Joyce Miller

The applicant was injured in a motor vehicle accident while a passenger in a vehicle insured by Allstate.

He applied for statutory accident benefits from Allstate, which refused payment on the basis that he was a dependant of his mother and should claim from her insurer, General Accident.

The arbitrator held a preliminary issue hearing to determine priority.

Finding that the applicant operated a cash business and was not principally dependent for financial support on his mother, the arbitrator concluded he was not a dependant.

Allstate was ordered to pay the benefits.

The applicant was denied his expenses due to his misrepresentations regarding his employment and income.

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

The insurer refused to pay, and the parties attended mediation in 1991, reaching an agreement for a limited period of benefits.

The applicant later applied for arbitration for ongoing benefits.

The insurer raised preliminary issues, arguing the 1991 mediation resulted in a full and final settlement, or alternatively, that the applicant missed the two-year limitation period under s. 281(5) of the Insurance Act following a clear denial.

The arbitrator found that the mediation agreement did not constitute a full and final settlement.

Furthermore, the insurer's subsequent correspondence to the applicant's legal representative did not constitute clear and unequivocal notice of termination to the applicant himself.

Therefore, the applicant was not barred from proceeding to arbitration.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on an orthopaedic assessment.

The applicant sought continued benefits under section 7 of the Statutory Accident Benefits Schedule, claiming a lower back injury prevented him from working.

The arbitrator found that the applicant's lower back problems were a recurrence of a pre-existing condition and not caused by the accident, dismissing the section 7 claim.

However, the arbitrator found that the insurer was required to pay benefits under section 64 of the Schedule from the date the applicant provided a signed medical release form until the date he was notified of the negative Designated Assessment Centre report.

The applicant sought weekly income benefits following a motor vehicle accident.

The insurer terminated benefits after approximately two and a half years, arguing her ongoing physical complaints were due to a pre-existing condition rather than the accident.

The arbitrator found the applicant lacked credibility, noting she deliberately misrepresented her extensive pre-accident medical history and the severity of her initial injuries to various medical practitioners.

Relying on the insurer's physiatrist, the arbitrator concluded the applicant's pain magnification was conscious and deliberate, and that she failed to establish a causal connection between the minor accident and her alleged disability.

The application for benefits and expenses was dismissed.

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

The Insurer reduced and later terminated his weekly income benefits, alleging an overpayment.

The Applicant sought arbitration, claiming his benefits should be based on a $2,400 cash contract he allegedly performed in the four weeks prior to the accident.

The arbitrator found the Applicant lacked credibility and failed to provide objective evidence of the alleged contract or earnings.

The arbitrator concluded the Applicant fabricated the contract to inflate his benefits, set the weekly income benefit at the minimum rate of $185.60, and denied the Applicant his expenses.

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

The applicant applied for arbitration, claiming ongoing entitlement under section 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant suffered from chronic pain syndrome resulting from the accident, which continuously prevented him from engaging in any employment for which he was reasonably suited by education, training, or experience, including the alternative position of a service advisor.

The arbitrator ordered the insurer to pay weekly income benefits from the date of termination, along with interest and arbitration expenses.

The applicant was injured in a motor vehicle accident in Ontario while driving a Quebec-registered vehicle.

He applied for statutory accident benefits in Ontario.

The insurer denied benefits, arguing the applicant was a resident of Quebec and must apply to the SAAQ.

On a preliminary issue, the arbitrator held that the applicant's place of residence was not determinative of his entitlement to benefits under the Ontario Schedule, as section 45(1) of the Insurance Act allows non-residents involved in accidents in Ontario to claim benefits in Ontario.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied transportation expenses because the applicant paid a friend to drive him, and paid only the minimum weekly income benefits, arguing the applicant lacked sufficient financial records.

The arbitrator ordered the insurer to pay the transportation expenses, finding them reasonable and required.

The arbitrator also ordered the insurer to pay weekly income benefits based on the applicant's trip sheets, finding them to be the best evidence of income for a cash business, resulting in an award for the underpaid amount.

The Arbitrator issued a correction to a previous decision dated November 24, 1995.

The correction amended references to a cited case, Polus, to correctly identify the arbitrator as Arbitrator Seife instead of Arbitrator Palmer, and to change the corresponding pronouns from female to male.

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

The applicant applied for arbitration but failed to attend a scheduled independent medical examination (IME).

The insurer brought a motion to stay the arbitration hearing.

The arbitrator held that under sections 23(2) and 25 of the Statutory Accident Benefits Schedule, an applicant cannot proceed with the dispute resolution process unless they make themselves reasonably available for a medical examination.

The motion was granted, and the applicant was precluded from proceeding with the arbitration until she makes herself available for the IME.

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

After mediation failed, the applicant applied for arbitration but subsequently failed to provide required medical and financial documentation, lost contact with his representative, and did not attend the hearing.

The arbitrator dismissed the claims for failure to prove entitlement and found the applicant's conduct constituted an abuse of process.

The applicant was ordered to pay $2,000 to each insurer for their assessment fees pursuant to section 282(11.2) of the Insurance Act.

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

The insurer terminated weekly benefits and sought repayment, arguing the applicant drove without the owner's consent.

The arbitrator found the applicant was not entitled to further weekly income or care benefits as he was unemployed and able to perform his essential tasks.

However, the insurer's claim for repayment was dismissed because it failed to prove the applicant knew or ought to have known he was driving without consent.

The applicant was awarded his filing fee as expenses.

The applicant sought statutory accident benefits for herself as a common-law spouse and for her two children as dependants following the death of her former husband in a motor vehicle accident.

The insurer denied the claims.

The arbitrator found that the applicant and the deceased had divorced and were not cohabiting in an integrated spousal relationship at the time of the accident.

The arbitrator also found that the children were not principally dependent for financial support on the deceased.

The claims for death benefits were dismissed.

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

The Insurer terminated benefits after the Applicant returned to work full-time for over 90 days following the two-year anniversary of the accident, relying on section 16(2) of the Statutory Accident Benefits Schedule.

On a preliminary issue, the Arbitrator found that while the Applicant had worked for a continuous period of 90 days, section 16(2) does not automatically preclude a claim for further benefits.

Instead, it shifts the onus to the Applicant to re-establish the causal link between the accident and the disability.

The preliminary objection was dismissed.

The Applicant was injured in a motor vehicle accident on March 8, 1993, and received statutory accident benefits until March 26, 1993.

She applied for arbitration seeking ongoing weekly benefits under section 13 of the Schedule.

The arbitrator found that the Applicant's chronic pain and inability to perform essential tasks were caused by a prior accident in 1989 and pre-existing degenerative disc disease, not the 1993 accident.

The application for ongoing weekly benefits was dismissed, but the Applicant was awarded her expenses.

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

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

The arbitrator found the applicant's testimony regarding her pre-accident health and essential tasks to be unreliable.

Relying on objective medical evidence and reports from rehabilitation facilities, the arbitrator concluded that the applicant was no longer substantially disabled from performing her essential tasks as a homemaker when her benefits were terminated.

The claim for ongoing weekly benefits was dismissed, while a claim for gas expenses was settled during the hearing.

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

She applied for arbitration seeking ongoing weekly benefits under sections 13(1) and 13(8) of the Schedule.

The arbitrator found the applicant was not a credible witness, noting inconsistencies in her testimony and surveillance evidence showing her performing physical activities with relative ease.

The arbitrator concluded the applicant did not suffer a substantial inability to perform her essential tasks and dismissed the claim for weekly benefits, but awarded the applicant her arbitration expenses.

The applicant sought statutory accident benefits, including weekly benefits and housekeeping and care benefits, following a motor vehicle accident.

The arbitrator dismissed all claims, finding the applicant and her witnesses lacked credibility.

Surveillance evidence and testimony from an insurance broker contradicted the applicant's claims of severe disability.

The arbitrator concluded the claim was fraudulent and denied the applicant's request for a special award and expenses.

The applicant was injured in a motor vehicle accident and received statutory accident benefits under section 13 of the Schedule until October 1993.

He applied for arbitration seeking further weekly benefits under section 12 or 13, and a special award.

The arbitrator found that the applicant was not entitled to section 12 income benefits because he was not self-employed at the time of the accident, having ceased his freelance editing business after his wife's death.

The arbitrator also denied further section 13 benefits, finding that medical evidence, including from the applicant's own doctors, established he was capable of performing the essential tasks of daily living by October 1993.

The claim for a special award was dismissed as the insurer did not act unreasonably in failing to provide a computer and chair.

The applicant was awarded expenses.