Frederika Rotter

The applicant sought arbitration for increased income replacement benefits following a motor vehicle accident.

The insurer claimed repayment of benefits paid.

The applicant failed to attend the pre-hearing and the hearing, and his counsel had lost contact with him.

The arbitrator dismissed the applicant's claim due to abandonment and dismissed the insurer's claim for repayment due to lack of evidence.

The insurer was awarded expenses of $1,157.35.

The applicant was injured in a motor vehicle accident and initially received statutory accident benefits from the insurer after being refused workers' compensation.

The Workers' Compensation Appeals Tribunal later determined the accident occurred in the course of employment, entitling the applicant to workers' compensation benefits.

The applicant failed to attend the arbitration hearing regarding ongoing accident benefits.

The arbitrator dismissed the application, finding the insurer was not obliged to pay further benefits under the Schedule, and awarded the insurer $500 in expenses due to the applicant's failure to communicate or attend.

The appellant appealed an arbitration decision that denied him ongoing weekly income benefits under subsection 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator had found that while the appellant could not return to his pre-accident work as a tile layer, he was capable of performing a customer service position at Goodwill Industries after completing a work conditioning program.

The Director's Delegate dismissed the appeal, finding no palpable or overriding error in the arbitrator's assessment of the evidence regarding the appellant's physical restrictions, educational limitations, and capacity for suitable employment.

The appellants, husband and wife, were injured in a motor vehicle accident and received weekly income benefits.

The insurer later terminated the husband's benefits and sought repayment of an alleged overpayment, arguing he had underreported post-accident self-employment income and overstated pre-accident income.

The arbitrator ordered the husband to repay over $92,000.

On appeal, the Director's Delegate found the arbitrator erred in calculating the start date of a pre-accident contract and the method of deducting post-accident corporate income from periodic benefits.

The appeal was allowed in part, reducing the husband's repayment to $32,475.23 and ordering the insurer to pay the wife an additional $8,953.54.

The arbitrator's finding that the husband's lack of candour contributed to the overpayment, justifying the repayment order, was upheld.

The applicant claimed he was injured when a public transit bus braked suddenly, causing him to support his weight on his leg.

He sought ongoing statutory accident benefits, claiming physical and psychological impairments prevented him from continuing his English as a Second Language classes and carrying on a normal life.

The arbitrator dismissed the claim, finding the applicant's evidence lacked credibility and that he had concealed his refugee status from medical assessors.

The medical evidence established that the applicant's knee complaints were likely idiopathic and that he suffered no physical or psychological impairment disabling him from his studies or normal activities.

The arbitrator also denied the applicant's request for hearing expenses due to his lack of candour and failure to present a bona fide claim.

The applicant was injured in a motor vehicle accident and received weekly income benefits for approximately 158 weeks before the insurer terminated them.

The applicant brought a motion for interim benefits pending a full arbitration hearing.

The arbitrator found that the applicant had established a persuasive case for entitlement based on uncontroverted medical evidence of a severe brain injury, which outweighed the insurer's surveillance evidence.

The arbitrator also found that the applicant demonstrated financial necessity, as his sole income was General Welfare Assistance and he faced eviction.

The motion for interim benefits was granted.

The applicant was rendered a quadriplegic in a motor vehicle accident and applied for statutory accident benefits from the insurer.

The insurer denied coverage, arguing its policy on the leased vehicle had expired months prior, and thus it was not an 'insurer' under the Insurance Act or O. Reg. 283/95.

The applicant brought a motion for interim benefits.

The arbitrator held that because the applicant asserted a contractual nexus and the insurer admitted to previously insuring the vehicle, the insurer was required to respond.

Under O. Reg. 283/95, the first insurer to receive an application must pay benefits pending the resolution of any priority dispute through private arbitration.

Finding an urgent need, the arbitrator ordered the insurer to pay specified interim medical and rehabilitation benefits.

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

The insurer terminated weekly benefits on June 25, 1994.

The applicant applied for arbitration in August 1996.

The insurer raised a preliminary issue that the application was made beyond the two-year limitation period prescribed in the Insurance Act.

The arbitrator found that the insurer had given clear and unequivocal notice of its refusal to pay further weekly benefits in June 1994.

As the application was received more than two years after the refusal, it was out of time and could not proceed.

The insurer's request for an award for a frivolous or vexatious proceeding was denied.

The applicants sought statutory accident benefits following the death of their son in a motor vehicle accident.

The deceased was an uninsured passenger in an uninsured vehicle.

The parents claimed the deceased was their dependant, which would make their insurer, Co-operators, liable to pay benefits.

Alternatively, they claimed they were dependent on him for care due to their deafness.

The arbitrator found that the deceased was not principally dependent on his parents for financial support at the time of the accident, as he was employed and living with his spouse and child.

Furthermore, the parents were not principally dependent on the deceased for care, as they were capable of independent living despite relying on him for sign language interpretation.

The claims for death benefits were dismissed, and the Motor Vehicle Accident Claims Fund was found responsible for paying the undisputed benefits to the deceased's spouse and child.

The applicant claimed statutory accident benefits following an alleged motor vehicle accident.

The insurer terminated weekly income benefits and sought repayment, alleging material misrepresentation regarding vehicle ownership and the applicant's driving record.

The arbitrator found the applicant's evidence regarding his disability and income to be wholly unreliable and contradictory.

The arbitrator concluded that the insurance contract was obtained through material misrepresentation, precluding the applicant from receiving weekly income benefits.

The applicant was ordered to repay all weekly income benefits received and to pay the insurer's assessment costs due to his frivolous, vexatious, and abusive conduct throughout the proceedings.

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

A priority dispute arose between the insurer of the vehicle she was in (Simcoe & Erie) and the insurer of her sister and brother-in-law's vehicle (Farmers').

The issue was whether the applicant was a dependant of her sister and brother-in-law, with whom she lived.

The arbitrator found that the applicant provided extensive childcare and household services in exchange for room and board, and also earned part-time income.

Relying on expert economic evidence, the arbitrator concluded that the value of the applicant's services and income significantly exceeded the value of the room and board she received.

Therefore, she was not principally dependent on her relatives, and Simcoe & Erie was liable to pay her benefits.

The applicant's husband committed suicide by running a hose from the exhaust pipe into the passenger compartment of his car.

The applicant sought funeral and death benefits under the Statutory Accident Benefits Schedule.

The insurer denied the claim on the basis that the death was not an 'accident'.

The arbitrator held that while the death resulted from an 'incident' involving the use of an automobile, the term 'incident' in the definition must be restricted to the category of 'accident'.

Since the death was planned and deliberate, it was not an accident.

The application for benefits was dismissed.

The applicant claimed statutory accident benefits, alleging she was a passenger in a vehicle involved in a collision in a mall parking lot.

The insurer denied the claim, asserting she was not in the vehicle.

After hearing evidence from the applicant, the driver, the other driver, and the investigating police officer, the arbitrator found the applicant's evidence implausible and contradictory.

The independent witnesses confirmed no women were in the vehicle.

The arbitrator concluded the applicant was not involved in the accident, dismissed her claims for benefits and a special award, and ordered her to repay interim benefits with interest.

Finding the claim abusive and vexatious, the arbitrator also ordered the applicant to pay the insurer's $1,000 assessment fee.

The Applicant, a farmer, was injured in a motor vehicle accident and claimed ongoing weekly income benefits after the Insurer terminated them.

The Insurer argued the Applicant was no longer substantially disabled and that a $1,500 payment from his father should be deducted as post-accident income.

The Arbitrator found the Applicant was substantially disabled from performing the essential heavy tasks of farming, such as driving a tractor and lifting machinery, supported by medical evidence.

The Arbitrator also held the $1,500 payment was a gift or loan, not earned income, and therefore not deductible.

The Applicant was awarded ongoing benefits and expenses.

The applicant was injured in a motor vehicle accident while a passenger in a vehicle insured by Lambton Mutual.

The applicant had no personal motor vehicle insurance.

Lambton Mutual argued its policy was void ab initio due to material misrepresentations by the named insured regarding ownership and principal driver status, and claimed General Accident (the insurer of the other vehicle) should pay the statutory accident benefits.

The arbitrator found that while there was material misrepresentation, the defence of void ab initio is not available against an innocent third party claiming statutory accident benefits, pursuant to section 233(2) of the Insurance Act.

Lambton Mutual was held liable to pay the benefits.

The applicant, a truck driver, was injured in a motor vehicle accident and received statutory accident benefits.

He returned to work full-time for nearly six months before stopping due to chronic pain, and sought reinstatement of his weekly income benefits and vocational retraining.

The insurer argued that returning to work for more than 90 days after the two-year anniversary of the accident precluded further benefits under section 16(2) of the Schedule.

The arbitrator held that section 16(2) creates a rebuttable presumption of ineligibility, which the applicant successfully rebutted with medical evidence showing he was substantially disabled from his essential tasks.

The applicant was awarded weekly income benefits up to the 156-week mark and vocational retraining costs, but was denied benefits beyond 156 weeks as he failed to prove he was continuously prevented from engaging in any suitable occupation.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits from the Insurer until they were terminated.

The parties participated in mediation and the Insurer claimed a final settlement of $8,375 was reached, issuing a cheque to the Applicant's counsel in trust.

The Applicant later sought to proceed to arbitration, arguing the settlement was only for a limited period.

The arbitrator found that a final and binding settlement had been concluded between competent parties represented by counsel, with no vitiating factors present.

As the dispute was settled, the Applicant was precluded from proceeding to arbitration.

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

The parties attended mediation, where the insurer claimed a settlement was reached, but the applicant later denied it and sought arbitration.

The arbitrator found that the applicant, represented by counsel, had fully understood and agreed to the settlement terms at mediation.

The arbitrator concluded that the applicant was merely having second thoughts and held that a binding settlement had been reached, precluding the applicant from proceeding to arbitration.

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

The insurer terminated benefits based on an independent medical examination which concluded the applicant was fit to return to work.

The applicant sought ongoing benefits, while the insurer sought repayment of an overpayment resulting from erroneous income information.

The arbitrator dismissed the claim for ongoing benefits, finding the applicant was no longer substantially disabled.

The arbitrator ordered the applicant to repay the $560 overpayment, noting his failure to provide requested financial documentation.

The applicants, who were injured in motor vehicle accidents, applied for arbitration regarding statutory accident benefits.

After multiple adjournments and failing to comply with production orders, the applicants sought to withdraw their applications to proceed with a court action.

The insurer opposed the withdrawal and sought expenses, arguing the withdrawal was an abuse of process.

The arbitrator allowed the withdrawal, finding no rule preventing it before the hearing commenced.

However, the arbitrator found the applicants' conduct constituted an abuse of process and ordered each applicant to pay $1,000 in expenses to the insurer.