James Robinson

The applicant was involved in two motor vehicle accidents and sought statutory accident benefits.

The arbitrator found that the applicant suffered a catastrophic impairment as a result of the second accident, primarily due to psychiatric impairments including major depressive disorder, which resulted in a marked impairment in work adaptation.

The claims for attendant care and housekeeping benefits were dismissed as statute-barred because the applicant failed to provide timely notice and an assessment of attendant care needs prior to mediation.

Various medical and rehabilitation benefits were found to be reasonable and necessary and were awarded.

The claim for a special award was dismissed as the insurer acted reasonably in adjudicating the complex claims.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs).

The insurer denied ongoing IRBs, arguing that the applicant's impairments were due to pre-existing depression or a subsequent head injury caused by a falling Jacuzzi motor.

The arbitrator rejected the insurer's arguments, accepting expert evidence that the applicant suffered from post-traumatic stress disorder and a concussive injury directly resulting from the accident.

The arbitrator found the applicant completely unable to engage in any employment for which she was reasonably suited, entitling her to ongoing IRBs.

The claim for a special award was dismissed as the insurer had genuine issues to try.

The minor applicants were severely injured in a motor vehicle accident and required attendant care from their mother.

The parties agreed on the quantum of attendant care benefits but disputed whether the expenses were 'incurred' under s. 3(7)(e)(iii)B of the Statutory Accident Benefits Schedule.

The arbitrator found that the mother sustained an economic loss because she had to forego a cooperative job placement as a medical records administrator and accept a less remunerative placement to care for her children, while also facing the burden of repaying her student loans.

The arbitrator concluded the attendant care claims were incurred and ordered the insurer to pay the agreed amounts.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit and various medical and rehabilitation benefits from her insurer.

The arbitrator dismissed the claim for a non-earner benefit, finding that the applicant's pre-existing fibromyalgia and medical history contradicted her assertion that she suffered a complete inability to carry on a normal life as a result of the accident.

However, the arbitrator awarded several medical benefits, including palliative treatments, household aids, and a stair lift, finding them reasonable and necessary to address the pain and difficulties caused by the accident.

Claims for a vibration machine and an assistive bed were denied.

The applicant was awarded $30,000 in expenses.

The applicant was injured in a motor vehicle accident and sought attendant care benefits and the cost of an in-home assessment from her insurer.

The insurer denied both claims in 2012.

The applicant filed for mediation in October 2014, more than two years after the denials.

The insurer raised a preliminary issue that the claims were statute-barred under subsection 56(1) of the Statutory Accident Benefits Schedule.

The arbitrator applied the objective test from Turner, finding that the insurer's notices of refusal were clear and unequivocal, and that subsequent communications did not create an estoppel or waiver.

The arbitrator concluded that the application was statute-barred and dismissed the claims, awarding expenses to the insurer.

The Applicant sought expenses following a successful arbitration for statutory accident benefits.

The arbitrator awarded $139,851.68 in expenses, applying the Dispute Resolution Practice Code and Expense Regulation to cap certain expert disbursements and applying a 4:1 preparation-to-hearing ratio for legal fees.

The arbitrator also held that he lacked jurisdiction to reopen the hearing to address the calculation of interest, as the previous arbitrator was functus officio after issuing the final order.

The applicant was injured in a motorcycle accident while driving his uninsured motorcycle.

He later sought statutory accident benefits under his automobile policy with the respondent insurer.

The insurer raised preliminary issues arguing the applicant was precluded from arbitration because there was no Report of Mediator and because he failed to notify the insurer and submit an application within the prescribed time limits.

The Arbitrator found that the absence of a Mediator's Report did not preclude arbitration, as the 60-day period for mediation had expired.

The Arbitrator also found that the applicant had a reasonable explanation for the delay in applying for benefits, given his brain injury and reliance on an unresponsive neurologist.

The preliminary issues were resolved in favour of the applicant.

The applicant sought weekly caregiver benefits following a 2009 motor vehicle accident.

The insurer terminated benefits without requesting a Disability Certificate under s. 37(1) of the Schedule.

The arbitrator applied the Court of Appeal's decision in Stranges, holding that the insurer's procedural failure did not relieve the applicant of her burden to prove entitlement.

The arbitrator found the applicant's evidence lacked credibility, noting she had submitted fraudulent expense reports bearing a forged signature of her cousin, and gave inconsistent testimony regarding her living arrangements, education, and work experience.

The applicant's medical reports were outweighed by the credible testimony of her cousin, who observed the applicant functioning normally shortly after the accident.

The application was dismissed, and the applicant was ordered to pay the insurer's arbitration expenses.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After failing to resolve disputes through mediation, the applicant applied for arbitration.

The applicant failed to make required documentary production, his representative was removed from the record, and he failed to attend the arbitration hearing.

The arbitrator found the applicant had abandoned his application and dismissed the claims in their entirety.

The applicant was ordered to pay $1,000 in expenses to the insurer.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After failing to make documentary production and his representative removing himself from the record, the applicant failed to attend the arbitration hearing.

The arbitrator found the applicant had abandoned his application and dismissed the claims in their entirety.

The applicant was ordered to pay the insurer's expenses fixed at $1,000.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After failing to attend pre-hearings, failing to make documentary production, and having his representative removed from the record, the applicant failed to attend the arbitration hearing.

The arbitrator found that the applicant had abandoned his application and dismissed the claims in their entirety.

The applicant was ordered to pay the respondent's expenses of the arbitration, fixed at $1,500.00, due to the considerable inconvenience and needless expense caused by his failure to participate.

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment, non-earner benefits, attendant care, housekeeping, and medical benefits.

The arbitrator found that the applicant failed to prove catastrophic impairment, noting evidence of sub-maximal effort and malingering on psychological tests, and surveillance contradicting physical impairment claims.

The claim for non-earner benefits was dismissed because the applicant was already completely unable to carry on a normal life prior to the accident due to a pre-existing major depressive disorder.

However, the arbitrator awarded attendant care, housekeeping, and certain medical benefits for the first 12 months post-accident, finding them reasonable and necessary for that limited period.

Claims for a special award were dismissed.

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

After the applicant withdrew his application, the insurer sought its expenses for the arbitration proceeding.

The arbitrator awarded the insurer its expenses fixed at $1,292.72, finding the quantum reasonable and proportionate to the degree of success and complexity of the matter.

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

After the insurer terminated benefits, the applicant applied for arbitration.

The applicant failed to attend the pre-hearing, failed to comply with production orders, and failed to attend the arbitration hearing.

The arbitrator found that the applicant had abandoned his claim and dismissed the application in its entirety.

The applicant was ordered to pay $2,260 in costs to the insurer.

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

After the insurer terminated benefits, the applicant applied for arbitration.

However, the applicant failed to attend the pre-hearing, failed to comply with production orders, and failed to attend the arbitration hearing.

The applicant's former counsel had removed himself from the record, and mail to the applicant was returned as undeliverable.

The arbitrator found that the applicant had abandoned his claim, dismissed the application in its entirety, and ordered the applicant to pay $2,260.00 in expenses to the insurer.

The applicant was injured when struck by a piece of airborne scrap metal while waiting in his truck.

He applied for statutory accident benefits.

The insurer initially investigated whether the incident met the definition of an 'accident' under the Schedule.

After several months, the insurer issued an OCF-9 stating its investigation was complete and it was accepting the claim.

A year later, the insurer attempted to terminate benefits, arguing the incident was not an accident.

The arbitrator held that the insurer had expressly and unequivocally waived its right to dispute the 'accident' issue when it confirmed the completion of its investigation and accepted the claim.

The parties settled the applicant's claim for statutory accident benefits prior to the arbitration hearing, leaving only the issue of expenses to be determined.

The applicant sought $25,228.49 in fees and disbursements.

The arbitrator found that the applicant was entitled to expenses, but reduced the claimed amounts, noting that the matter was not complex and that certain disbursements for web-based document services were not recoverable.

The arbitrator fixed the applicant's expenses at $12,250.00, inclusive of fees, disbursements, and taxes.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, attendant care, and housekeeping benefits.

The arbitrator found the applicant's testimony lacked credibility due to inconsistencies and failure to disclose a subsequent accident to medical assessors.

However, relying on objective medical evidence, the arbitrator concluded the applicant suffered a substantial inability to perform his pre-accident employment as a cleaner for the first 104 weeks.

The applicant did not meet the complete inability test for the period after 104 weeks.

The arbitrator awarded income replacement benefits for the initial period, subject to deductions for post-accident earnings, and granted attendant care and housekeeping benefits for a limited period.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $25,000 for surgery in the United States.

The insurer denied the claim and raised a preliminary issue that the application for arbitration was statute-barred under section 281.1 of the Insurance Act, as it was commenced more than two years after the denial.

The applicant argued that a letter sent to the Commission requesting to add the issue to a previous arbitration satisfied the limitation period or that the insurer waived the limitation period.

The Arbitrator found that the letter did not constitute a valid application for arbitration and that the insurer did not consent to adding the issue or waive the limitation period.

The claim was held to be statute-barred and the application for arbitration was dismissed.

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

The applicant failed to attend the arbitration hearing or provide particulars of her claims.

The insurer presented an engineering report concluding that the vehicles involved never made contact and the damage was inconsistent with the reported collision.

The arbitrator found that the accident was staged and dismissed the application in its entirety, ordering the applicant to pay the insurer's arbitration expenses.