Deena Baltman

The applicant was severely traumatized in a motor vehicle accident and received extensive psychological treatment for post-traumatic stress disorder.

The insurer terminated payments for the treatments, arguing they were no longer reasonable in frequency or duration.

The arbitrator found that while ongoing psychotherapy was appropriate, the frequency of two to three visits per week over several years was excessive.

The insurer was ordered to pay 50 per cent of the outstanding accounts.

Additionally, the arbitrator granted a special award of $2,500 because the insurer violated the 'pay pending dispute' provision by withholding payments while the dispute was ongoing.

The applicant sought to recover the cost of rehabilitation services following a motor vehicle accident.

At the commencement of the arbitration hearing, the applicant brought a motion requesting the arbitrator disqualify herself, alleging the Commission had a systemic bias against the service provider.

The applicant subpoenaed an acting registrar/arbitrator to testify on the bias motion.

The Commission's counsel successfully moved to quash the subpoena, relying on statutory provisions exempting Commission employees and arbitrators from testifying in civil proceedings.

The arbitrator dismissed the bias motion, finding no evidence of institutional bias.

Following this ruling, the applicant called no evidence on the substantive claim, which was consequently dismissed.

The insurer was awarded its expenses of the arbitration.

The applicant, an assembly line worker, was struck by a van while crossing the street, sustaining a severe left knee injury.

The insurer paid income replacement benefits until July 1995, when it terminated them based on medical assessments suggesting she could return to work.

The applicant sought ongoing benefits up to the 104-week mark.

The arbitrator found that the applicant's job required prolonged sitting with her knee bent, which caused disabling pain and reduced concentration.

Preferring the evidence of the treating specialists over the insurer's assessor, the arbitrator concluded the applicant suffered a substantial inability to perform the essential tasks of her employment.

The claim for ongoing income replacement benefits was allowed, but the request for a special award was dismissed as the insurer's initial termination was based on medical reports available at the time.

The applicant sought a death benefit following the death of his son in a motor vehicle accident.

The insurer denied the claim on the basis that the applicant failed to apply for benefits within the two-year limitation period and that the deceased was not a dependant.

The arbitrator held that the applicant was precluded from proceeding to arbitration because he failed to submit an application within two years of the accident, and that section 129 of the Insurance Act did not provide relief from forfeiture for this failure.

Furthermore, the arbitrator found that the deceased, a university student whose parents were divorced and shared his expenses equally, was not principally dependent for financial support on the applicant.

The applicant was injured in a motor vehicle accident and applied for arbitration after a dispute over weekly income benefits.

He subsequently disappeared, failing to attend the pre-hearing or the hearing, and failing to comply with production orders.

The arbitrator found that the applicant had constructively withdrawn his application and that his conduct amounted to an abuse of process.

The application was stayed, and the applicant was ordered to pay the insurer's $2,000 assessment fee and $500 in expenses.

The Applicant was injured in a motor vehicle accident and applied for arbitration following a dispute over income replacement benefits.

Shortly before the hearing, the parties negotiated a settlement.

The Insurer subsequently refused to pay the Applicant's legal fees, arguing they were not part of the settlement and that the settlement was void for mistake, uncertainty, and failure to comply with the Settlement Regulation.

The Arbitrator found that the correspondence clearly established an objective agreement to pay expenses, including legal fees.

The Arbitrator held that the Insurer could not rely on its own failure to provide the required settlement disclosure notice to invalidate the agreement.

The settlement was declared binding, and the Insurer was ordered to pay a $7,500 special award for unreasonably delaying payment and attempting to evade the settlement.

The applicant, a real estate agent, was injured in a motor vehicle accident and claimed weekly income benefits.

The issue was whether a real estate commission from an agreement of purchase and sale executed before the 52-week pre-accident period, but which closed within that period, should be included in her pre-accident income calculation.

The arbitrator held that the commission was earned when the agreement became unconditional, which occurred prior to the 52-week period.

Therefore, the commission was excluded from the calculation, resulting in a weekly income benefit of $216.16.

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

The applicant sought ongoing benefits and vocational training costs.

The arbitrator found that the applicant's ongoing difficulties were related to pre-existing physical and psychiatric conditions, including paranoid delusions, and an unrelated subsequent ankle fracture, rather than the motor vehicle accident.

The medical evidence supporting her claim was rejected as flawed or incomplete.

The application for ongoing income replacement benefits and vocational training was dismissed.

The applicant was injured in a motor vehicle accident while enrolled in a job-orientation program with a prospective employer.

At the time of the accident, he was earning a training wage but had a contract to begin work as a casual driver at a higher wage upon completion of the program.

The insurer paid income replacement benefits based on the training wage.

The arbitrator held that under section 4.3 of the Statutory Accident Benefits Schedule, the applicant was entitled to benefits based on the higher wage of the prospective casual driver position, as he had a legitimate contract of employment made before the accident to start that work within one year.

The applicant sought her expenses for an arbitration hearing regarding a claim for physiotherapy expenses, which had been dismissed.

The arbitrator denied the applicant's request for expenses, finding that her claim was unmeritorious, misguided, and that her conduct during the hearing, including a baseless bias application, unreasonably prolonged the proceedings.

However, the arbitrator ordered the insurer to pay $1,000 in expenses due to its failure to produce documents in a timely fashion.

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

The insurer terminated the benefits, and the applicant requested a Designated Assessment Centre (DAC) assessment.

The parties postponed the assessment for settlement discussions, but when those failed, the insurer refused to arrange the DAC assessment or reinstate benefits, arguing the applicant had waived his rights.

The arbitrator found that the insurer egregiously breached section 64 of the Statutory Accident Benefits Schedule by failing to continue benefits pending the DAC assessment.

The arbitrator ordered the insurer to reinstate the applicant's income replacement benefits with interest, finding the breach alone justified the interim award, and alternatively, that the applicant met the threshold criteria for interim benefits.

The applicant, a taxi driver, was injured when pinned between two vehicles.

He claimed ongoing weekly income benefits, alleging chronic pain and depression prevented him from working.

The insurer terminated benefits after medical assessments indicated he could return to work.

The arbitrator dismissed the claim for ongoing benefits, finding the applicant lacked credibility, exaggerated his symptoms, and had been working covertly at his brother's store, as revealed by surveillance evidence.

The medical opinions supporting disability were rejected as they relied on the applicant's unreliable subjective reporting.

The applicant was awarded one-third of his expenses.

The applicant was injured in a motor vehicle accident and elected to receive education benefits instead of income replacement benefits.

She later sought to change her election, arguing the insurer misinformed her about the calculation of income replacement benefits by stating tips could not be included unless declared on her income tax return.

The arbitrator found that while the insurer's advice was incorrect, the applicant did not rely on this misrepresentation when making her election.

The application to re-elect was dismissed.

The applicant sought other disability benefits and medical and rehabilitation benefits following a motor vehicle accident.

The insurer denied the claims on the basis that the applicant did not suffer a partial or complete inability to carry on a normal life.

The arbitrator found that the applicant's medical difficulties pre-dated the accident and that he failed to present reliable evidence connecting his complaints to the collision.

The claims for benefits were dismissed.

Finding the arbitration to be frivolous, vexatious, and an abuse of process, the arbitrator ordered the applicant to pay $1,000 to the insurer under section 282(11.2) of the Insurance Act.

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

The insurer denied benefits based on collateral deductions.

The applicant applied for arbitration solely on the issue of collateral benefits deduction.

The insurer sought to add the issue of entitlement to the arbitration.

The arbitrator held that under the amended section 282(3) of the Insurance Act, the arbitrator shall determine all issues in dispute, whether raised by the insured or the insurer.

The insurer was permitted to raise the issue of entitlement at the hearing.

The applicant was injured when she fell after descending from a bus.

She was knocked over by a crowd of students attempting to board the bus.

The insurer denied statutory accident benefits, arguing the incident did not involve the use or operation of an automobile.

The arbitrator found that the movement of persons onto a bus is integral to its use or operation, and that the flow of persons onto the bus caused the applicant to fall.

The arbitrator concluded the applicant was involved in an 'accident' as defined in the Schedule and is eligible for benefits.

The applicant sought income replacement benefits and the cost of a replacement penile prosthesis following a motor vehicle accident.

The insurer terminated income benefits after medical assessments concluded the applicant was capable of returning to work as a limousine driver.

The arbitrator dismissed the claim for income benefits, finding the applicant's evidence of ongoing disability lacked objective medical support and his credibility was undermined by a failure to disclose pre-accident medical issues.

The claim for a replacement prosthesis was also dismissed, as the evidence indicated the device was malfunctioning prior to the accident.

The applicant was ordered to repay a $3,000 advance provided by the insurer for the prosthesis.

The applicant was injured in a motor vehicle accident while at work and elected to receive workers' compensation benefits.

After the Workers' Compensation Board terminated his benefits, he applied for statutory accident benefits from his motor vehicle insurer.

The insurer denied the claim on the basis that he had already elected and received WCB benefits.

The Arbitrator held that section 76 of the Statutory Accident Benefits Schedule precludes an insured person from receiving accident benefits if they have elected to receive WCB benefits, and they cannot re-elect accident benefits after exhausting their WCB claim.

The applicant was injured in a motor vehicle accident and sought payment for a naturopathic treatment known as bovine extract under section 6 of the Statutory Accident Benefits Schedule.

The insurer denied the claim.

The arbitrator dismissed the claim, finding no reliable evidence that the experimental bovine therapy was reasonable or likely to benefit the applicant.

The arbitrator noted the lack of scientific support for the treatment and the applicant's failure to pursue active rehabilitation measures recommended by other assessors.

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

The insurer terminated the benefits based on a medical report, providing notice to the applicant.

The applicant sought an interim order reinstating the benefits, arguing the insurer failed to comply with the technical requirements of section 64 of the Statutory Accident Benefits Schedule and failed to provide adequate reasons.

The arbitrator found that the insurer substantially complied with the notice requirements and provided adequate reasons for the termination.

The request for an interim order was dismissed.