Elisabeth Sachs

The appellant was injured in a snowmobile accident and received statutory accident benefits until they were terminated by the insurer.

An arbitrator dismissed his claims for ongoing weekly benefits, primary caregiver benefits, and expenses for various goods and services, but awarded him arbitration expenses.

The appellant appealed the arbitrator's findings on his inability to perform essential tasks, and the insurer cross-appealed the award of expenses.

The Director of Arbitrations dismissed both the appeal and cross-appeal, finding that the arbitrator applied the correct legal tests, made factual findings supported by the evidence, and appropriately exercised discretion in awarding expenses.

The insurer appealed an arbitration order awarding the claimant $3,720 for babysitting and housekeeping services under paragraph 6(1)(f) of the Statutory Accident Benefits Schedule.

The insurer argued that because the claimant was already receiving weekly benefits as an unemployed primary caregiver under section 13, he was precluded from recovering replacement services under section 6.

The Director of Arbitrations dismissed the appeal, holding that receipt of section 13 benefits does not foreclose recovery of supplementary care benefits under section 6, provided the expenses relate to the insured person's own needs.

The Director also declined to interfere with the arbitrator's factual findings regarding the apportionment of the housekeeper's duties.

The respondent was injured in a motor vehicle accident while vacationing in Vietnam.

She applied for statutory accident benefits under a standard motor vehicle liability policy issued by the appellant.

The appellant denied the claim on the basis that the policy applies only to accidents in Canada, the United States, or on a vessel travelling between the ports of those countries.

An arbitrator initially held that the Statutory Accident Benefits Schedule operated without territorial limitation.

On appeal, the Director of Arbitrations allowed the appeal, finding that the Schedule does not operate independently of the contract of insurance, which contains a valid territorial limitation.

The respondent was therefore not eligible to receive benefits for the accident in Vietnam.

The insurer appealed an arbitration order finding that the insured's application for arbitration was not statute-barred.

The insurer argued that it had mailed a notice of refusal to pay benefits, triggering the two-year limitation period under the Insurance Act.

The Director of Arbitrations dismissed the appeal, finding insufficient evidence that the notice of refusal ever left the insurer's internal mail system or was received by the insured.

As a result, the limitation period had not commenced, and the insured's application was allowed to proceed.

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

An arbitrator found that while the appellant suffered from accident-related pain, he was not substantially unable to perform the essential tasks of his employment as a machinist.

The appellant appealed, arguing the arbitrator misapprehended the medical and surveillance evidence, misapplied the test under section 12 of the Statutory Accident Benefits Schedule, and that the hearing was unfair because he was unrepresented.

The Director of Arbitrations dismissed the appeal, finding the arbitrator's factual conclusions were supported by the evidence, the correct legal test was applied, and the arbitration process was fair.

The appellant insurer appealed an arbitration decision that calculated the respondent's weekly income benefit based on his pre-accident salary as an employee of his closely-held corporation, rather than treating him as self-employed.

The Director of Arbitrations dismissed the appeal, finding that the respondent's consistent pattern of salary-based payments and treatment as an employee justified the arbitrator's conclusion.

The arbitrator did not err in her interpretation and application of the Statutory Accident Benefits Schedule.

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

The insurer terminated benefits and claimed a repayment after the appellant began receiving CPP disability benefits.

The appellant disputed the reduction and claimed the cost of airfare to Italy as a medical expense.

The Director of Arbitrations dismissed the appeal, confirming that CPP disability benefits are deductible from weekly benefits under section 13(3) of the Schedule, and upholding the arbitrator's finding that the airfare was not a reasonable medical expense.

The appellant insurer appealed an arbitration order that awarded the respondent insured weekly income benefits for pre-accident employment delivering newspapers.

The insurer argued the arbitrator erred by presuming the parties agreed the respondent was employed delivering papers before the accident, and sought to deduct collateral disability benefits.

The Director of Arbitrations dismissed the appeal, finding that while the arbitrator erred in presuming an agreement, there was sufficient independent evidence accepted by the arbitrator to support the finding of pre-accident employment and the quantum of earnings.

The Director also declined to deduct collateral benefits, as insufficient evidence was presented regarding the respondent's entitlement to such benefits under the policy.

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

At arbitration, the arbitrator found that the appellant's right ulnar neuropathy was not caused by the accident and confirmed the termination of benefits.

The appellant appealed, seeking to introduce new medical evidence and arguing that her condition was a direct result of the accident.

The Director of Arbitrations refused to admit the new evidence, finding it either could have been adduced at the hearing or would not have affected the result.

The Director dismissed the appeal, holding that the arbitrator's findings on causation were fully supported by the evidence and that the appellate function does not permit re-weighing the evidence.

The appellant was denied her appeal expenses.

The insurer appealed an arbitrator's decision awarding the surviving children of a couple killed in a motor vehicle accident $10,000 each in respect of the death of their mother, in addition to the $10,000 each already paid in respect of their father.

The insurer argued that under the Statutory Accident Benefits Schedule, a person can only be 'principally dependent for financial support' on one person at a time.

The Director of Arbitrations dismissed the appeal, finding that the wording of s. 3(2) allows a child to be a dependant of both parents, entitling them to death benefits for each.

The respondents' cross-appeal for a special award was also dismissed, as the insurer's position was based on a legitimate dispute over statutory interpretation.

The insurer, Canadian General Insurance Company, sought an extension of time to appeal an arbitrator's decision regarding priority for payment of statutory accident benefits, and alternatively applied to vary or revoke the order.

The insurer argued that a subsequent Ontario Insurance Commission bulletin and a court decision in a different case constituted grounds for relief.

The Director of Arbitrations dismissed the appeal, finding that a conflicting court decision does not constitute an apparent ground for granting an extension of time to appeal.

The variation application was also dismissed, as there was no material change in the insured's circumstances, no new evidence, and the alleged error of law was properly the subject of an appeal rather than a variation application.

The appellants, family members of a deceased who was fatally injured in a motor vehicle accident, appealed an arbitrator's decision dismissing their motion for an interim award of expenses.

The appellants sought $29,358.00 from the respondent insurer to cover travel expenses from Ethiopia to Ontario to attend the arbitration hearing.

The Director of Arbitrations determined the appeal on the record.

The Director found that the arbitrator correctly exercised her discretion by applying the criteria from the Bernicky case, concluding that the application did not disclose a case of sufficient merit to warrant pursuit.

The Director noted the lack of evidence demonstrating why the personal attendance of the minor appellants was necessary or why alternative forms of evidence could not be used.

The appeal was dismissed with no order as to expenses.

The appellant appealed an arbitrator's preliminary motion decision which held that an insurer may require an insured person to attend a medical examination under s. 23(2) of the Statutory Accident Benefits Schedule even after terminating weekly income benefits.

The appellant also appealed the arbitrator's refusal to grant an interim order reinstating benefits pending the arbitration hearing.

The Director of Arbitrations dismissed the appeal, finding that the termination of benefits does not alter a claimant's status as an "insured person" subject to the examination requirement.

Furthermore, the Director held that under the Insurance Act as it stood prior to January 1, 1994, an arbitrator had no jurisdiction to make interim orders reinstating benefits.

The appellant appealed an arbitrator's decision that her application for arbitration was barred by the two-year limitation period under s. 281(5) of the Insurance Act.

The appellant argued that the insurer's conduct estopped it from relying on the limitation period and that the notice of termination was insufficient.

The Director of Arbitrations dismissed the appeal, finding no error in the arbitrator's conclusion that the appellant and her counsel were aware of the termination date and that the insurer's conduct did not induce them to believe the limitation period would not be relied upon.

The appellant sought to appeal or revoke a settlement order and an arbitrator's decision on expenses arising from a statutory accident benefits dispute.

The Director of Arbitrations refused to extend the time to appeal the settlement order, finding no apparent grounds as the consent order and release were clear and the appellant had acted in accordance with them.

The request to revoke the settlement order was dismissed because there was no material change in circumstances or error.

The appeal of the arbitrator's decision on expenses was also dismissed, as the arbitrator had sufficient evidence to support her findings of fact and properly exercised her discretion in determining reasonable expenses.

The appellant's request for expenses of the proceedings was denied.

Wellington Insurance Company appealed a preliminary arbitral order finding it responsible for paying statutory accident benefits to the Chapmans.

Shortly before the scheduled oral submissions, Wellington purported to unilaterally withdraw its appeal.

Allstate objected and sought an order for repayment of benefits and costs, while the Chapmans sought an interim order for continued benefits.

The Director of Arbitrations held that a tribunal has the inherent power to control its own process and is not bound to accept a unilateral withdrawal if it prejudices other parties.

However, since the underlying entitlement to benefits was now before the courts, there was no prejudice in allowing the withdrawal.

The Director also found no statutory authority to award expenses to Allstate from Wellington.

The applicant appealed an arbitrator's decision denying his claim for expenses after he withdrew his application for arbitration at the start of the hearing.

The applicant sought an oral rehearing to re-establish his statutory accident benefits and claim expenses.

The Director of Arbitrations held there was no jurisdiction to hear the benefits claim as it was never arbitrated.

The Director also declined to admit fresh evidence and found no reason to interfere with the arbitrator's discretionary decision to deny expenses, noting the applicant's withdrawal was capricious.

The appeal was dismissed with no expenses awarded.

The appellant appealed an arbitrator's decision denying him weekly benefits and a lump sum award under the Insurance Act following a motor vehicle accident.

The appellant argued the arbitrator misapprehended the medical evidence and his ability to perform tasks, and requested a referral to the Medical and Rehabilitation Advisory Panel.

The Director of Arbitrations found no error in the arbitrator's assessment of the evidence, noting the appellant's ability to engage in activities such as cross-country skiing and municipal election campaigning.

The appeal was dismissed, but the appellant was awarded his filing fee expenses.

The insurer appealed an arbitrator's preliminary decision that the insured had not finally settled her weekly benefits claim at mediation and could proceed to arbitration.

The insurer argued that mediation is strictly confidential and the Report of Mediator confirming settlement should be conclusive.

The Director of Arbitrations held that while statements made to or by the mediator are privileged to protect the mediator's neutrality, evidence of the parties' own understanding and subsequent conduct is admissible to determine if a settlement was actually reached when the Report is ambiguous.

The appeal was dismissed, allowing the arbitration for weekly benefits to proceed.

The unrepresented applicant reached a lump sum settlement with the insurer during a pre-hearing discussion and signed a full and final release.

Shortly after, she attempted to revoke the settlement, arguing it was unfair and that there was an inequality of bargaining power.

The arbitrator found the settlement binding.

On appeal, the Director of Arbitrations upheld the arbitrator's decision, finding no evidence of unconscionability, undue influence, or other vitiating factors, and noting that the pre-hearing arbitrator had taken appropriate steps to ensure the applicant understood the consequences of signing the release.