoing weekly income benefits, denied his arbitration expenses, and ordered him to pay a $1,000 assessment to the insurer for abuse of process.

The Director's Delegate dismissed the appeal, finding that the arbitrator properly exercised his discretion to deny expenses due to the appellant's failure to comply with production orders and disruptive behaviour at the hearing.

The Delegate also upheld the $1,000 assessment, agreeing that there was no evidence the 1991 accident significantly affected the appellant's ability to work, which was already compromised by a 1989 accident and pre-existing arthritis.

The insurer appealed two arbitration decisions regarding statutory accident benefits.

The insurer argued it should be allowed to set off an overpayment of benefits against future payments, and that it should be allowed to deduct post-accident income the insured reported from her husband's business.

The Director's Delegate dismissed these grounds, finding the insured did not materially contribute to the overpayment and the reported income was merely for income splitting.

However, the Director's Delegate allowed the appeal regarding a special award ordered against the insurer, finding that the arbitrator breached procedural fairness by raising the issue in her decision without giving the insurer a reasonable opportunity to present evidence in response.

The special award was revoked and a partial rehearing was ordered.

The appellant appealed an arbitration order terminating his weekly income benefits after 156 weeks.

The arbitrator found that the appellant, who suffered a hip fracture requiring a replacement, was capable of engaging in suitable alternative light work despite his previous experience in physically demanding construction jobs.

On appeal, the Director's Delegate held that the appeal was not restricted to questions of law because the arbitration commenced before the statutory amendment limiting appeals.

However, the Delegate upheld the arbitrator's findings that the burden of proof did not shift to the insurer merely because it paid benefits beyond the 156-week mark, and that the appellant was reasonably suited for alternative employment.

The appeal was dismissed.

The appellant, who was paralyzed in a motorcycle accident, appealed an arbitration decision that denied several of his claims for rehabilitation expenses under the Statutory Accident Benefits Schedule.

The disputed expenses included apartment furnishings, home renovation extras, vehicle leasing costs, and additional minivan options.

The Director's Delegate dismissed the appeal, finding that the arbitrator's conclusions were reasonably supported by the evidence and that the appellant failed to prove the denied expenses were necessary and reasonable.

No appeal expenses were awarded.

The insurer appealed an arbitration decision that found the insured was entitled to ongoing weekly income benefits after the 156-week mark, calculated the weekly benefit amount at $385, and declined to award interest on an overpayment.

The Director's Delegate dismissed the appeal, finding no error in the arbitrator's assessment of the insured's reasonable efforts to pursue suitable employment, the calculation of pre-accident income, or the decision to set off the overpayment against ongoing benefits without awarding interest.

The appellant was injured in a motor vehicle accident and claimed caregiver benefits under the Statutory Accident Benefits Schedule.

The insurer paid a lower rate of disability benefits and later terminated them after an independent medical examination.

The appellant requested a Designated Assessment Centre (DAC) evaluation, which also concluded she was not disabled.

At arbitration, the arbitrator found the appellant was entitled to the higher caregiver benefit rate but only until the date of the first medical examination.

On appeal, the appellant argued that section 64 of the SABS required the insurer to pay benefits until the DAC report was issued.

The Director's Delegate dismissed the appeal, holding that section 64 governs the process for stopping benefits but does not create an absolute entitlement immune from a later finding that disability ended earlier.

The appellant was injured in a work-related automobile accident and initially elected to receive workers' compensation benefits.

After his workers' compensation benefits were cancelled, he attempted to re-elect to sue the at-fault driver and claim statutory accident benefits from the respondent automobile insurer.

The Director's Delegate held that while the legislation permits an injured worker to re-elect after receiving workers' compensation benefits, the appellant's re-election was invalid because it was made primarily for the purpose of claiming accident benefits after his workers' compensation claim was denied.

The appeal was dismissed.

The appellant was injured in a motorcycle accident after losing control on a public highway and crashing on private property.

He did not have a motorcycle licence.

The insurer denied his claim for income replacement benefits under the 'not authorized by law to drive' exclusion in section 58(1)(d) of the Statutory Accident Benefits Schedule.

The appellant argued the exclusion did not apply because the injury occurred on private property where no licence is required.

The Director's Delegate dismissed the appeal, upholding the arbitrator's finding that the accident was an unbroken chain of events that began on the highway where a licence was required.

The appellant's husband was killed in a motor vehicle accident while in the course of his employment.

The appellant and her children received death benefits from the respondent automobile insurer, and subsequently received survivor's benefits from the Workers' Compensation Board.

The insurer demanded repayment of the death benefits under section 20 of the Statutory Accident Benefits Schedule, which precludes payment where the insured person is entitled to workers' compensation benefits.

The Director's Delegate upheld the arbitrator's decision that section 20 applies to prevent double recovery, even though the workers' compensation benefits were payable to the survivors rather than the deceased insured person.

The appellant appealed an arbitration decision denying his claims for statutory accident benefits, including housekeeping, medication, chiropractic expenses, a whirlpool spa, and weekly income benefits, as well as a special award and arbitration expenses.

The Director's Delegate dismissed the appeal, finding no unfairness in the arbitration process and agreeing with the arbitrator that there was insufficient medical evidence to support the appellant's claims.

The Delegate also confirmed that business losses and replacement labour costs are not payable as weekly income benefits or rehabilitation expenses under the Schedule.

No appeal expenses were awarded to either party.

The appellant insurer appealed an arbitration decision that found the respondent insured was entitled to ongoing weekly income benefits after the 156-week mark.

The insurer argued the arbitrator erred in finding that the respondent could not work as a locksmith without an apprenticeship and that working as a security guard was not a suitable alternative occupation.

The Director's Delegate dismissed the appeal, finding no error in the arbitrator's assessment of the expert evidence or the conclusion that the respondent lacked the education, training, or experience to engage in the suggested occupations without further retraining.

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

The insurer terminated benefits after 156 weeks, arguing that the appellant's ongoing neuropathic leg pain was not caused by the accident.

An arbitrator dismissed the appellant's claim for ongoing benefits, preferring the medical evidence that a causal link was unlikely given the delayed onset of symptoms.

On appeal, the Director's Delegate upheld the arbitrator's decision, finding no error in the assessment of the expert medical evidence regarding causation.

The appeal was dismissed and no appeal expenses were awarded.

The insurer appealed an arbitration decision that refused to order the respondent to repay weekly income benefits under section 27 of the Statutory Accident Benefits Schedule.

The insurer argued that it paid the benefits through error because it mistakenly believed the respondent was on a temporary lay-off at the time of the accident.

The Director's Delegate dismissed the appeal, finding that the insurer did not pay the benefits through error, as it had calculated them properly based on the information provided and the prevailing case law at the time.

The Delegate affirmed that an innocent insured person should not be required to repay benefits due to a later reassessment based on new information or developing case law.

The appellant insurer appealed an arbitration decision finding it responsible for paying statutory accident benefits to the claimant.

The claimant was injured while a passenger in a vehicle insured by the respondent insurer.

The claimant applied for benefits from the appellant insurer on the basis that she was the spouse of its named insured.

The arbitrator found that the claimant and the named insured had cohabited in a relationship of some permanence and were therefore spouses under the Insurance Act.

On appeal, the Director's Delegate upheld the arbitrator's finding, concluding that there was sufficient evidence to support the determination of cohabitation despite the parties maintaining separate residences.

The appeal was dismissed, with a new issue regarding policy interpretation reserved for further submissions.

The appellant insurer appealed an arbitration decision finding that future economic loss (FEL) benefits received by the respondent under the Workers' Compensation Act were not deductible from his income replacement benefits under the Statutory Accident Benefits Schedule (SABS).

The Director's Delegate dismissed the appeal, upholding the arbitrator's finding that FEL benefits do not fall within the definition of 'temporary disability benefits' under the SABS and are therefore not deductible.

The appellant appealed an arbitration decision regarding his entitlement to statutory accident benefits following a motor vehicle accident.

He sought ongoing weekly income benefits at a higher rate, expenses for retraining, and a special award against the insurer.

The Director's Delegate dismissed the appeal, finding that the arbitrator's conclusions were supported by the medical and financial evidence.

The evidence indicated the appellant was substantially able to perform the essential tasks of his pre-accident employment by the date benefits were terminated, and the calculation of his income benefits was reasonable.

The Director's Delegate issued a correction to an appeal decision dated March 13, 1997.

The correction amended the reasons for decision to properly refer to the respondent by his surname, Arabpour, rather than his first name, Fathulla.