K. Julaine Palmer

The applicant, a taxi driver, was injured in a motor vehicle accident and received weekly income benefits for approximately one year.

He disputed the insurer's termination of benefits, claiming a substantial inability to perform the essential tasks of his occupation due to reduced working hours, and later claiming he was continuously prevented from engaging in any suitable occupation.

The arbitrator found the applicant's self-reported post-accident income records lacked credibility, particularly when contradicted by surveillance evidence showing he worked longer hours and took more fares than recorded.

The arbitrator concluded the applicant was capable of working 12-hour shifts and did not suffer a substantial inability, except for a brief period following sinus surgery.

The claim for ongoing benefits was dismissed as the temporary disability did not meet the continuity requirement.

The applicant sought an assessment of legal and agent's fees following the settlement of a dispute over statutory accident benefits.

The insurer disputed the amount of time claimed by the applicant's legal assistants and lawyer.

The arbitrator adopted a global approach to assessing the fees, finding that the time claimed was excessive for the single issue involved.

The insurer was ordered to pay $1,819 in fees and GST.

The applicant was injured in a motor vehicle accident while riding a transit bus.

She applied for statutory accident benefits, including caregiver benefits, medical benefits (physiotherapy, back support, taxi expenses), and housekeeping expenses.

The insurer denied the claims.

At arbitration, the arbitrator dismissed the claims for caregiver and housekeeping benefits, finding the applicant did not suffer a substantial inability to perform those activities.

The claims for the back support and taxi expenses were dismissed for lack of evidence.

However, the arbitrator awarded $3,172.50 for physiotherapy and massage therapy services incurred shortly after the accident, noting the insurer's obligation to pay for early treatment under section 38(16) of the Schedule.

Each party was ordered to bear its own expenses.

The applicant was injured in a motor vehicle accident and received income replacement benefits until returning to heavy physical work.

Ten months later, he stopped working due to back pain and sought reinstatement of benefits, claiming the disability resulted from the accident.

The insurer denied the claim, arguing the new disability was a work-related repetitive strain injury.

The arbitrator agreed with the insurer on causation, dismissing the claim for income replacement benefits.

However, because the insurer unilaterally terminated payment for medical and rehabilitation treatments without following the mandatory dispute resolution procedures under the Statutory Accident Benefits Schedule, the arbitrator ordered the insurer to pay for those treatments up to the date it formally notified the providers of the negative assessment results, plus a 25% special award for unreasonable withholding.

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

The parties disputed the calculation of income replacement benefits, loss of earning capacity benefits, and attendant care benefits.

The arbitrator found that the applicant, a seasonal truck driver, was entitled to extrapolate his income under section 9(7) of the Schedule because he was on a layoff from employment during the winter months.

The arbitrator also determined the applicant's pre-accident earning capacity based on a vocational evaluation, awarded additional attendant care benefits, and granted a 25% special award against the insurer for unreasonably reducing the attendant care benefits without a proper basis.

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

The insurer terminated his income replacement benefits (IRBs) based on a Designated Assessment Centre report.

The applicant sought IRBs for the period before he returned to work, for days missed after returning to work, and reimbursement for chiropractic expenses.

The arbitrator found the applicant was not entitled to IRBs for the period before returning to work, but was entitled to five days of IRBs for days missed after returning.

The arbitrator also ordered the insurer to recalculate the IRB amount and pay for chiropractic treatments incurred before a subsequent DAC assessment.

A special award of 30% was granted against the insurer for unreasonably withholding payment of the chiropractic expenses.

The applicant, a pedestrian, was struck by a car and sustained physical injuries and a traumatic brain injury.

He subsequently developed bipolar affective disorder.

The insurer terminated his weekly non-income benefits.

The arbitrator found that the applicant's psychiatric illness was caused by the accident and that he was substantially unable to perform his essential tasks for the period up to 156 weeks post-accident, entitling him to benefits under s. 13(1) of the Schedule.

However, the arbitrator concluded the applicant did not meet the stricter test under s. 13(8) for benefits beyond 156 weeks, as he was not continuously prevented from engaging in substantially all of his normal activities.

The claim for a special award was dismissed as the insurer's termination of benefits was not unreasonable.

The applicant applied for statutory accident benefits following an alleged motor vehicle accident.

The insurer denied the claim on the basis that the applicant was not involved in an accident.

After the initial arbitration hearing was adjourned to allow the applicant to retain new representation, the applicant failed to appear at the rescheduled hearing and could not be reached.

The arbitrator proceeded in her absence and dismissed the arbitration as no evidence was presented.

The arbitrator declined to award expenses to the insurer because the application was commenced prior to the November 1, 1996 legislative amendments.

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

The applicant brought a motion for interim weekly income benefits, and the insurer brought a cross-motion for the production of the clinical notes of the applicant's treating psychologist.

The arbitrator granted the motion for interim benefits, finding the applicant had established a prima facie case for entitlement and demonstrated financial need.

The arbitrator dismissed the insurer's motion for production of the clinical notes, finding the potential harm to the applicant's treatment outweighed the probative value of the notes, but ordered the production of raw testing data to the insurer's psychologist.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them at the 104-week mark.

The applicant brought a motion for interim benefits and a special award, arguing the insurer failed to follow the termination provisions of the Statutory Accident Benefits Schedule.

The arbitrator found that the insurer unreasonably withheld benefits by failing to properly transition the applicant to loss of earning capacity benefits or continue the termination procedure.

The arbitrator ordered the insurer to pay interim income replacement benefits, ongoing loss of earning capacity benefits, and a 10 percent special award for unreasonable delay.

The applicant was injured in a motor vehicle accident in January 1993 but did not notify the insurer or apply for statutory accident benefits until September 1994, almost 20 months later.

The insurer denied the claim due to the delay.

On a preliminary issue hearing, the arbitrator found that the applicant, who was a licensed insurance broker, did not have a reasonable excuse for the delay.

The applicant's assertion that she did not know the full extent of her injuries was rejected, as she had sought medical treatment shortly after the accident and was referred to a specialist within 13 months.

The arbitration was dismissed.

The applicant was injured in a motor vehicle accident and sought ongoing weekly caregiver benefits, as well as costs for medical devices, housekeeping services, and a case manager.

The insurer had terminated caregiver benefits.

The arbitrator found that the applicant suffered a psychological impairment resulting from the accident, including depression and a driving phobia, which caused a partial inability to carry on a normal life.

The arbitrator awarded ongoing caregiver benefits, the costs of a massager and an orthopaedic mattress, and partial housekeeping expenses, but denied the claim for a case manager.

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

The insurer suspended her benefits after she failed to attend a rescheduled insurer's examination.

The arbitrator found the suspension was unlawful because the insurer applied the wrong version of the Statutory Accident Benefits Schedule and failed to schedule the examination at a convenient time, ignoring her psychologist's advice that she was too emotionally fragile to attend.

The arbitrator awarded caregiver benefits up to the two-year mark, ongoing housekeeping expenses, vehicle modifications to provide automatic transmissions, and various medical and rehabilitation expenses.

A 40% special award was granted against the insurer for unreasonably withholding benefits.

The applicant claimed statutory accident benefits for income replacement following two motor vehicle accidents in 1995 and 1996.

The insurer paid benefits for a period but subsequently terminated them.

The arbitrator found the applicant to be an unreliable historian who concealed prior workplace and motor vehicle injuries from his medical assessors.

Preferring the objective medical evidence of the insurer's experts, the arbitrator concluded that the applicant's ongoing shoulder and back problems were chronic pre-existing conditions and that he was no longer disabled as a result of the motor vehicle accidents.

The claim for further income replacement benefits was dismissed, but the applicant was awarded one-half of his arbitration expenses.

The applicant was injured in a rear-end motor vehicle accident and received weekly income benefits for 156 weeks.

The insurer terminated benefits, arguing the applicant's ongoing severe anxiety disorder was not caused by the accident and that he was not continuously prevented from working.

The arbitrator found that the applicant's psychological disability was materially caused by the accident and rendered him unable to maintain employment.

The arbitrator ordered the insurer to pay ongoing weekly income benefits and awarded a $5,000 special award under section 282(10) of the Insurance Act, finding the insurer had unreasonably withheld payments without a reasonable basis.

The applicant was injured in a motor vehicle accident just before starting a new job as a general labourer for a demolition company.

The insurer terminated his weekly income replacement benefits based on a Designated Assessment Centre report concluding he could return to work.

At arbitration, the arbitrator found that the DAC assessor failed to properly consider the specific, heavy physical demands of the applicant's prospective job, which included repeatedly swinging a sledgehammer and lifting up to 50 pounds.

The arbitrator concluded the applicant continued to suffer a substantial inability to perform the essential tasks of his employment and ordered the insurer to pay income replacement benefits for the disputed period, along with interest and expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits, physiotherapy expenses, and the cost of a psychological assessment.

The insurer terminated benefits, arguing the applicant could return to his work as a piece-work upholsterer.

The arbitrator found that the applicant suffered from post-traumatic stress disorder and residual physical problems that substantially disabled him from performing the high-speed, repetitive tasks of his employment.

The arbitrator ordered the insurer to pay the claimed benefits, along with a special award under section 282(10) of the Insurance Act for unreasonably withholding payments.

The applicants sought to withdraw their application for arbitration regarding death benefits following a motor vehicle accident, intending to pursue the claim in court instead.

The insurer opposed the withdrawal, arguing it was forum shopping and an abuse of process, and requested reimbursement of its $2,000 assessment fee.

The arbitrator permitted the withdrawal on the condition that the applicants pay the insurer the $2,000 assessment fee within 40 days, and ordered that the applicants may not reapply for arbitration on the same issues.

The applicant was injured in a workplace accident and subsequently in a motor vehicle accident while on a graduated return-to-work program.

The insurer terminated statutory accident benefits, arguing the applicant had returned to his pre-accident state.

The arbitrator found that the motor vehicle accident only aggravated the pre-existing injuries for a period of six to seven months.

Relying on the treating physicians' contemporaneous records, the arbitrator concluded the applicant's ongoing disability after June 1994 was not caused by the motor vehicle accident.

Claims for ongoing weekly income benefits and supplementary medical expenses were dismissed.

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

The parties signed a settlement agreement, which the applicant later disputed.

The insurer argued the agreement was a full and final release of all claims.

The arbitrator found that while the parties had reached an agreement, the disclosure statement provided by the insurer failed to comply with section 9.1(2) of the Settlement Regulation because it omitted the commuted value of future benefits.

As a result, the applicant was entitled to rescind the settlement under section 9.1(4) and proceed to arbitration.