Elisabeth Sachs

The appellant insurer appealed an arbitrator's decision finding that the respondent suffered psychological injuries as a result of an "accident" under the Statutory Accident Benefits Schedule.

The respondent, a limousine driver, was forced at gunpoint by a passenger to drive his vehicle for 45 minutes before being ordered out.

The Director of Arbitrations applied the two-part test from Amos v. Insurance Corp. of British Columbia and found that the respondent was engaged in the ordinary use of his vehicle, and that the forced operation of the vehicle at gunpoint indirectly caused his psychological injuries.

The appeal was dismissed and the arbitration order confirmed.

The appellant insurer appealed an arbitration decision finding that the respondent was not excluded from receiving weekly statutory accident benefits.

The respondent had been convicted of failing to produce an insurance card, but a charge of driving without insurance was stayed under the Kienapple principle.

The Director of Arbitrations dismissed the appeal, holding that the exclusion under paragraph 17(1)(c) of the Schedule requires a specific conviction for driving without insurance, which did not occur.

Furthermore, the exclusion under paragraph 17(1)(d) for driving while not authorized by law relates to licensing issues, not insurance status.

The appellant appealed an arbitrator's decision regarding the calculation of weekly income benefits under the Statutory Accident Benefits Schedule.

The appellant argued that his income should be averaged only over the 33 weeks he actually worked in the 52 weeks preceding the accident, rather than the full 52 weeks.

He also argued that the arbitrator erred by not following a previous appellate decision, raising the issue of whether stare decisis applies to the tribunal.

The Director of Arbitrations held that appellate decisions of the Director are binding on first-instance arbitrators.

However, the Director agreed with the arbitrator's interpretation of the Schedule, finding that the gross weekly income must be averaged over the full 52 weeks, regardless of periods of unemployment.

The appeal was dismissed.

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

The appellant appealed an arbitrator's decision finding he was not employed at the time of the accident under subsection 12(3) of the Statutory Accident Benefits Schedule and was limited to benefits under section 13.

The Director of Arbitrations upheld the arbitrator's finding that the appellant's employment relationship had ended months before the accident when he decided not to return to his courier job and sought other work.

The Director also upheld the finding that the appellant was no longer substantially unable to perform his essential tasks of personal care and household duties, preferring the medical evidence of the insurer's experts over a later, uncorroborated report from the appellant's physician.

The appeal was dismissed.

The appellant appealed an arbitrator's decision denying him continued weekly income benefits following a motor vehicle accident.

The appellant alleged that the arbitrator demonstrated bias against him and erred in excluding two psychiatric reports submitted late in the hearing.

The Director of Arbitrations found no reasonable apprehension of bias, noting the arbitrator accommodated the unrepresented appellant and conducted the hearing fairly.

The Director also upheld the exclusion of the late medical reports due to lack of timely notice to the insurer.

The arbitrator's findings that the appellant lacked credibility and was not disabled from performing his essential tasks were supported by the evidence.

The appeal was dismissed.

The appellant appealed an arbitration decision denying her claims for continued weekly benefits and medical expenses following an incident on a TTC bus.

The arbitrator had found that the appellant's physical and psychological problems were not causally related to the accident, which was considered a minor mishap that did not materially aggravate her pre-existing conditions.

On appeal, the Director of Arbitrations held that the arbitrator made no error in weighing the evidence, including preferring contemporaneous medical records over oral testimony.

The appeal was dismissed and the arbitration order confirmed.

The appellant, a teenager injured in a motor vehicle accident, appealed an arbitrator's decision denying her claim for ongoing weekly statutory accident benefits.

The appellant argued that she sustained a psychological or mental injury in the accident that continuously disabled her.

The arbitrator had concluded that the accident was not a significant factor in the development of her psychological condition, preferring the respondent's expert evidence over the appellant's.

On appeal, the Director of Arbitrations found that the arbitrator properly weighed the conflicting medical and psychological evidence, including the appellant's pre-existing behavioural issues and family circumstances.

The appeal was dismissed, and the arbitration order was confirmed.

The appellant, a self-employed gas station owner, was injured in a motor vehicle accident and received weekly income benefits.

He appealed an arbitration decision denying his claim for reimbursement of costs incurred to hire replacement labour to run his business while he was disabled.

The appellant argued that section 12 of the Statutory Accident Benefits Schedule protects a source of income, or alternatively, that the costs were compensable as "economic rehabilitation" under paragraph 6(1)(f).

The Director of Arbitrations dismissed the appeal, holding that section 12 provides limited income loss compensation based on pre-tax earnings, not business revenue or replacement labour costs.

Furthermore, the "basket clause" in paragraph 6(1)(f) covers expenses related to personal rehabilitation, not the financial health of a business.

The respondent's husband died in a motor vehicle accident.

The respondent applied for a death benefit as a dependant under the Statutory Accident Benefits Schedule.

The arbitrator awarded the benefit, finding the respondent was principally dependent on her husband because the family's social assistance cheque was made payable to him.

On appeal, the Director's Delegate rescinded the order, holding that where both spouses are dependent on government assistance, neither can be said to be principally dependent for financial support on the other.

The appellant was injured in a motor vehicle accident and received weekly income benefits until they were terminated.

He subsequently signed a release and received a settlement cheque, but later applied for arbitration seeking further benefits.

The arbitrator found that while the release document was deficient, the parties had reached a binding final settlement.

On appeal, the appellant argued the arbitrator exceeded her jurisdiction by deciding the broader issue of settlement rather than strictly the validity of the release as framed in the pre-hearing letter.

The Director of Arbitrations dismissed the appeal, holding that the arbitrator was not strictly bound by the pre-hearing letter and had jurisdiction to determine the real issue in dispute based on the evidence presented.

The appellant, a self-employed individual injured in a motor vehicle accident, appealed an arbitration decision regarding the calculation of his weekly income benefits.

The core issue was the arbitrator's interpretation of 'ceasing expenses' under the Statutory Accident Benefits Schedule, specifically whether a proportional reduction in ongoing business expenses qualified as a ceasing expense.

The Director of Arbitrations dismissed the appeal, finding that the arbitrator's factual findings and legal conclusions were supported by the evidence.

The Director also refused to admit new evidence regarding the post-hearing purchase of a cellular telephone, as it did not meet the criteria for admission on appeal and could not affect the original calculation.

The insurer applied to vary an arbitration order, arguing the arbitrator erred by refusing to deal with the deductibility of the insured's Canada Pension Plan (CPP) disability benefits and the insurer's claim for repayment of benefits.

The Director of Arbitrations found that the arbitrator erred in concluding that no repayment was sought by the insurer, as the record showed the insurer had raised the issue of deductibility for both past and future benefits.

The application to vary was granted, and the issues of CPP deductibility and repayment were remitted for adjudication.

The appellant sought to appeal an arbitration decision that denied his claim for ongoing weekly income benefits for a psychological injury allegedly caused by a motor vehicle accident.

The appellant requested a referral to the Medical and Rehabilitation Advisory Panel, the admission of fresh evidence regarding an expert witness's credibility, or a new hearing.

The Director of Arbitrations dismissed the appeal, finding no basis to refer the matter to the panel, refusing to admit the new evidence as it could have been produced earlier or was irrelevant to the expert's medical opinion, and concluding there were no grounds to order a new hearing.

The appellant was injured while travelling as a passenger on a bus and received statutory accident benefits until they were terminated by the insurer.

At arbitration, it was determined that the appellant did not suffer a substantial inability to perform his essential tasks after the termination date.

The appellant appealed, arguing the arbitrator failed to accord appropriate weight to medical reports and misapplied the law.

The Director of Arbitrations dismissed the appeal, finding that the arbitrator's factual conclusions were supported by the evidence and that she correctly applied the provisions of the Statutory Accident Benefits Schedule to those findings.

The appellant, a pedestrian injured in a motor vehicle accident, appealed an arbitration decision that terminated his weekly income benefits and ordered him to repay overpaid benefits.

The Director of Arbitrations upheld the arbitrator's findings that the appellant was no longer substantially unable to perform the essential tasks of his occupation, based on medical and rehabilitation evidence.

Furthermore, the Director affirmed the arbitrator's conclusion that the appellant's financial records were unreliable and constructed after the accident, justifying the calculation of his income benefits at the minimum rate.

The appeal was dismissed.

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

At arbitration, he was awarded the minimum weekly amount because he failed to prove a higher pre-accident income, having relied on unreported cash taken from his business.

On appeal, the appellant sought to introduce fresh evidence of his living expenses to prove he must have earned a higher income, and requested a rehearing.

The Director of Arbitrations dismissed the appeal, finding that the fresh evidence was available at the time of the hearing and would not prove the source of the income.

The request for a rehearing was also denied, as the arbitrator's findings of fact were supported by the evidence.

The appellant, a martial arts instructor injured in a motor vehicle accident, appealed an arbitration decision that terminated his weekly income benefits and ordered repayment of amounts paid above the statutory minimum.

The Director of Arbitrations dismissed the appeal, finding the arbitrator did not misinterpret the test for 'substantial inability to perform essential tasks' and reasonably relied on surveillance and medical evidence.

Furthermore, the arbitrator correctly awarded only the minimum benefit because the appellant's financial evidence regarding his pre- and post-accident income was unreliable and contradictory.

The appellant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them.

The appellant disputed the termination and the benefit amount, but an arbitrator found he was not entitled to benefits beyond the termination date and was only entitled to the minimum benefit amount, resulting in an overpayment.

The appellant appealed the arbitration order.

The Director of Arbitrations dismissed the appeal, finding that the arbitrator's conclusions regarding the appellant's ability to return to work and his employment status were fully supported by the evidence.

The Director also upheld the denial of arbitration expenses and declined to award appeal expenses, noting the appeal was an ill-considered attempt to relitigate credibility findings.

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

An arbitrator upheld the termination, finding the appellant was substantially able to perform the essential tasks of his employment as a band saw operator.

On appeal, the appellant argued the arbitrator erred in her assessment of the medical evidence and credibility.

The Director of Arbitrations dismissed the appeal, holding that the arbitrator's findings of fact and credibility were supported by the evidence and that it is not the appellate function to re-weigh evidence absent a palpable error.

The insurer appealed an arbitration order granting the insured weekly benefits and housekeeping expenses following a motor vehicle accident.

The insurer argued the arbitrator misconstrued medical evidence regarding the insured's ability to perform essential tasks and erred in awarding housekeeping expenses for services provided by family members.

The Director of Arbitrations dismissed the appeal, finding the arbitrator's conclusions on disability were supported by the evidence.

The Director also upheld the housekeeping award, confirming that paragraph 6(1)(f) of the Schedule allows compensation for reasonable services provided by family members when required for the insured's care or rehabilitation.