Frederika M. Rotter

The applicant's wife was murdered during an armed robbery while sleeping in their motor home.

The applicant sought funeral expenses and death benefits under the No-Fault Benefits Schedule.

The insurer denied the claim on the basis that the death was not an 'accident' as defined in the Schedule.

The arbitrator held that the incident did not involve the use or operation of an automobile, nor was it caused by such use or operation.

The vehicle was merely the location of the crime.

The application for benefits was dismissed.

The Applicant was injured in a motor vehicle accident and received no-fault benefits until the Insurer terminated them after he twice failed to attend an independent medical examination.

The Applicant applied for mediation and then arbitration.

The Insurer brought a preliminary motion arguing the arbitrator lacked jurisdiction because the Applicant failed to make himself reasonably available for the medical examination, which is a prerequisite for mediation under section 25 of the No-Fault Benefits Schedule.

The arbitrator found that the Applicant did not have a reasonable excuse for missing the appointments and was therefore barred from mediation and arbitration.

The Insurer's motion was granted, the application was dismissed for lack of jurisdiction, and the Insurer was entitled to a refund of its arbitration assessment fee.

The applicant was injured in a motor vehicle accident and claimed ongoing weekly benefits, supplementary medical and rehabilitation expenses, and a special award under the Insurance Act.

The arbitrator found that while the applicant experienced pain and her ability to perform her essential tasks as a home-maker and mother was limited, she did not suffer a 'substantial inability' to perform those tasks as required by the No-Fault Benefits Schedule.

The claim for ongoing weekly benefits was dismissed.

The insurer agreed to pay most of the supplementary medical and rehabilitation expenses, and the arbitrator remained seized of one disputed invoice.

The claim for a special award was dismissed as the insurer did not unreasonably withhold benefits.

The applicant was awarded her expenses for the arbitration.

The applicant was injured in a motor vehicle accident and received weekly income benefits, which were terminated by the insurer on the basis that he failed to make progress in a rehabilitation program.

The applicant applied for arbitration, arguing that chronic back pain prevented him from returning to his heavy physical job.

The arbitrator found the applicant credible and accepted medical evidence that the accident aggravated a pre-existing back condition, resulting in chronic pain.

The arbitrator concluded that the applicant's inability to perform the essential tasks of his employment was genuine and not due to a deliberate failure to cooperate in rehabilitation.

The applicant was awarded ongoing weekly income benefits.

The applicant was injured in a motor vehicle accident and his weekly income benefits were suspended by the insurer.

In a previous decision, the arbitrator found the insurer unreasonably withheld benefits and ordered a special award under s. 282(10) of the Insurance Act.

In this decision on the quantum of the special award, the arbitrator rejected the insurer's attempt to introduce new evidence to reconsider the unreasonableness finding.

The arbitrator determined that a special award is not equivalent to punitive damages and does not require bad faith, but must be substantial enough to deter unreasonable conduct.

The arbitrator awarded a lump sum of 15% of the amount the applicant was entitled to, plus interest.

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

At the time of the accident, he was receiving Canada Pension Plan (CPP) disability benefits and Family Benefits.

The Insurer refused to pay accident benefits, arguing that the CPP and Family Benefits payments were deductible as 'payments for loss of income' under section 13 of the No-Fault Benefits Schedule.

The arbitrator held that Family Benefits are not employment-related and thus not deductible.

Furthermore, the arbitrator found that only payments for loss of income arising from the same accident are deductible, meaning the pre-existing CPP disability benefits were also not deductible from the Applicant's weekly accident benefits.

The applicant, a self-employed duct cleaner, was injured in a motor vehicle accident and received weekly income benefits until they were terminated by the insurer.

The applicant sought reinstatement of benefits for the period from May 10, 1991, to September 30, 1991, arguing he was substantially unable to perform the physical tasks of his employment.

The insurer relied on surveillance evidence and an independent medical examination suggesting the applicant could return to work.

The arbitrator found the applicant credible, noting his essential tasks were physically demanding, and concluded the medical evidence supported his inability to work during the disputed period.

The applicant was awarded the claimed benefits, interest, and expenses.

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

The Insurer terminated these benefits based on outdated medical predictions without providing notice or seeking updated medical information.

At the arbitration hearing, the Insurer conceded that the Applicant remained disabled and was entitled to ongoing benefits.

The arbitrator found that the Insurer acted unreasonably in withholding the benefits and ordered a special award under section 282(10) of the Insurance Act, with the quantum to be determined after further submissions.

The applicant, a self-employed motorcycle mechanic, was injured in a motor vehicle accident and received weekly income benefits until they were terminated by the insurer.

He applied for arbitration claiming entitlement to maximum weekly benefits, supplementary medical and rehabilitation benefits, and care benefits.

The arbitrator found the applicant lacked credibility due to inconsistent testimony, failure to declare income for tax purposes, and surveillance evidence showing him performing physical tasks without restriction.

The arbitrator concluded the applicant failed to prove ongoing disability beyond March 21, 1991, and awarded minimum weekly benefits up to that date.

Claims for a rental vehicle and further therapy were denied, but full mileage for travel to his chiropractor was allowed.

The applicant was injured in a motor vehicle accident while driving a bus in the course of his employment.

He elected to sue the at-fault third party rather than claim workers' compensation benefits, and subsequently applied for interim no-fault benefits under Section 21 of the No-Fault Benefits Schedule.

The insurer denied the claim under Section 20, arguing that the applicant was entitled to workers' compensation benefits.

The arbitrator held that Section 21 only applies to bona fide threshold claims where damages are recoverable, not to cases where a lawsuit is initiated solely to qualify for no-fault benefits.

The application for no-fault benefits was dismissed.

The applicant, a self-employed vendor of cosmetic products, was injured in a motor vehicle accident and claimed weekly income benefits at the maximum rate of $600.00 per week.

The insurer disputed the applicant's documentation of his earnings and paid $252.00 per week.

At arbitration, the arbitrator found the applicant's evidence regarding his sales and profits to be contradictory, unreliable, and largely unsubstantiated.

Relying only on objectively verifiable documentation, the arbitrator calculated the applicant's gross weekly income to be $232.00, entitling him to the statutory minimum benefit of $185.00 per week.

The applicant was ordered to repay the insurer the $67.00 weekly overpayment.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and claimed weekly income benefits at the maximum rate of $600 per week.

The insurer disputed the calculation of his income, preferring to rely on his 1990 tax return rather than his daily run sheets.

The arbitrator accepted the run sheets as prima facie evidence of earnings but adjusted the expenses based on the 1990 tax return, concluding the applicant was entitled to a weekly benefit of $252.10.

The applicant was injured in a motor vehicle accident and could no longer lift her handicapped child into her vehicle.

She traded in her van for a comparable vehicle that could accommodate a wheelchair lift.

The insurer disputed the trade-in value she received and the total replacement cost.

The arbitrator found that the applicant acted reasonably by shopping at three dealerships and accepting the best trade-in offer, and ordered the insurer to pay the full difference in cost between the trade-in and the replacement vehicle.

The Applicant sought weekly income benefits following a motor vehicle accident while driving an uninsured vehicle.

The arbitrator determined that the Toronto Transit Commission, as the owner of the other vehicle involved, was the proper insurer.

However, the arbitrator dismissed the claim for benefits, finding that the Applicant had never been employed as claimed and that the claim was entirely fraudulent.

The arbitrator noted the inability to award costs against a fraudulent applicant under the existing legislation.

The self-employed applicant was injured in a motor vehicle accident and claimed maximum weekly income benefits of $1050 under the No-Fault Benefits Schedule.

The insurer paid $755.23 based on incomplete financial records and later sought to reduce the amount to $523 based on a forensic accounting report.

The arbitrator accepted the insurer's accounting evidence, finding the applicant failed to produce adequate records and deliberately delayed the hearing.

The arbitrator set the weekly benefit at $523, ordered the applicant to repay the overpayment, and denied the applicant's claims for interest, a special award, and costs.