Fred Sampliner

The applicant was injured in a motor vehicle accident and sought weekly disability benefits and reimbursement for damaged clothing under the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant's pre-existing heart condition and limited pre-accident activities meant she did not suffer a complete inability to lead a normal life as a result of the accident.

The claim for weekly disability benefits was dismissed.

The arbitrator awarded $175 for damaged clothing, finding insufficient evidence to support the $4,170 claimed for wholesale replacement.

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

The insurer raised a preliminary issue that the applicant failed to file for arbitration within the two-year limitation period under s. 281(5) of the Insurance Act.

The arbitrator reviewed the correspondence and notices provided by the insurer to determine if they constituted clear and unequivocal denials.

The arbitrator found that the claims for further disability benefits, taxi expenses, prescriptions, cognitive aids, biobeam, and certain rehabilitation expenses were statute-barred.

However, the claims for vocational rehabilitation and case management services were not clearly denied and may proceed to arbitration.

The applicant sought ongoing statutory accident benefits following a motor vehicle accident, claiming physical and psychological disabilities prevented him from working as a superintendent.

The arbitrator found that the applicant suffered from chronic fatigue and psychological issues prior to the accident, stemming from previous torture in Turkey, which had already impaired his job performance.

Medical opinions supporting the applicant's claim were rejected because the experts were unaware of his pre-accident condition.

The arbitrator concluded the accident did not significantly contribute to the applicant's disability, denying further weekly benefits and the insurer's claim for repayment, but awarded reimbursement for a medical report.

The applicant was injured in a motor vehicle accident and sought income replacement, rehabilitation, housekeeping, and transportation benefits from his insurer.

The insurer terminated income replacement benefits after medical assessments found no objective physical impairment and noted signs of exaggerated pain.

The arbitrator dismissed the claims for income replacement, housekeeping, and transportation expenses, finding insufficient medical evidence to support a substantial inability to perform essential tasks.

However, the arbitrator ordered the insurer to pay $2,030 for a portion of the claimed rehabilitation expenses, finding that specific physiotherapy program was reasonable and necessary.

The applicant sought reimbursement for private taxi expenses to attend treatment for soft tissue injuries sustained in a motor vehicle accident.

The insurer paid the public transit rate but refused the taxi fare.

The arbitrator found that the applicant failed to establish that taxi service was reasonable or necessary, as he had access to a vehicle and his treating chiropractor did not indicate any travel restrictions.

The claims for transportation expenses and a special award were dismissed.

The insurer was awarded its arbitration expenses due to the applicant's representative prolonging the hearing with unfounded arguments.

The applicant sought assessment of his expenses following a successful arbitration for ongoing income replacement benefits arising from a motor vehicle accident.

The arbitrator reviewed the claimed legal fees, law clerk time, expert witness fees, and various disbursements.

After adjusting the hourly rates and disallowing certain unsubstantiated disbursements, the arbitrator ordered the insurer to pay the applicant $15,427.42 for his expenses of the arbitration process.

The arbitrator issued a correction to a previous arbitration decision to include a ruling on the applicant's entitlement to reimbursement for medical reports.

The corrected decision confirms the applicant's entitlement to caregiver benefits, $52.35 for housekeeping expenses, and an $8,000 special award under the Insurance Act.

It adds an award of $1,110 for medical reports, plus interest.

The claim for psychological counselling was denied pending a current assessment.

The applicant was injured in a rear-end motor vehicle accident and sought ongoing income replacement benefits after the insurer terminated them.

The arbitrator found no objective physical injury but accepted that the applicant developed significant emotional and psychological problems resulting in a substantial inability to perform her essential job tasks.

However, evidence showed she was functionally able to operate a chip wagon business on her own by the summer of 1997.

The arbitrator ordered the insurer to pay income replacement benefits from the date of termination until June 1, 1997.

The applicant was struck by a car and claimed ongoing income replacement benefits and physiotherapy expenses.

The insurer terminated benefits, arguing she could return to her job as a light duty cleaner and sought to deduct alleged post-accident income.

The arbitrator found the applicant suffered a substantial inability to perform the essential tasks of her job due to accident-related knee tendinitis, entitling her to ongoing income replacement benefits.

The arbitrator also found no evidence of actual post-accident income to deduct, and allowed only one month of the claimed physiotherapy expenses, finding the remainder unreasonable.

The applicant was injured in a rear-end motor vehicle accident and sought income replacement benefits, physiotherapy expenses, and the cost of a functional assessment after the insurer terminated her benefits.

The arbitrator found that while the applicant's physical injuries were mild, she suffered from depression and anxiety significantly contributed to by the accident, which caused a substantial inability to perform the essential tasks of her pre-accident employment as a home health aide.

Income replacement benefits were awarded up to July 20, 1997, when psychological evidence indicated she was capable of resuming her pre-accident lifestyle.

The claims for physiotherapy and a functional assessment were dismissed as not reasonable or necessary.

The applicant was injured in a motor vehicle accident and claimed ongoing caregiver benefits, housekeeping expenses, psychological counselling, and a special award after the insurer terminated her benefits.

The arbitrator found that the applicant suffered a substantial inability to perform caregiver tasks due to physical and psychological impairments until her condition stabilized in January 1999, awarding caregiver benefits for that period.

The arbitrator also awarded a nominal amount for housekeeping expenses and an $8,000 special award, finding the insurer unreasonably terminated psychological counselling and vocational retraining benefits without a reasonable basis.

The applicant was struck by a vehicle while crossing the street and claimed statutory accident benefits for income replacement, housekeeping, and travel expenses.

The insurer denied income replacement benefits after December 26, 1995, and housekeeping expenses.

At arbitration, the arbitrator found the applicant to be an unreliable historian whose testimony was contradicted by video surveillance showing him walking normally.

The medical evidence did not support the applicant's claims of debilitating physical or cognitive impairments preventing him from performing his job as a furniture assembler.

The claims for income replacement and housekeeping were dismissed, but the applicant was awarded $590 for uncontested travel expenses.

The Arbitrator issued a decision correction pursuant to Rule 63.4 of the Dispute Resolution Practice Code.

Paragraph 3 of the arbitration order was corrected to order the insurer to pay the applicant a $10,000 lump sum special award, together with simple two percent interest per month from the date of the Order.

The applicant was receiving weekly income benefits following a motor vehicle accident.

The insurer reduced her benefits by the amount of her CPP disability benefits.

The insurer argued the applicant was barred from contesting the deduction due to the two-year limitation period.

The arbitrator held that a reduction in benefits is not a denial, so the limitation period was not triggered.

Relying on recent jurisprudence, the arbitrator found that CPP disability benefits are not an indemnity for loss of income and therefore cannot be deducted from weekly income benefits.

The insurer was ordered to pay the applicant's expenses.

The Applicant was injured in a motor vehicle accident and claimed ongoing income replacement benefits.

The Insurer argued his condition was not caused by the accident and he was not motivated to return to work.

The Arbitrator found that the Applicant suffered continuous depression, reduced cognitive skills, and chronic pain as a result of the accident.

Due to these cognitive and physical disabilities, the Applicant suffered a substantial inability to perform the essential tasks of his job as a welder.

The Arbitrator ordered the Insurer to pay ongoing income replacement benefits and the expenses of the arbitration.

The applicant was injured in a motor vehicle accident and claimed weekly benefits and yard maintenance expenses from his insurer.

The insurer denied the claims, arguing the applicant's disability was not caused by the accident and that he lacked motivation.

The arbitrator found that the accident aggravated the applicant's pre-existing spinal degeneration, causing a substantial inability to perform his essential daily tasks, including home renovations and strenuous recreational activities.

The arbitrator awarded three years of weekly benefits and partial yard maintenance expenses.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award under section 282(10) of the Insurance Act, finding that the insurer's continued denial of the claim after receiving objective MRI evidence was unreasonable.

In a supplementary decision, the insurer requested to setoff an overpayment of benefits against the insured's arbitration expenses previously ordered by another arbitrator.

The arbitrator denied the request, finding that the previous arbitrator specifically awarded partial expenses to the insured because the insurer had called unnecessary witnesses and prolonged the proceedings.

Allowing a setoff would undermine the intention that the insured not bear the costs of the insurer's inefficient conduct.

The applicant sought ongoing income replacement benefits, medical expenses, and a special award following a motor vehicle accident.

The insurer denied the claims, arguing the accident did not cause the applicant's injuries and sought repayment of benefits paid, alleging wilful misrepresentation.

The arbitrator found the applicant's evidence unreliable and accepted expert medical evidence that the applicant exaggerated his symptoms and that the accident did not cause his delayed symptoms.

The claims for benefits and a special award were dismissed.

The insurer's request for repayment was also dismissed, as the applicant's exaggeration did not amount to wilful misrepresentation.

The applicant was awarded half of his arbitration expenses.

The Applicant was injured in a motor vehicle accident while riding a bicycle and received weekly income benefits until July 18, 1994.

She applied for ongoing benefits under section 12(5)(b) of the Statutory Accident Benefits Schedule, claiming she was continuously prevented from engaging in any occupation reasonably suited to her education, training, or experience.

The arbitrator found that while the Applicant suffered a permanent moderate restriction in her right elbow, she had the necessary skills and physical ability to work as a retail sales clerk or restaurant hostess.

The claim for ongoing weekly income benefits and a special award was dismissed, but the Applicant was awarded her arbitration expenses.

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

The applicant sought arbitration to reinstate the benefits, claiming a substantial inability to perform his pre-accident job as a machinist due to soft tissue injuries.

The arbitrator found that the applicant had successfully worked full-time at another manufacturing job post-accident without seeking medical attention.

Relying on this work history and the opinion of the insurer's orthopaedic examiner, the arbitrator concluded the applicant failed to prove a substantial inability to perform the essential tasks of his employment and dismissed the claim for further benefits.