Joyce Miller

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.

Following the dismissal of the applicant's arbitration for statutory accident benefits, the insurer sought an assessment of its expenses.

The arbitrator awarded the insurer legal fees for 36 hours of preparation and attendance, along with reasonable disbursements.

The insurer's claim for a $3,000 assessment fee under subsection 282(11.2) of the Insurance Act was denied because it was not raised during the arbitration hearing.

The insurer was also denied the costs of the expense assessment itself, as the applicant successfully disputed the assessment fee claim.

The applicant was successful in an arbitration for statutory accident benefits and was awarded her expenses.

In this expense assessment, the arbitrator determined the quantum of legal fees and disbursements payable by the insurer.

The arbitrator allowed a 3:1 ratio for preparation to hearing time, resulting in 260 hours for lead counsel.

The arbitrator also awarded an enhanced hourly rate of $150, noting that the insurer had unreasonably refused a settlement offer.

Additional fees were awarded for previous counsel, an articling student, and law clerks, along with disbursements including expert witness fees and court reporting services.

The applicant was injured in a motor vehicle accident and received caregiver benefits from the insurer until they were terminated.

The applicant applied for arbitration more than two years after receiving the notice of termination.

The arbitrator found that the notice of termination was clear and unequivocal, and there was no evidence that the insurer was estopped from relying on the limitation period.

The arbitrator held that she had no jurisdiction to extend the time limits or grant relief from forfeiture.

The application for arbitration was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident and received weekly income benefits for five years before the insurer terminated them.

The applicant sought ongoing benefits under subsection 12(5) of the Statutory Accident Benefits Schedule, claiming she was continuously prevented from engaging in any suitable employment due to a psychological disability.

The arbitrator found the applicant credible and rejected the insurer's argument, based on video surveillance and one psychiatric opinion, that she was feigning her disability.

The arbitrator concluded the accident significantly contributed to her post-traumatic stress disorder and major depression, rendering her totally disabled.

The arbitrator also fixed the weekly benefit amount at $311.66 based on the insurer's own accountant's report, and dismissed the insurer's claims for repayment and post-accident income deductions.

The insured was injured in a motor vehicle accident while driving a rented van.

He initially applied for accident benefits from the van's insurer, which denied the claim.

He then applied to his wife's insurer, State Farm, which also denied the claim.

State Farm brought a preliminary issue motion to dismiss the arbitration as an abuse of process and a multiplicity of proceedings, arguing the insured was obligated to pursue the first insurer.

The arbitrator dismissed the motion, finding no legal basis to bar the insured from applying to State Farm, and noting that any priority dispute should be resolved between the insurers under O. Reg. 283/95.

The insured was awarded his expenses for the preliminary hearing.

The applicant, a child care provider, was injured in a rear-end motor vehicle accident and claimed statutory accident benefits.

The insurer terminated her weekly income replacement benefits on multiple occasions.

The arbitrator found the applicant credible and accepted medical evidence that she developed chronic pain syndrome as a result of the accident, rendering her substantially disabled from performing the essential tasks of her employment.

The arbitrator ordered the insurer to pay income replacement benefits for the disputed periods and ongoing.

Additionally, the arbitrator found the insurer acted unreasonably in prematurely terminating benefits and awarded a special award of $3,500, along with interest and arbitration expenses.

The applicant sought interim income replacement benefits, a Loss of Earning Capacity offer, and a special award following a motor vehicle accident.

The insurer had terminated benefits after the applicant was convicted of driving without insurance.

Although the applicant's conviction was stayed pending an arbitration to determine if he had a valid insurance policy with another insurer, the arbitrator found that the stay alone did not entitle him to interim benefits.

The arbitrator concluded that the exclusion clause for driving without insurance remained applicable until the appeal of the conviction was concluded.

The motion for interim benefits and other relief was dismissed.

The Applicant was injured in a motor vehicle accident while on an unpaid vacation from his employment.

The parties disputed the correct method for calculating his weekly income benefit under subsection 12(7) of the Statutory Accident Benefits Schedule.

The Applicant argued for the Scavuzzo method, which would only average the weeks he actually earned income, resulting in $600 per week.

The Insurer argued for the Vo method, which averages income over the entire four-week period preceding the accident, including the unpaid vacation weeks, resulting in $468 per week.

The Arbitrator held that she was bound by the Director of Arbitration's appeal decision in Vo, and concluded that the Applicant's weekly income benefit is $468.

The applicant sought an assessment of expenses following the settlement of an arbitration for statutory accident benefits.

The arbitrator assessed legal fees and disbursements, applying the Legal Aid Tariff rate.

The arbitrator held there was no jurisdiction to award interest or a special award on arbitration expenses, as the relevant statutory provisions apply only to the payment of benefits.

The arbitrator also held that an expense assessment is an integral part of the arbitration process and awarded the applicant expenses for the assessment hearing itself.

The applicant was involved in a motor vehicle accident and subsequently applied for income replacement benefits, claiming she was substantially disabled from her employment as a waitress due to a liver ailment, abdominal pain, and a soft tissue injury.

The insurer denied the claim.

At arbitration, the arbitrator found that the applicant failed to present reliable, objective medical evidence linking her liver fistula or abdominal pain to the accident, or proving that any soft tissue injury substantially disabled her from working.

The claim for income replacement benefits was dismissed.

Furthermore, the arbitrator exercised her discretion under section 282(11) of the Insurance Act to deny the applicant her arbitration expenses and ordered her to pay the insurer's expenses, finding the claim lacked merit and abused the arbitration process, though the insurer was denied expenses for one day due to unnecessarily prolonging the proceeding.

The applicant was injured in a motor vehicle accident while riding his bicycle and subsequently claimed income replacement benefits.

The insurer terminated these benefits based on a Designated Assessment Centre report.

The arbitrator found that the applicant was substantially disabled from performing the essential tasks of his pre-accident employment, which included multiple labour-intensive part-time jobs.

The arbitrator preferred the evidence of the applicant's medical experts over the insurer's assessors.

Furthermore, the arbitrator awarded a $5,000 special award, finding that the insurer acted unreasonably by ignoring additional medical evidence that supported the applicant's claim.

The applicant sought ongoing weekly income benefits and medical-rehabilitation expenses following a 1991 motor vehicle accident.

The insurer had terminated benefits in 1995 and sought repayment of overpaid amounts.

The arbitrator found that the applicant, with the assistance of his doctor, had shifted responsibility for a pre-existing back condition to the minor 1991 accident.

Video surveillance demonstrated the applicant engaging in vigorous exercise inconsistent with his claimed disability.

The arbitrator dismissed the claims for ongoing benefits and expenses, determined the correct quantum of weekly benefits based on pre-accident income, and ordered the applicant to repay $66,967.56 in overpaid benefits plus interest, finding he had deliberately misled the insurer.

The applicants were injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them.

More than two years later, the applicants applied for mediation and subsequently arbitration.

The insurer argued the application was barred by the two-year limitation period under section 281(5) of the Insurance Act.

The applicants argued for a 'rolling limitation period' based on prior case law.

The arbitrator held that she was bound by a Director's Delegate decision which rejected the rolling limitation period, and therefore dismissed the application for arbitration as out of time.

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

The Insurer terminated income replacement benefits on the basis that the Applicant was a resident of Ontario at the time of the accident but only held a Quebec driver's licence, and was therefore not authorized by law to drive under section 32 of the Highway Traffic Act.

The Arbitrator found that the Insurer presented substantial objective evidence proving the Applicant had been a resident of Ontario since 1993.

The Applicant's evidence to the contrary was found not credible.

Consequently, the Applicant was precluded from receiving income replacement benefits pursuant to section 58(1)(d) of the Schedule.

Despite this, the Arbitrator awarded the Applicant two-thirds of his arbitration expenses because the Insurer unnecessarily prolonged the hearing.

The applicant, a taxi driver, was stabbed by a passenger while waiting to be paid his fare.

He applied for statutory accident benefits, but the insurer denied the claim on the basis that the injuries were not caused by an 'accident' as defined in the Schedule.

The arbitrator applied the two-part test from Amos and found that the applicant was engaged in the ordinary use and operation of a motor vehicle at the time of the assault, and that there was a direct causal link between the use and operation of the taxi cab and the injuries.

The arbitrator concluded that the applicant was injured as a result of an accident and is entitled to proceed to arbitration.

The applicant, whose common-law spouse died in a motor vehicle accident, applied for arbitration claiming interest on a $10,000 dependent death benefit paid by the insurer.

The applicant argued interest should run from her initial April 1994 application for spousal death benefits, while the insurer maintained it only received the application for dependent benefits in March 1995.

The arbitrator found the initial application did not claim dependent benefits and the insurer paid interest for the correct period.

The claims for further interest and a special award were dismissed, but the applicant was awarded her expenses.

The applicant was injured in a motor vehicle accident and received income replacement benefits, which were later terminated.

In a previous decision, the arbitrator found the applicant entitled to benefits for a specific period.

The issue in this hearing was the quantum of those benefits, specifically whether sick leave benefits received by the applicant should be deducted.

The arbitrator held that under section 75(2)(b) of the Statutory Accident Benefits Schedule, only 'available' but unreceived sick leave benefits are exempt from deduction.

Since the applicant had actually received the sick leave benefits, they were properly deducted, resulting in an award of $376.76 per week.

Following an arbitration decision awarding weekly income benefits to the applicant, the arbitrator considered whether the insurer was liable for a special award under s. 282(10) of the Insurance Act.

The arbitrator found that the insurer acted unreasonably and in bad faith by terminating the applicant's benefits based on a flimsy excuse and ignoring substantial medical evidence of her disability.

The insurer was ordered to pay a special award of $7,500 plus interest.

The applicant was seriously injured in a motor vehicle accident and received statutory accident benefits.

The insurer terminated her weekly income benefits after 156 weeks, arguing she was capable of returning to work.

The arbitrator found that the applicant suffered from chronic pain syndrome as a result of the accident and was continuously prevented from engaging in suitable employment.

The arbitrator ordered the insurer to pay ongoing weekly income benefits, denied the insurer's claim for repayment of an overpayment caused by its own error, and allowed the deduction of 80% of the applicant's actual post-accident earnings, but rejected the deduction of potential future income.