Joyce Miller

The applicant, who was injured in a motor vehicle accident, brought a motion for interim income replacement benefits and an interim special award pending arbitration.

The insurer had terminated his benefits and argued he was unemployed at the time of the accident and failed to request a designated assessment centre evaluation in a timely manner.

The arbitrator dismissed the motion, finding the applicant failed to establish a prima facie case for entitlement to benefits, as there was insufficient objective evidence of his employment at the time of the accident and credibility issues remained to be determined at a full hearing.

The applicant was injured in a motor vehicle accident and applied for an income replacement benefit.

The insurer denied the benefit on the basis that the applicant was not employed at the time of the accident.

The applicant, a seasonal construction worker, had stopped working months prior due to a work-related injury but believed he would be recalled.

The arbitrator found that as a seasonal worker, the applicant had no guarantee of continuous employment and was no longer an employee once he stopped working due to his prior injury.

The arbitrator concluded the applicant was not employed at the time of the accident.

The applicant, who was injured in a motor vehicle accident, brought a motion for interim expenses to pay his accountant to prepare a financial statement for an upcoming arbitration regarding the quantum of his income replacement benefits.

The arbitrator applied the Bernicky criteria and found that while the application raised a bona fide issue, the applicant failed to prove he was unable to carry the expenses until the arbitration hearing, noting he had recently prepaid his brother a $19,000 salary advance.

The motion for interim expenses was dismissed.

The applicant sought accident benefits after allegedly being injured when a public transit bus door closed on his leg as he attempted to board, causing him to fall and strike his head on a pole.

The insurer denied the claim, asserting the applicant ran into the pole while chasing the bus and was not involved in an 'accident' under s. 2(1) of the Statutory Accident Benefits Schedule.

The arbitrator found the applicant's version of events more credible and plausible than the bus driver's contradictory evidence.

The arbitrator concluded the applicant's injuries were a direct result of the normal use and operation of a motor vehicle, satisfying the definition of an accident.

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

The insurer terminated weekly income replacement benefits, arguing the applicant was only entitled to a non-earner benefit.

At a preliminary issue hearing, the insurer argued the applicant had an income continuation benefit plan available to him through his former employer.

The arbitrator found that the applicant did not have collateral benefits available to him because he applied for long-term disability benefits outside the limitation period without any tactical intent to hide information.

Furthermore, the eligibility test under the collateral disability policy was stricter than the test under the Statutory Accident Benefits Schedule.

The applicant was injured when he tripped on a groove in the pavement of a parking lot after unloading groceries from the trunk of his car.

He applied for statutory accident benefits, which the insurer denied on the basis that the incident was not an 'accident' under the Schedule.

The arbitrator found that while the use of the vehicle brought the applicant to the location, the direct cause of the injuries was a new and independent source, namely the cracked pavement.

The claim for accident benefits was dismissed.

The applicant applied for arbitration after the insurer terminated his statutory accident benefits following a motor vehicle accident.

The applicant failed to attend the scheduled arbitration hearing and did not notify the Commission.

The arbitrator dismissed the application due to the applicant's failure to provide evidence to prove his entitlement to benefits.

Finding that the applicant's failure to pursue his claims amounted to an abuse of process, the arbitrator ordered the applicant to pay the insurer's legal expenses and disbursements.

The applicant was injured in a motor vehicle accident and claimed accident benefits.

The parties entered into a settlement agreement, but a dispute arose over the interpretation of a term regarding ongoing payment for a shop assistant and housekeeping expenses.

The arbitrator held that the settlement agreement implicitly required the applicant to demonstrate continuing entitlement to the benefits and to provide reasonable verification of her expenses, rather than providing a 'blank cheque' for life.

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

The insurer disputed the hourly rate claimed for the applicant's counsel and the preparation time claimed for expert witnesses.

The arbitrator held that under the applicable regulation in force at the time the application was filed, the maximum hourly rate for legal fees was restricted to the Legal Aid Act rate of $83.75, and expert preparation time was not recoverable.

The arbitrator awarded the applicant $13,100.73 for legal expenses and $8,889.42 for disbursements.

The Applicant was injured in a motor vehicle accident and received income replacement benefits until they were terminated by the Insurer.

The Applicant sought reinstatement of benefits for a closed period, while the Insurer sought payment of a cancellation fee for a missed psychological assessment.

The Arbitrator found that the Applicant failed to provide cogent medical evidence to prove a substantial inability to perform the essential tasks of his employment, relying instead on a multidisciplinary assessment that concluded he was not disabled.

The Arbitrator also dismissed the Insurer's claim for the cancellation fee, finding that the Applicant was not given sufficient notice of the appointment to comply with the cancellation policy.

The arbitration was dismissed.

The applicant was involved in a motor vehicle accident and applied for education disability benefits.

The insurer denied the claim, and the applicant applied for mediation more than two years after the refusal.

The insurer raised a preliminary issue that the arbitration application was time-barred under s. 281(5) of the Insurance Act and s. 72(1) of the Statutory Accident Benefits Schedule.

The arbitrator found that the insurer provided a clear and unequivocal refusal of benefits and that the applicant understood the refusal.

The arbitrator held that the applicant was precluded from proceeding to arbitration because the limitation period had expired.

The applicant sought statutory accident benefits following a minor motor vehicle accident.

The insurer terminated weekly income replacement and medical benefits, and sought repayment of an overpayment.

The arbitrator found that the applicant's severe headaches were not caused by the accident, but were related to a pre-existing chronic pain condition.

Furthermore, the applicant was not substantially disabled from performing the essential tasks of her employment as a travel agent.

The arbitrator dismissed the claims for benefits and a special award, and ordered the applicant to repay $20,166.25 in overpaid income replacement benefits because her tax returns showed higher employment income than she had reported to the insurer.

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

The insurer terminated his medical rehabilitation benefits based on a Designated Assessment Centre report and the discharge report of his own chiropractor.

The applicant sought payment for ongoing chiropractic treatments, a special award, and arbitration expenses.

The arbitrator dismissed the claim for medical expenses, finding the applicant failed to provide objective medical evidence that the ongoing treatment was reasonable and necessary.

The claim for a special award was also dismissed as the insurer's denial was not unreasonable.

However, the arbitrator awarded the applicant his arbitration expenses, concluding that his claim was legitimate, presented in a timely manner, and not frivolous.

The applicant was largely unsuccessful in her claim for statutory accident benefits, being awarded only a small amount for transportation expenses.

Both parties sought their expenses for the arbitration proceeding.

The arbitrator held that the new expense regulation did not restrict the discretion to award expenses to an unsuccessful applicant, as the system is designed to facilitate access to dispute resolution.

Finding that the applicant had a legitimate claim and did not unreasonably prolong the proceedings, the arbitrator awarded the applicant her expenses and denied the insurer's claim for expenses, noting that the insurer's offer to settle was a full and final offer rather than one limited to the issues in arbitration.

The applicant, who was six years old at the time of the motor vehicle accident, sought various statutory accident benefits including an education disability benefit, medical and rehabilitation expenses, transportation expenses, and attendant care.

The arbitrator found no objective medical evidence supporting the claims for education disability, prescription drugs, chiropractic care, rehabilitation, or attendant care, noting the applicant did not miss school and his physical activities were not limited.

The applicant was awarded transportation expenses for only two visits to his family doctor.

The arbitrator denied the applicant's request for arbitration expenses, finding the application frivolous and an abuse of process.

The applicant sought to withdraw his application for arbitration regarding statutory accident benefits shortly before the second scheduled hearing date.

The insurer argued that the applicant had abused the process by failing to provide requested productions, forcing an adjournment, and withdrawing without explanation.

The arbitrator allowed the withdrawal but found the applicant's conduct amounted to an abuse of process.

Pursuant to section 282(11.2) of the Insurance Act and Rule 67.3(c) of the Dispute Resolution Practice Code, the applicant was ordered to pay the insurer's $3,000 assessment fee.

The applicant was injured in a minor motor vehicle accident and sought caregiver benefits under the Statutory Accident Benefits Schedule.

The insurer terminated weekly caregiver benefits, and the applicant applied for arbitration.

The arbitrator found that the applicant's testimony regarding her inability to perform caregiver duties was contradicted by statements she made to various medical assessors.

Relying on independent medical examinations which found no musculoskeletal impairment and noted symptom magnification, the arbitrator concluded the applicant failed to prove a substantial inability to engage in her pre-accident caregiving activities.

The arbitrator also found that any psychological issues were more likely related to pre-existing family stressors rather than the minor accident.

The arbitration was dismissed.

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

He previously commenced a court action to enforce a settlement agreement regarding medical rehabilitation benefits.

He subsequently applied for arbitration for new medical and rehabilitation benefits arising from later surgeries.

The insurer brought a preliminary motion to dismiss the arbitration, arguing the applicant was bound to the court forum under s. 282(3) of the Insurance Act.

The arbitrator dismissed the motion, finding that the issue in the arbitration was distinct from the court claim, and the applicant was entitled to proceed with the arbitration.

The applicant was struck by a slow-moving vehicle while walking in a parking lot and claimed ongoing income replacement benefits for chronic pain.

The insurer terminated benefits based on an independent medical examination finding no objective injury.

At arbitration, the arbitrator found the applicant's subjective complaints of disabling pain were not credible, noting inconsistencies in her testimony regarding child care, her refusal of recommended treatments, and surveillance video showing her walking briskly and moving freely.

The arbitrator concluded the applicant failed to prove she was substantially disabled from performing the essential tasks of her employment and dismissed the claim.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, including non-earner, attendant care, and housekeeping benefits.

The arbitrator dismissed the claims for non-earner, attendant care, and housekeeping benefits, finding that the applicant did not suffer a complete inability to carry on a normal life, as evidenced by video surveillance and her own statements.

The arbitrator also found no evidence that the applicant incurred expenses for care provided by her daughter.

The applicant was awarded $15.53 for transportation expenses to medical appointments.