Fred Sampliner

The applicants were injured in a motor vehicle accident and sought statutory accident benefits.

The insurer terminated the husband's weekly income benefits, prompting an arbitration.

The arbitrator found that the husband was entitled to benefits for a limited period but had failed to disclose post-accident self-employment income, resulting in a substantial overpayment.

Surveillance evidence demonstrated the husband was capable of performing his pre-accident work.

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

The wife was found to have been underpaid and was awarded the balance owed.

The applicant was involved in two motor vehicle accidents and received weekly income benefits from the insurer.

The insurer terminated benefits, alleging the applicant was no longer disabled and had post-accident earnings resulting in an overpayment.

The arbitrator found the applicant failed to establish a substantial inability to perform her essential tasks after the termination date, relying on surveillance evidence and the unreliability of her testimony.

The arbitrator recalculated the benefit amounts and determined the insurer had overpaid the applicant by $14,664 due to a failure to deduct post-accident income.

However, the arbitrator declined to order repayment, finding the overpayment resulted primarily from the insurer's own adjusting errors rather than the applicant's misrepresentations.

The applicant's husband was killed in a motor vehicle accident while in the course of his employment.

The family received workers' compensation benefits and also claimed death benefits under the deceased's automobile insurance policy.

The insurer denied the claim, arguing that section 20 of the Statutory Accident Benefits Schedule precludes payment of no-fault benefits when workers' compensation benefits are payable.

The arbitrator agreed, finding that section 20 reflects a legislative intent to prevent double recovery and makes the auto insurer the payer of last resort.

The applicants were ordered to repay the $45,000 in death benefits previously advanced by the insurer, along with interest.

The applicant sought statutory accident benefits, including weekly income benefits and yard work expenses, following a 1991 motor vehicle accident.

The insurer had terminated weekly income benefits in 1992.

The arbitrator found that the applicant's ongoing disability was caused by a pre-existing arthritic condition and a prior 1989 accident, not the 1991 accident.

The applicant's evidence was deemed unreliable and contradictory.

The claims for weekly income benefits, yard work expenses, and a special award were dismissed.

Due to the applicant's failure to comply with production orders, disruptive behaviour at the hearing, and pursuit of a frivolous claim, the arbitrator ordered the applicant to pay the insurer's $1,000 assessment fee.

The applicant was injured in a rear-end motor vehicle accident and received weekly income benefits for three years.

He applied for ongoing benefits, claiming physical and psychological disability prevented him from working.

The arbitrator found that while the applicant suffered a herniated disc from the accident, he exaggerated his symptoms and his psychological condition was caused by pre-existing and psycho-social factors unrelated to the accident.

The arbitrator concluded the applicant retained the capacity and skills for suitable employment, such as a retail clerk or in construction trades, and dismissed the claim for ongoing benefits.

The applicant, a physiotherapist, sought statutory accident benefits including weekly income benefits and physiotherapy expenses following a motor vehicle accident.

The applicant had opened his own physiotherapy clinic shortly after the accident and billed the insurer for self-administered treatments.

The arbitrator found the applicant's evidence regarding his disability and need for treatment to be unreliable and entirely without merit, noting an irreconcilable conflict of interest in his self-treatment and billing practices.

The claims were dismissed, and the applicant was ordered to reimburse the insurer's $1,000 assessment fee due to the frivolous and vexatious nature of the arbitration.

The applicant, a registered nurse, was seriously injured in a motor vehicle accident and received weekly income benefits for three years.

The insurer terminated benefits, arguing she could return to part-time, less demanding employment.

The arbitrator found that the applicant's residual spinal cord injury, combined with the competitive job market, prevented her from returning to any suitable employment without retraining.

The arbitrator held that the applicant remained continuously prevented from engaging in suitable employment and was entitled to ongoing weekly income benefits.

The applicant sought reimbursement of a $16.59 television rental expense incurred during a hospitalization three years after a motor vehicle accident.

The arbitrator dismissed the claim, finding no evidence of a causal link between the hospitalization and the accident.

The arbitrator also declined to award expenses to the applicant and warned that her multiple mediation applications and threats of small claims actions bordered on an abuse of process, though an assessment fee was not imposed due to an undertaking to cease further actions.

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

He owned a courier service that continued to operate for two months post-accident.

The insurer sought to deduct payments made to the applicant by his business during this period.

The arbitrator found that as the sole proprietor, any money flowing to the applicant from the business qualified as post-accident income under section 15 of the Schedule.

The arbitrator concluded that the applicant received $9,130 in post-accident compensation, of which 80% was deductible from his weekly income benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from her insurer.

The parties disputed the calculation of weekly income benefits for a self-employed farmer, specifically regarding the deduction of ceasing expenses, Canada Pension Plan disability benefits, and post-accident farm income.

The arbitrator determined the appropriate weekly income benefit amounts for 1991-1993.

The arbitrator also reviewed claims for supplementary medical and rehabilitation expenses, granting the cost of an exercise bike, bench, and cane, but denying claims for a hot tub, electric bed, replacement farm labour, and future housekeeping and transportation expenses.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including weekly income benefits, for three years.

The insurer terminated benefits after 156 weeks.

The applicant sought ongoing benefits under section 12(5)(b) of the Schedule, claiming chronic pain and sciatica prevented her from working.

The arbitrator found that surveillance evidence and psychological assessments contradicted the applicant's claims of severe pain and inability to work.

The arbitrator concluded the applicant was exaggerating her symptoms and was physically and psychologically capable of resuming office work.

The claim for ongoing weekly benefits was dismissed, but the applicant was awarded the expenses of the arbitration.

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

The insurer paid a minimum weekly income benefit of $185.60, disputing the applicant's self-reported income as an independent newspaper carrier.

Following an arbitration hearing, the arbitrator determined that independent documentation corroborated the applicant's income, entitling him to the maximum weekly benefit of $600.

The arbitrator also granted a $4,000 special award against the insurer for unreasonably withholding benefits despite possessing independent verification of the applicant's income.

The applicant, an 18-year-old, was severely injured in a motor vehicle accident while driving a stolen vehicle.

He applied for statutory accident benefits from his parents' insurer, Simcoe & Erie, and the insurer of the stolen vehicle, Pilot.

The issue was which insurer was liable to pay the benefits, which depended on whether the applicant was "principally dependent for financial support" on his parents at the time of the accident.

The arbitrator reviewed the applicant's living arrangements and financial support in the years leading up to the accident.

The arbitrator found that the applicant had returned to live with his parents in the months prior to the accident because he had no independent means of support.

Consequently, the applicant was principally dependent on his parents, making Simcoe & Erie liable to pay the statutory accident benefits.

The applicant sought an adjournment of his arbitration hearing regarding weekly benefits.

The applicant and his newly retained counsel had not prepared for the hearing and requested a three-month adjournment.

The arbitrator denied the request, noting the lack of preparation over the 11 months since the application was filed and the failure to show extenuating circumstances.

After the adjournment was denied, the applicant's counsel withdrew, and the unrepresented applicant declined to present evidence.

The arbitrator dismissed the applicant's claim for weekly benefits due to a lack of evidence, but also declined to hear the insurer's claim for repayment of overpaid benefits, directing the insurer to pursue that remedy in court.

The applicant, a 65-year-old retired man, was injured in a motor vehicle accident and received statutory accident benefits for one year.

The insurer terminated weekly benefits, arguing his ongoing disability was due to a pre-existing condition.

The arbitrator found that the applicant's back pain and headaches pre-dated the accident, relying on clinical notes that contradicted the family physician's testimony.

The arbitrator concluded the applicant failed to prove a substantial inability to perform his essential tasks of daily life, as he continued to shop, socialize, and travel as he did before the accident.

The claim for ongoing weekly benefits and a special award was dismissed, but the applicant was awarded expenses.

The deceased was fatally injured in a motor vehicle accident.

Her former common law spouse claimed entitlement to the $25,000 death benefit under the Statutory Accident Benefits Schedule.

The deceased's children disputed his entitlement, arguing the spousal relationship had terminated prior to the accident.

The arbitrator held that under section 224 of the Insurance Act, unmarried parties are only spouses as long as they continue to cohabit.

Since the parties had separated and ceased cohabiting before the accident, the former common law spouse was not a spouse at the time of the accident.

The death benefit was ordered payable to the deceased's children.

The applicant, a high school student injured in a motor vehicle accident, had a legitimate offer for a summer job at the time of the accident.

The insurer paid increased weekly benefits during the summer employment period but reduced them after the job would have ended.

The applicant sought to have the higher benefit rate continue indefinitely.

The arbitrator held that under section 12 of the Statutory Accident Benefits Schedule, the weekly benefit for an insured with a time-limited employment offer is based on the contract of employment only for the expected duration of that employment.

After the summer job period ended, the applicant's benefits were correctly reduced to the statutory minimum of $185.60 per week.

The applicant was awarded expenses due to the novel legal question.

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

At mediation, the parties signed an agreement to be bound by the opinion of an orthopaedic specialist regarding the applicant's ability to work.

The specialist opined that the applicant was substantially unable to perform his essential tasks.

The arbitrator held that the mediation agreement was binding and ordered the insurer to pay weekly benefits in accordance with the specialist's opinion until the date the specialist no longer found the applicant disabled.

The claim for a special award was dismissed.

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

The insurer argued the applicant was barred from arbitration because she filed her application more than two years after the termination.

The arbitrator found that the insurer's initial letter terminating benefits was unclear and did not satisfy the notice requirements under the Statutory Accident Benefits Schedule.

A subsequent letter was clear enough to trigger the limitation period, and the application was filed within two years of that second letter.

The applicant was permitted to proceed to a hearing on the merits.

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

The Insurer refused to pay weekly income benefits.

The Applicant filed for arbitration more than two years after the Insurer's clear refusal to pay.

The arbitrator found that the Insurer's subsequent settlement offers during mediation did not mislead the Applicant or change its position on the refusal.

The application for arbitration was dismissed as being filed out of time, though the Applicant was awarded expenses of the arbitration.