Frederika Rotter

The applicant, a high school student, was severely injured in a motor vehicle accident and suffered significant psychological trauma.

His therapist recommended a transfer to a private boarding school to assist his recovery by providing a structured social environment.

The insurer refused to pay the tuition, arguing it was not a reasonable or necessary expense resulting from the accident.

The arbitrator found that the applicant's pre-existing psychological vulnerability made him particularly susceptible to trauma, and that the boarding school placement was a successful and reasonable rehabilitation measure.

The insurer was ordered to reimburse the tuition and boarding expenses for two years.

The applicant was injured when struck by an automobile while riding his bicycle.

He applied for statutory accident benefits from Guardian, which insured a vehicle owned by his father and on which the applicant was listed as the principal driver.

Guardian argued that Liberty Mutual, the insurer of the striking vehicle, should pay the benefits, claiming the applicant was not an 'insured person' or a 'dependant' under its policy.

The arbitrator found that the applicant was an 'insured' under the Guardian policy pursuant to sections 224 and 270 of the Insurance Act, as he was the principal driver for whom a specific premium was paid.

Alternatively, the arbitrator found the applicant was a dependant of his parents.

Guardian was held responsible for paying the statutory accident benefits.

The applicant's father died in a motor vehicle accident while the applicant's mother was pregnant with him.

Following his birth, a claim was made for a $20,000 death benefit under section 11(2) of the No-Fault Benefits Schedule, arguing the legal fiction that an unborn child subsequently born alive should be treated as a living dependant.

The arbitrator dismissed the claim, finding that under the specific wording of the Schedule, the applicant was not a 'person' and could not be considered a surviving dependant 'who was a dependant at the time of the accident'.

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

The applicant disputed the termination and applied for arbitration.

At the hearing, the applicant's representative requested an adjournment, which was denied due to a lack of reasonable grounds and a history of uncooperative behaviour, including failing to attend a pre-hearing discussion and medical examinations.

The applicant withdrew from the hearing.

The arbitrator heard evidence from the insurer, including medical reports indicating the applicant was exaggerating his disability.

The arbitrator dismissed the applicant's claim for ongoing benefits and denied his request for arbitration expenses.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, which were later terminated by the insurer.

The applicant applied for mediation but walked out within five minutes of the meeting's commencement, refusing to participate.

The mediator issued a report stating that mediation did not take place.

The applicant then applied for arbitration.

The arbitrator held that the applicant was not entitled to proceed to arbitration because the statutory requirement to seek and fail at mediation requires meaningful participation in good faith, not merely filing forms and walking out.

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

The applicant sought ongoing benefits, claiming a hearing loss resulting from the accident prevented her from working as a waitress.

The arbitrator found the hearing loss was a pre-existing condition and dismissed the claim for ongoing benefits.

The insurer sought repayment of an overpayment, arguing the applicant's pre-accident income was misstated.

The arbitrator agreed, finding the applicant had no earnings in the four weeks prior to the accident, and ordered the applicant to repay the overpayment with interest.

The applicants, two young children severely injured in a motor vehicle accident, applied for statutory accident benefits.

A priority dispute arose between the father's former insurer and the insurer of the vehicle involved in the accident.

The father's former insurer claimed it had cancelled his policy for non-payment of premiums prior to the accident by sending a notice via registered mail.

The vehicle's insurer argued the cancellation was invalid because the notice was never received.

The arbitrator found that the former insurer had validly terminated the policy in accordance with the statutory requirements, as the notice was received at the destination post office in time to provide the required 15 days' notice.

Consequently, the vehicle's insurer was held responsible for paying the statutory accident benefits.

The applicant was injured when her car door fell off its hinges.

She received weekly income benefits until the insurer terminated them based on medical reports indicating she could return to work.

The applicant sought arbitration, claiming ongoing chronic pain prevented her from performing her job as an accounts receivable clerk.

The arbitrator dismissed the claim, finding the medical evidence did not support a causal link between the minor trauma and her ongoing complaints.

Furthermore, video surveillance evidence contradicted her claims of physical limitation, leading the arbitrator to conclude she had not established a substantial inability to perform the essential tasks of her employment.

The applicants, injured in motor vehicle accidents, claimed legal fees charged by their lawyers for completing their applications for no-fault benefits under Section 6(1)(f) of the No-Fault Benefits Schedule.

The insurers refused to pay these fees.

The arbitrator held that legal fees for completing claim forms are not recoverable as they are not a reasonable expense resulting from the accident, nor are they required because of the accident.

The arbitrator noted that while some individuals may have difficulty completing the forms, the services of a lawyer are not essential, and such expenses fall outside the realm of medical or rehabilitative necessity contemplated by the legislation.

The Applicant suffered catastrophic injuries in a motorcycle accident, resulting in paraplegia.

He applied for no-fault benefits, including home renovations and a suitably modified motor vehicle.

The Insurer refused to provide a vehicle, arguing it was only liable for transportation costs to and from treatment.

The arbitrator held that a modified mini van was a reasonable expense resulting from the accident under section 6(1)(f) of the No-Fault Benefits Schedule, as it was necessary for the Applicant's rehabilitation and independence.

The arbitrator dismissed the Applicant's claim for a special award under section 282(10) of the Insurance Act, finding that the Insurer had not unreasonably withheld or delayed payments.