Deena Baltman

The applicant was a passenger on a bus headed to a casino when it was hijacked by armed assailants.

The assailants took control of the bus, robbed the passengers, and pistol-whipped the applicant.

The insurer denied statutory accident benefits on the basis that the incident was not an 'accident' under the Schedule, arguing the use of the vehicle did not directly cause the impairment.

The arbitrator found that the bus played a central role in the robbery, acting as a moving prison and a weapon, and thus the use of the vehicle was a direct cause of the applicant's injuries.

The preliminary issue was resolved in favour of the applicant.

Following an arbitration where the insured was largely unsuccessful in claiming income replacement and non-earner benefits, the insurer sought its expenses.

The arbitrator found that the insured's claim for income replacement benefits was manifestly unfounded and that his representative's conduct prolonged and hindered the proceeding.

The insured was ordered to pay two-thirds of the insurer's arbitration expenses, fixed at $6,428.10.

The applicant sought income replacement benefits, non-earner benefits, and medical expenses following a motor vehicle accident.

The arbitrator found that the applicant fabricated his pre-accident employment and was therefore not entitled to income replacement benefits.

The claim for non-earner benefits was dismissed as the applicant failed to prove a complete inability to carry on a normal life.

The arbitrator also held that the applicant's failure to attend a Designated Assessment Centre (DAC) barred him from recovering medical expenses incurred after the scheduled assessment date, but he was entitled to reasonable and necessary expenses incurred prior to that date.

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

The insurer denied benefits on the basis that the applicant was operating an uninsured vehicle and had made a material misrepresentation.

The arbitrator found that the applicant deliberately misled his insurance broker by producing ownership documentation for a 1983 vehicle while claiming to insure a 1988 vehicle that he did not own.

The arbitrator concluded that the applicant knew or ought reasonably to have known that he was operating an uninsured vehicle at the time of the accident.

As a result, the applicant was barred from recovering benefits under section 30(1) of the Statutory Accident Benefits Schedule.

The applicant was injured in a motor vehicle accident and claimed ongoing income replacement benefits (IRBs) and medical rehabilitation benefits.

The arbitrator determined that the applicant was an independent contractor, not an employee, and calculated her pre-accident income accordingly, resulting in a lower IRB rate.

The arbitrator found insufficient medical evidence to support a substantial inability to perform the essential tasks of her employment beyond the insurer's termination date.

Consequently, the applicant was ordered to repay the insurer for the overpayment of IRBs.

However, the insurer was ordered to pay for outstanding physiotherapy treatments, which were found to be reasonable and necessary.

Following a decision dismissing the applicant's claims for medical and rehabilitation benefits due to a lack of causation, both parties sought their expenses of the arbitration.

The arbitrator found that the applicant's claim was brought in good faith and awarded him 75 percent of his legal fees and 100 percent of his assessable disbursements.

The arbitrator reduced the claimed counsel hours from 90 to 40, set the hourly rate at $110, and allowed the full $1,100 cost of an occupational therapist's report.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including Loss of Earning Capacity Benefits (LECBs), speech therapy, and psychotherapy.

The insurer disputed the calculation of her pre-accident earning capacity, arguing she would not have worked full-time in the future due to a pre-existing back injury.

The arbitrator held that the applicant only needed to demonstrate a real or serious possibility of future full-time employment under section 86 of the Schedule, which she successfully established.

The arbitrator also ordered the insurer to pay for missed and ongoing speech and psychological therapies, finding that the expenses were 'incurred' even though the missed treatments could no longer be obtained, and that the insurer improperly relied on outdated Designated Assessment Centre (DAC) reports to terminate benefits.

The claim for a special award was dismissed.

The Arbitrator issued a decision correction to fix a typographical error in the original decision dated November 2, 1999.

The name 'Mr. Thanh' was corrected to 'Mr. Truong' in two sentences regarding a signed statement.

The applicant, a self-employed baker and greenhouse operator, was injured in a head-on motor vehicle collision.

The insurer terminated her income replacement benefits at the 104-week mark, arguing she was no longer disabled and seeking repayment for allegedly overstated pre-accident income.

The arbitrator found the applicant remained substantially disabled from the essential tasks of her pre-accident employment, relying heavily on compelling lay witness testimony regarding her post-accident cognitive and physical decline.

The arbitrator also accepted the applicant's evidence regarding her pre-accident earnings, setting the ongoing benefit at $634.82 weekly and ordering the insurer to pay $34,233 in arrears.

The arbitrator issued an amended arbitration order to include an omitted issue of expense entitlement.

The applicant's law firm was removed as solicitors of record, the claim for accident benefits was dismissed, and the insurer was awarded its assessment fee, disbursements, and expenses.

The applicant sought accident benefits following a motor vehicle accident but failed to attend the arbitration hearing.

At the outset of the hearing, the arbitrator granted a motion by the applicant's counsel to be removed from the record due to a lack of instructions.

Proceeding in the applicant's absence, the arbitrator dismissed the claim for benefits as no evidence was presented.

The arbitrator further found that the applicant's conduct—including failing to provide medical information, ignoring communications, and failing to attend—amounted to an abuse of process under section 282(11.2) of the Insurance Act, and ordered the applicant to pay the insurer's assessment fee and disbursements.

Following an arbitration where the applicant was denied income replacement benefits but awarded medical and rehabilitation benefits, the parties disputed the applicant's entitlement to expenses.

The arbitrator applied the criteria in Regulation 464/96, noting that success is only one factor and that the insurer's conduct in unnecessarily questioning doctors about an irrelevant pre-accident overdose prolonged the proceeding.

The applicant was awarded 80 percent of her legal fees and 100 percent of her assessable expenses, including fees for services subsequent to the arbitration.

The applicant sought income replacement benefits (IRBs) and other expenses following a 1995 motor vehicle accident.

The insurer reduced and then terminated the IRBs, and sought repayment of all benefits paid, alleging fraud.

The arbitrator found that the applicant had fabricated his employment history, concealed a previous disabling car accident, and grossly exaggerated his injuries, with medical evidence suggesting malingering.

The applicant's claims were dismissed in their entirety.

The arbitrator ordered the applicant to repay $37,879 in IRBs and rehabilitation expenses obtained through fraudulent misrepresentation, and awarded the insurer its arbitration expenses and assessment fee, finding the application frivolous and an abuse of process.

The insurers brought a motion to combine or hear together nine separate arbitration proceedings involving eleven applicants who received treatment from affiliated clinics.

The insurers argued the cases shared common issues regarding the reasonableness of the clinics' fees and alleged conflicts of interest.

The arbitrator dismissed the motion, finding that the cases involved distinct factual inquiries into each applicant's injuries and treatment needs, and that combining them would be unmanageable.

Instead, the arbitrator ordered that one case proceed first to provide guidance for the remaining cases, which were adjourned pending that decision.

The applicant claimed death benefits following her husband's fatal car accident.

The dispute centered on whether an ex gratia payment and a sick leave payout received by the deceased upon his retirement, within the 156 weeks preceding the accident, should be included as income for calculating the death benefit.

The arbitrator held that the purely discretionary ex gratia payment was income earned upon retirement and thus included in the calculation.

However, the sick leave payout accrued steadily throughout the deceased's employment and was not included as income within the 156-week period.

The applicant was injured in a motorcycle accident and received income replacement benefits of $185 per week.

He claimed entitlement to a higher benefit rate, arguing he had a legitimate contract of employment to start full-time work as a mechanic shortly after the accident, or alternatively, that he was employed on a casual basis in the four weeks preceding the accident.

The arbitrator dismissed both claims, finding that the applicant's pre-existing medical conditions rendered him incapable of full-time work, and that the alleged employment letter was created solely to secure a bank loan.

The arbitrator also found insufficient evidence to prove the applicant was employed in the four weeks prior to the accident.

The applicant was injured in a motor vehicle accident and reported it to the insurer two days later.

The insurer mailed an application package, but the applicant did not submit it until over nine months after the 90-day time limit expired.

The applicant claimed he was unaware of the time limit because the explanation form was missing from his package.

The arbitrator rejected this argument, finding it implausible that the insurer removed the form and noting the applicant's lack of medical treatment or follow-up.

The arbitrator concluded the applicant failed to demonstrate a reasonable excuse for the delay, and the claim for accident benefits was dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them in June 1996.

The applicant applied for mediation, which failed in April 1997.

She filed an application for arbitration in November 1998, more than two years after the insurer's refusal to pay further benefits.

The arbitrator held that the two-year limitation period under section 72(1) of the Statutory Accident Benefits Schedule had expired.

The insurer's agreement to reconsider the claim upon receipt of updated medicals did not waive or reactivate the limitation period.

The application for arbitration was dismissed as out of time.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them, arguing she was no longer disabled.

The applicant sought further income replacement benefits and payment for medical and rehabilitation expenses.

The arbitrator found that the applicant was not substantially unable to perform the essential tasks of her pre-accident employment, noting her refusal to attempt a return to work and relying on the opinions of her treating physician and psychologist.

The claim for income replacement benefits was dismissed.

However, the arbitrator allowed the claim for medical and rehabilitation expenses, finding the treatments reasonable and beneficial.

The applicant was injured in a minor motor vehicle accident and claimed medical and rehabilitation benefits for various assistive devices, including a boat, snowmobile, and ATV, to help him function at his remote cottage.

The insurer denied the claims, arguing the need for the devices arose from a pre-existing back condition.

The arbitrator found that the applicant had a long history of severe back problems, including a prior surgery, and that the minor car accident did not materially contribute to his need for the assistive devices.

The claim for benefits was dismissed.