David R. Draper

The appellant, a homemaker injured in a motor vehicle accident, appealed an arbitrator's decision denying her ongoing weekly benefits under section 13 of the Statutory Accident Benefits Schedule.

The appellant argued the arbitrator applied an overly strict test, improperly relied on surveillance evidence showing her visiting a grave, and erred in considering her lack of cooperation with rehabilitation.

The Director's Delegate dismissed the appeal, finding the arbitrator correctly assessed whether the appellant was substantially unable to perform her essential tasks, and reasonably considered her ability to modify tasks, the surveillance evidence, and her failure to pursue rehabilitation.

The appellant was awarded her appeal expenses.

State Farm appealed an arbitration decision finding it liable to pay statutory accident benefits to a claimant who was listed as a driver on her parents' policy but injured while an occupant in a vehicle insured by Pilot.

Pilot cross-appealed the finding that the claimant was not a dependant of her parents.

The Director's Delegate allowed State Farm's appeal, holding that being a listed driver does not make one an 'insured person' under the Statutory Accident Benefits Schedule for accidents in other vehicles.

The Delegate dismissed Pilot's cross-appeal, upholding the arbitrator's finding that the 18-year-old claimant was living independently and was not principally dependent on her parents for financial support.

Pilot was ordered to pay the accident benefits.

The appellant insurer appealed an arbitration order requiring it to pay the respondent additional weekly income benefits.

The respondent, a self-employed plumber, was injured in a motor vehicle accident but provided unreliable evidence regarding his pre- and post-accident income.

The Director's Delegate upheld the finding that the respondent was entitled to some benefits but found the arbitrator erred in calculating the quantum and the termination date.

The Delegate recalculated the benefits, finding the respondent had been overpaid by $8,987.92, and ordered him to repay this amount with interest.

The Delegate also overturned the award of interest on overdue payments, finding the payments were not overdue until finally determined because the respondent's misrepresentations made it impossible for the insurer to determine the correct amount.

The insured person committed suicide by carbon monoxide poisoning in his parked car.

His widow applied for death and funeral benefits under his automobile insurance policy.

The insurer denied the claim on the basis that suicide is not an 'accident' under the Statutory Accident Benefits Schedule.

The arbitrator found in favour of the widow, concluding that the definition of 'accident' in the Schedule was broad enough to include suicide.

On appeal, the Director's Delegate reversed the arbitrator's decision, holding that the definition of 'accident' restricts rather than expands the common law meaning, and does not include intentional acts such as suicide.

The appeal was allowed and the claim for benefits was dismissed.

The appellant insurer appealed an arbitration decision finding that the deceased's daughter was entitled to death benefits as a dependant.

The daughter was financially dependent on her mother, who had previously been the common law spouse of the deceased but was no longer his spouse at the time of the accident.

The Director's Delegate allowed the appeal, holding that spousal status must be determined at the time of the accident.

Because the mother was no longer the deceased's spouse at the time of the accident, the daughter could not qualify as a dependant based on her financial dependence on the mother.

The appellant, a self-employed house painter, appealed an arbitration decision terminating his weekly income benefits and ordering repayment of interim benefits.

He sought to introduce a new medical report on appeal to address the arbitrator's concerns about his chronic pain syndrome diagnosis.

The Director's Delegate refused to admit the new evidence, finding it would not have affected the result.

The Delegate upheld the arbitrator's conclusion that the appellant was substantially able to perform the essential tasks of his occupation, noting that job flexibility is an appropriate consideration for self-employed individuals.

The Delegate also affirmed the arbitrator's reliance on the mediator's report over the appellant's testimony regarding an alleged agreement to pay benefits during rehabilitation.

The appeal was dismissed, but the appellant was awarded his reasonable appeal expenses due to the merit of the issues raised.

The appellant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, claiming he had returned to work.

An arbitrator found the appellant was able to perform his essential tasks and ordered him to repay $26,125.36 in overpaid benefits.

On appeal, the Director's Delegate upheld the arbitrator's decision, finding no error in the credibility assessment or the conclusion that the appellant's post-accident business income demonstrated a return to work.

The appeal was dismissed with no expenses payable.

The appellant was injured in a motor vehicle accident in December 1990 and received weekly income benefits until June 1991, when the insurer terminated them.

The appellant applied for arbitration, seeking ongoing weekly income benefits and rehabilitation expenses, arguing that his continuing back problems were caused by the accident.

The arbitrator dismissed the claims, finding that the appellant was no longer substantially unable to perform the essential tasks of his pre-accident occupation by June 1991, and that his ongoing back problems were primarily caused by factors other than the accident.

On appeal, the Director's Delegate confirmed the arbitrator's decision, finding no error in the assessment of the medical evidence or the application of the causation standard.

The appeal was dismissed with no expenses payable.

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

After applying for arbitration, the appellant's lawyers discovered her claim for weekly income benefits was based on a fictitious job offer and withdrew the application.

The arbitrator ordered the appellant to pay the respondent's $2,000 assessment fee, finding the withdrawal was an abuse of process.

The appellant appealed the order.

The Director's Delegate dismissed the appeal, finding the arbitrator had a reasonable basis to exercise her discretion to order the payment.

The Director's Delegate declined to award appeal expenses to either party.

The insured was injured in a motor vehicle accident and received weekly income benefits from her automobile insurer, as well as disability benefits from her employer's group plan.

The automobile insurer reduced her weekly income benefits by the gross amount of her disability benefits.

The insured argued that only the net after-tax amount should be deducted.

An arbitrator agreed with the insured, finding that deducting the gross amount was unfair.

On appeal, the Director's Delegate rescinded the arbitration order, holding that the plain language of section 12(4)(b) of the Schedule requires the deduction of the full amount of the disability benefits received by or available to the insured, regardless of the tax consequences.

The appellant's wife died in a motor vehicle accident.

The insurer paid the appellant a $50,000 death benefit as a surviving spouse, but denied his claim for an additional $20,000 benefit as a dependant.

On appeal, the Director's Delegate held that a surviving spouse is not precluded from also claiming death benefits as a dependant under section 11 of the Statutory Accident Benefits Schedule.

However, the appeal was dismissed because the appellant failed to establish that he was principally dependent for financial support on his wife at the time of the accident.

The appellant appealed an arbitration decision that dismissed his claim for weekly income benefits after he and his representative failed to present evidence at the hearing.

The appellant requested an extension of the 30-day appeal period, which was granted.

On the merits of the appeal, the appellant argued the arbitrator erred in refusing an adjournment to allow him to retain new counsel.

The Director's Delegate dismissed the appeal, finding that the arbitrator correctly refused the adjournment because the appellant provided no valid reason for being unprepared and had acted irresponsibly.

The appellant was denied his appeal expenses.

The insurer appealed a preliminary arbitration decision finding that the insured was not disentitled to weekly income benefits under section 16(2) of the Schedule, as she had not worked for a continuous period of 90 days after the two-year anniversary of the accident.

The insured appealed a subsequent arbitration decision finding she was no longer eligible for weekly income benefits under section 12(1).

The Director's Delegate dismissed both appeals, upholding the arbitrator's interpretation of section 16(2) as referring to continuous periods of work, and finding no error in the arbitrator's evaluation of the evidence regarding the insured's eligibility.

The insurer was ordered to pay the insured's expenses for the preliminary issue appeal, but no expenses were awarded for the eligibility appeal.

The applicant sought an extension of time to appeal an arbitration decision that dismissed his claim for weekly income benefits.

The applicant's agent had failed to present evidence at the original hearing after an adjournment request was denied.

The applicant subsequently retained a lawyer who filed the notice of appeal 80 days after the decision was issued, well beyond the 30-day statutory limit.

The Director's Delegate considered whether there were reasonable grounds for the delay and apparent grounds for granting the extension.

Lambton Mutual appealed an arbitration order finding it responsible for paying statutory accident benefits to an injured passenger.

Lambton Mutual argued its policy was void ab initio because the named insured misrepresented her ownership of the vehicle, meaning she had no insurable interest.

The Director's Delegate dismissed the appeal, holding that while misrepresentation of ownership may invalidate coverages based on ownership, it does not render the entire policy void ab initio.

An innocent third party occupant remains entitled to claim accident benefits under the policy.

The appellant was involved in two motor vehicle accidents and claimed weekly income benefits and supplementary medical benefits.

The arbitrator terminated weekly income benefits as of October 1, 1992, and denied the medical benefits.

Both the appellant and one of the insurers appealed the decision.

The Director's Delegate dismissed the appeals, finding that the arbitrator's conclusions were supported by the evidence, including the finding that the appellant's fibromyalgia was not significantly contributed to by the accidents.

The appellant appealed an arbitration decision that terminated her weekly income benefits and ordered her to repay an overpayment.

The appellant failed to file materials or written submissions for the appeal, which proceeded on the record.

The Director's Delegate found no merit in the appeal, confirming the arbitrator's decision.

The insurer was awarded $500 under the Insurance Act on the basis that the appeal was frivolous, vexatious, or an abuse of process, as the appellant raised no serious question and failed to pursue the appeal beyond filing the notice.

The insurer appealed a pre-hearing arbitrator's order requiring it to produce all internal memoranda from the date of the accident to the date the applicants requested mediation.

The applicants sought the documents to support a claim for a special award under s. 282(10) of the Insurance Act.

The Director's Delegate allowed the appeal and revoked the production order, finding that a bald assertion that benefits were unreasonably withheld is not a sufficient basis for ordering the production of the insurer's entire file.

A special award is a statutory direction to the arbitrator, not a separate claim that creates an independent basis for production.

The insurer appealed an arbitration decision determining the insured's weekly income benefits at $600 per week.

The central issue was when real estate commissions become income for the purpose of calculating pre-accident income under the Statutory Accident Benefits Schedule.

The Director's Delegate held that real estate commissions are earned when there is an unconditional agreement of purchase and sale, rejecting both the 'closing date' and 'work completed' approaches.

Applying this principle, the insured's weekly income benefits were recalculated to $348.61 per week.

The issue of whether the insured must repay any overpayment was referred back to arbitration.

The applicant sought to appeal an arbitrator's decision denying him weekly income benefits on the basis that he drove a company van without the owner's consent.

The applicant failed to file a proper Notice of Appeal within the 30-day statutory time limit and experienced significant delays, partly due to a refusal of legal aid.

The Director's Delegate refused to extend the time for the appeal, finding no reasonable grounds for the delay and no apparent grounds for granting the relief sought, as the arbitrator's findings on credibility, witness independence, and procedural fairness were sound.

The appeal was dismissed.