John Friendly

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

The insurer initially denied the claim on the basis that the applicant was receiving workers' compensation benefits.

When the workers' compensation benefits ended, the applicant submitted a revised claim, which the insurer subsequently denied on the merits.

The insurer argued the application for arbitration was barred by the two-year limitation period running from the initial denial.

The arbitrator held that the initial denial was conditional and only barred the claim for the period prior to the end of the workers' compensation benefits.

The claim for benefits after that date was subject to a new limitation period running from the second denial, and could therefore proceed.

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

Following a pre-hearing discussion, the lawyers for the parties negotiated a settlement.

The Insurer sent a release and disclosure notice to the Applicant's lawyer, but the Applicant never signed the release.

The Insurer argued a binding settlement was reached.

The Arbitrator held that under the Settlement Regulation, a binding settlement requires the insured to confirm acceptance after receiving the mandatory disclosure notice.

Since the Applicant did not sign the release or otherwise confirm acceptance, and later communicated her rejection, no binding settlement was entered into.

The Applicant was permitted to proceed to arbitration.

The applicant sought to rescind a settlement agreement for statutory accident benefits two days after signing it, despite having signed a waiver of the two-day cooling-off period under the Settlement Regulation.

The arbitrator held that the Settlement Regulation is consumer protection legislation and there is an implied prohibition against contracting out of its provisions.

The settlement was properly rescinded.

The arbitrator declined to order immediate repayment of the $15,000 settlement funds, leaving that for the hearing arbitrator, but ordered the applicant to pay the insurer's $2,000 assessment fee as a condition of continuing the arbitration due to his failure to attempt to return the funds.

The applicants, parents of a man fatally injured in a motor vehicle accident, claimed death benefits from the insurer.

The insurer denied the claim, arguing it was incomplete and submitted late under subsection 59(3) of the Statutory Accident Benefits Schedule.

The arbitrator found that the application submitted by the applicants' former solicitor did not sufficiently indicate a claim for death benefits, but rather focused on funeral expenses and a Family Law Act claim.

As the applicants did not argue a reasonable excuse for the delay, the insurer was entitled to rely on subsection 59(3) to deny the claim.

The applicants were awarded their expenses for the hearing.