Fred B. Sampliner

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

The insurer offered a final payment of $800 in exchange for a full and final release of future weekly disability benefits, which the applicant signed.

The applicant later sought further benefits, arguing the release was invalid due to mistake, duress, and unconscionability.

The arbitrator found that the applicant understood the release, was not under duress, and that the settlement was not unconscionable given medical opinions that he could return to work.

The arbitrator also held that the arbitration was timely because the release did not constitute a valid notice of refusal with reasons, which is required to trigger the two-year limitation period.

However, because the release was enforceable, the applicant was precluded from claiming further benefits.

The applicant was injured in a motor vehicle accident and initially received caregiver benefits.

She later sought to elect income replacement benefits instead.

The arbitrator found that the insurer's adjuster had negligently misrepresented the available benefits and failed to provide the required written explanation under section 59(2) of the Statutory Accident Benefits Schedule.

The insurer's failure to correct this misinformation led to the applicant's initial election.

The arbitrator ruled that the applicant was not bound by the deemed election provision and could now elect to receive income replacement benefits.

The applicant, a self-employed real estate broker, was struck by a vehicle and claimed ongoing weekly income benefits and expenses under the Statutory Accident Benefits Schedule.

The insurer terminated benefits at the three-year mark, arguing she could return to work or engage in other suitable employment.

The arbitrator found that the alternative jobs proposed by the insurer were unsuitable given the applicant's age, lack of administrative skills, and pre-existing arthritis.

However, based on surveillance evidence showing the applicant working full days without apparent restriction by May 1995, the arbitrator concluded she was no longer substantially unable to perform her essential tasks after that date.

The arbitrator also calculated her pre-accident income to establish a maximum weekly benefit of $1,050, allowed deductions for post-accident income, and awarded partial housekeeping and full snow removal expenses.

The applicant applied for arbitration after the insurer stopped paying weekly statutory accident benefits.

Following the application, the applicant was convicted of operating the motor vehicle involved in the accident without liability insurance.

The applicant did not appear at the telephone hearing.

The arbitrator found that under section 17(1)(c) of the Statutory Accident Benefits Schedule, the insurer is not required to pay weekly benefits to a driver convicted of operating an uninsured automobile.

The applicant's claim for weekly benefits was dismissed.

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

After mediation failed, he commenced a court action against the insurer for the benefits.

He subsequently applied for arbitration at the Ontario Insurance Commission seeking interest, a special award, and expenses.

The arbitrator held that because the applicant had elected to proceed in court for the substantive benefits, the arbitrator had no jurisdiction to hear the claims for a special award and interest, as these are dependent on an award of benefits.

The application was dismissed.

In a supplementary decision, the arbitrator determined two legal issues: the interest applicable to a special award and entitlement to caregiver benefits for a child en ventre sa mère at the time of the accident.

The arbitrator held that the 2 per cent compound interest under section 282(10) of the Insurance Act does not apply to the lump sum special award itself; rather, the special award bears interest under the Courts of Justice Act.

Furthermore, the arbitrator concluded that section 13(4) of the Statutory Accident Benefits Schedule requires a dependant to be born alive and residing with the insured at the time of the accident, thereby excluding a child en ventre sa mère.

The applicant was injured in a minor rear-end motor vehicle accident and claimed weekly accident benefits as a homemaker.

The insurer paid benefits until January 3, 1991, and then terminated them based on surveillance and an adjuster's lay observations, despite medical evidence supporting ongoing disability.

The arbitrator found that the applicant's part-time sales work from home did not disqualify her from claiming homemaker benefits under section 13 of the Statutory Accident Benefits Schedule.

The arbitrator concluded that the applicant suffered a somatoform pain disorder triggered by the accident and remained substantially unable to perform her essential homemaking tasks until December 1, 1991.

The arbitrator awarded weekly benefits of $285 for the disputed period and ordered a $4,000 special award against the insurer for unreasonably terminating and withholding benefits without medical evidence.

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

She applied for arbitration, claiming ongoing entitlement based on an alleged pre-accident offer of full-time employment.

The arbitrator found insufficient evidence of the full-time job offer and assessed her disability based on her part-time role.

Relying on medical evidence that she was fit to return to part-time work, the arbitrator dismissed the claim for ongoing benefits but awarded the applicant her arbitration expenses.

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

The applicant sought ongoing benefits, while the insurer claimed he had returned to work as a self-employed leathercutter.

Relying on surveillance evidence and medical observations of calluses on the applicant's hands, the arbitrator found the applicant was working and able to perform his essential tasks by January 22, 1992.

The arbitrator also found the applicant had post-accident earnings that were deductible from his benefits.

The applicant was ordered to repay $26,125.36 in overpaid benefits, and his claims for expenses and a special award were dismissed due to his lack of credibility and pursuit of a claim despite clear evidence he was working.

The Applicant was injured in a motor vehicle accident and received accident benefits until the Insurer allegedly terminated them.

The Insurer argued the Applicant's request for arbitration was barred by the two-year limitation period under s. 281(5) of the Insurance Act.

The arbitrator found that the Insurer failed to prove actual delivery of the notice of denial as required by s. 148(15) of the Insurance Act, rejecting the application of the 'mailbox rule'.

The Applicant was permitted to proceed to arbitration.

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

After returning to part-time work, the insurer deducted 80 per cent of her post-accident earnings from her weekly benefit.

The applicant disputed this calculation, arguing the deduction should be from her pre-accident gross earnings.

The arbitrator held that under section 15 of the No-Fault Benefits Schedule, the insurer is entitled to deduct 80 per cent of post-accident earnings directly from the weekly benefit payable.

The applicant was injured in a motor vehicle accident and initially applied for accident benefits from her son's insurer, The Personal, who paid her expenses for a year before realizing she had her own policy with Zurich.

The applicant then applied to Zurich, who denied the claim due to the delay in notice.

On a preliminary issue hearing, the arbitrator found that under section 268 of the Insurance Act, Zurich was the priority insurer.

The arbitrator also found that the applicant had a reasonable excuse for the delay in notifying Zurich, as The Personal's error in sending the wrong claim form and subsequent payment of benefits caused the delay.

Zurich was ordered to pay the applicant's accident benefits.

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

The parties attended mediation and the insurer paid a $6,000 lump sum, which it argued was a full and final settlement of the weekly benefits claim.

The applicant argued the sum was only a reinstatement of benefits for a limited period and that she did not agree to a final release.

The arbitrator found that the mediator's report did not clearly indicate a full and final release and that the applicant did not understand the settlement to be final.

The arbitrator held that the weekly benefits claim was not settled and allowed the matter to proceed to arbitration.

The Applicant was injured in a motor vehicle accident and received weekly income benefits.

She subsequently began receiving Canada Pension Plan (CPP) disability benefits.

The Insurer terminated her weekly benefits and sought repayment of the overpayment resulting from the retroactive CPP award.

The Applicant also claimed the cost of an airline ticket to Italy as a medical expense, arguing it was recommended by her doctor for therapy.

The Arbitrator held that CPP benefits are deductible from weekly income benefits under section 13(3) of the No-Fault Benefits Schedule.

The Arbitrator ordered the Applicant to repay the $10,224.40 overpayment through an offset against future benefits.

The claim for the airline ticket was dismissed as it was not a necessary medical expense.

The Applicant was injured in a motor vehicle accident and claimed weekly income benefits based on two jobs: one at Rayette Forest Products and another delivering newspapers for The Toronto Star.

The Insurer paid benefits based on the first job but disputed the income from the newspaper delivery, as the Applicant had not reported it to Revenue Canada and lacked business records.

The Insurer also alleged the Applicant had returned to work delivering newspapers after the accident, relying on surveillance evidence.

The Arbitrator found that the Applicant's income from the newspaper delivery was corroborated by the testimony of a district manager and business records.

The Arbitrator also concluded that the surveillance evidence misidentified the Applicant's cousin as the Applicant, and that the Applicant had not returned to work.

The Applicant was awarded the maximum $600 per week in income benefits and his arbitration expenses, but his claim for a special award was denied because the Insurer's questioning of his proof was reasonable.