Deena Baltman

The applicant was struck by a car and claimed ongoing income replacement benefits (IRBs) due to a left knee injury.

The insurer terminated benefits after the applicant failed to attend a scheduled medical examination and refused to participate in rehabilitation.

The arbitrator found that the applicant was not disabled from her pre-accident employment beyond April 6, 1995, relying on medical evidence and surveillance footage showing her performing physical tasks.

However, the arbitrator awarded full IRBs for a brief one-week period because the insurer had prematurely terminated benefits prior to the scheduled examination date.

The applicant was awarded 50% of her arbitration expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including weekly income benefits and the cost of physiotherapy and transportation.

The insurer denied benefits, arguing that the applicant's disabilities arose from a previous work-related injury for which she was receiving WCB benefits.

The arbitrator found that the applicant's pre-existing back injury was the principal cause of her inability to work, and dismissed the claim for weekly income benefits.

However, the arbitrator found it was reasonable for the applicant to undergo an initial 12-week physiotherapy program to alleviate neck symptoms, and ordered the insurer to pay for those treatments and associated transportation costs.

The applicant was awarded 50 percent of her arbitration expenses.

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

The insurer terminated benefits on the basis that the applicant did not meet the stricter test of being continuously prevented from engaging in any suitable occupation after 156 weeks.

The arbitrator found the applicant lacked credibility, as extensive video surveillance contradicted his claims of severe physical and cognitive disability, showing him engaging in vigorous activities and working as a waiter.

The arbitrator dismissed the claim for ongoing benefits, ordered repayment of an overpayment due to CPP benefits, and awarded the applicant only 50% of his arbitration expenses.

The applicant sought to withdraw her application for arbitration of accident benefits to combine it with a related court action.

The insurer consented to the withdrawal but sought reimbursement of its $2,000 filing fee, arguing the arbitration was an abuse of process since the applicant knew earlier that a court action was necessary.

The arbitrator found the applicant's conduct was not an abuse of process but was unwise and wasteful, amounting to frivolous or vexatious conduct under section 282(11.2) of the Insurance Act.

The applicant was permitted to withdraw but ordered to reimburse the insurer's $2,000 filing fee within 30 days of resolving the court action.

The applicant was injured in a motor vehicle accident and received weekly income benefits for 156 weeks.

The insurer terminated benefits, arguing she was capable of returning to work.

The arbitrator found that while the applicant suffered from chronic pain and was disabled from full-time work commensurate with her background, she was capable of part-time employment.

The arbitrator ordered the resumption of weekly income benefits but allowed the insurer to deduct 80% of the income available from part-time employment under section 15 of the Schedule.

The applicant was also awarded certain rehabilitation expenses, but her claim for a special award was dismissed.

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

The applicant sought benefits for an additional five months.

The insurer sought repayment of nearly $30,000, arguing the applicant failed to apply for available long-term disability (LTD) benefits through his employer.

The arbitrator dismissed the applicant's claim, finding insufficient evidence of ongoing disability.

The arbitrator also dismissed the insurer's claim for repayment, finding the applicant did not act fraudulently or in error by failing to apply for LTD benefits after his employment was terminated, and that the LTD benefits were not clearly available to him.

The applicant was injured in a motor vehicle accident and claimed accident benefits.

After disputes arose, she applied for arbitration but withdrew her application shortly before the hearing after her request for an adjournment was denied.

She later sought to refile her application.

The arbitrator found that her withdrawal was an abuse of process, as she had no reasonable grounds for an adjournment and withdrew to subvert the Commission's process.

However, balancing her right to a hearing, the arbitrator permitted her to refile on the condition that she pay the maximum statutory assessment fee of $1,000 to the insurer before proceeding.

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

When the insurer terminated benefits, the applicant applied for arbitration and subsequently produced a psychiatric report diagnosing him with major depression.

The insurer scheduled a psychiatric independent medical examination (IME), but the applicant arrived 40 minutes late to the 90-minute appointment, leaving insufficient time for an assessment.

The arbitrator held that arriving unreasonably late frustrated the purpose of the IME and constituted a failure to make oneself reasonably available under section 25 of the Schedule.

The arbitration was stayed until the applicant attended a psychiatric IME.

The Arbitrator issued a correction to a previous decision regarding statutory accident benefits.

The original decision incorrectly calculated the deduction of Canada Pension Plan benefits from the applicant's weekly income benefit.

The correction clarified that the deduction should be made from 80% of the applicant's gross weekly income, resulting in an increased weekly benefit amount and a higher total underpayment owed by the insurer.

The insurer was ordered to pay the corrected underpayment amount of $5,160.11 plus interest.

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

The applicant sought ongoing benefits, claiming physical and psychological disability.

The arbitrator found that the applicant's physical injuries had resolved and that there was no organic basis for his ongoing complaints.

Medical and vocational assessments indicated symptom magnification, malingering, and an unreasonable refusal to attempt a return to work.

The arbitrator concluded the applicant was not disabled beyond the termination date.

However, the arbitrator found the insurer had miscalculated the benefit amount prior to termination by improperly deducting ceasing business expenses, resulting in an underpayment.

The insurer was ordered to pay the arrears with interest, and the applicant was awarded one third of his hearing expenses.

The Applicant was injured when he rode his bicycle into a pothole after being distracted by the sound of a car engine starting.

He applied for statutory accident benefits.

The preliminary issue was whether the incident constituted an 'accident' under section 2 of the Statutory Accident Benefits Schedule.

The Arbitrator found that the starting of a car engine constitutes the 'use or operation' of an automobile, and that this use indirectly caused the Applicant's injuries by distracting him and causing him to hit the pothole.

The Arbitrator concluded the Applicant was injured as a result of an accident.

The applicant was severely injured in a motorcycle accident, resulting in the loss of several teeth.

He sought coverage for dental implants, but the insurer refused, offering only to pay for a removable denture.

The insurer maintained its refusal until the eve of the arbitration hearing, despite receiving multiple reports from the applicant's treating dentists and its own retained experts indicating that implants were reasonable and necessary.

The arbitrator found that the insurer unreasonably withheld the dental benefits and violated the 'pay pending dispute' provision of the Statutory Accident Benefits Schedule.

The arbitrator ordered the insurer to pay the $25,000 cost of the implants, awarded a $10,000 special award for the unreasonable delay, and ordered the payment of interest on the future expenses from the mid-point of the anticipated treatment period.