K. Julaine Palmer

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

The applicant commenced a court action against the insurer and subsequently applied for arbitration at the Ontario Insurance Commission.

The insurer brought a preliminary issue hearing to dismiss the arbitration due to the concurrent court action.

The arbitrator dismissed the arbitration application, finding that proceeding in two concurrent forums amounts to an abuse of process and a multiplicity of proceedings.

Costs of $250 were awarded to the insurer.

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

The parties' lawyers reached a settlement agreement over the telephone to reinstate benefits and pay arrears.

Shortly after, the insurer went into liquidation and repudiated the agreement, arguing it was frustrated by the winding-up order.

The arbitrator held that the settlement agreement was valid, not frustrated by the liquidation, and ordered the insurer to pay the agreed benefits, a special award for unreasonably withholding payments, and the applicant's arbitration expenses.

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

The insurer paid weekly income benefits at the minimum rate of $185.60, calculating her average gross weekly income over the four weeks preceding the accident.

The applicant argued her income should be averaged only over the two weeks she actually worked, which would yield a higher benefit.

The arbitrator held that the plain meaning of the Schedule requires averaging over the full four weeks, even if the applicant did not work during some of those weeks.

The applicant was awarded the minimum benefit and her arbitration expenses.

The applicant was injured in a snowmobile accident and received caregiver benefits until the insurer terminated them.

The arbitrator found that the applicant was deemed to have elected caregiver benefits.

While the applicant did not suffer a substantial inability to engage in caregiving activities after the termination date, she did suffer a partial inability to carry on a normal life due to her restricted mobility.

The arbitrator awarded caregiver benefits for the 104-week period following the accident, along with interest and expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including weekly income benefits, transportation expenses, and chauffeur/companion expenses for her husband.

The arbitrator found that the applicant, who worked in her husband's family business, did not suffer a substantial inability to perform the essential tasks of her employment and denied the weekly income benefits.

The claim for an increased transportation allowance was dismissed for lack of proof.

However, the arbitrator allowed the claim for chauffeur/companion expenses for out-of-town medical appointments, awarding 108 hours at the minimum wage rate.

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

He later developed intense lower back pain and was diagnosed with herniated discs, which he claimed were caused by the accident.

He also sought to include an unpaid $30,000 management fee in his pre-accident income calculation.

The arbitrator found that the medical evidence did not support a causal link between the accident and the back injuries, preferring the opinions of the insurer's and court-appointed experts.

The arbitrator also accepted the insurer's accounting expert's evidence that the unpaid management fee should not be included in the applicant's income.

The applicant's claims for further benefits were dismissed, though he was awarded his arbitration expenses.

The applicant was injured in a motor vehicle accident in January 1991 and received statutory accident benefits until January 1995.

He subsequently developed severe neuropathic pain in his left leg and sought ongoing weekly income benefits and medical benefits.

The insurer disputed that the neuropathic condition was caused by the accident.

The arbitrator reviewed extensive medical evidence and testimony, noting a significant time lag between the accident and the onset of the leg pain.

The arbitrator concluded that the applicant failed to prove on a balance of probabilities that the accident caused the neuropathic condition.

Consequently, the claims for ongoing benefits were dismissed.

The insurer's claim for repayment was also dismissed, and the applicant was awarded his arbitration expenses.

The Applicant's husband was killed in a motor vehicle accident.

The Applicant received a spousal death benefit but applied for an additional dependant's benefit under section 11(2)(c) of the Statutory Accident Benefits Schedule, arguing she was principally dependent on her husband because she planned to take maternity leave.

The arbitrator found that dependency must be assessed exactly at the time of the accident.

At that time, the Applicant was working full-time and earning more than her husband.

Therefore, she was not principally dependent on him for financial support and was not entitled to the dependant's benefit.

The Applicant was awarded her arbitration expenses.

The applicant was injured in a motorcycle accident, sustaining severe lacerations to his left hand that severed tendons and nerves.

The insurer terminated his weekly income benefits after 156 weeks, arguing he was reasonably suited for alternative occupations.

The arbitrator found that the applicant's education, training, and experience did not equip him for the sedentary or service occupations proposed by the insurer's vocational expert.

The arbitrator concluded the applicant remained continuously prevented from engaging in suitable employment and ordered the insurer to pay ongoing weekly income benefits, interest, and arbitration expenses.

The applicant sought to enforce a settlement agreement regarding statutory accident benefits after the insurer rescinded its offer.

The insurer argued the arbitrator lacked jurisdiction to determine if a settlement existed.

The arbitrator held that she had jurisdiction by necessary implication to determine if a settlement was reached.

However, because the insurer had not delivered the written notice required by the Settlement Regulation (O. Reg. 780/93) before the settlement was entered into, no enforceable settlement was achieved.

The applicant was awarded expenses for the preliminary hearing.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including weekly income benefits and transportation expenses.

The insurer denied the claims, arguing the applicant was not substantially disabled from his work as a commercial cleaner and alleging a material misrepresentation or change in risk regarding the insured vehicle.

The arbitrator found the applicant was substantially unable to perform his essential tasks for nine weeks and awarded minimum weekly income benefits due to insufficient financial evidence.

The arbitrator also awarded transportation expenses for chiropractic treatments and a 40% special award against the insurer for unreasonably withholding those expenses.

The insurer failed to prove a material misrepresentation or intentional failure to notify of a change in risk that would exclude the applicant from receiving benefits.

The Applicant was found unconscious and severely injured on a sidewalk and claimed he was struck by a motor vehicle.

The Insurer denied his claim for statutory accident benefits, arguing his injuries resulted from a fall, not a motor vehicle accident.

The arbitrator found on a balance of probabilities that the Applicant was injured in an 'accident' as defined in the Schedule, likely a hit-and-run.

The Applicant was awarded weekly income benefits of $61.63 per week for a specified period, supplementary medical and rehabilitation benefits for physiotherapy and psychological services, plus interest and arbitration expenses.

The Insurer brought a motion for the production of accident benefit claims files from Economical Mutual Insurance Company relating to two third parties, alleging that the Applicant's claim was part of a scheme involving fraudulent employment information.

The Arbitrator ordered the production of the requested files, excepting any documents relating to the setting of claims reserves, and directed that notice be given to the affected third parties and the other insurer to allow them to make submissions.

The applicant was injured in a motor vehicle accident while driving a taxicab.

He applied for statutory accident benefits from the insurer of the taxicab fleet (Coachman) and the insurer of his spouse's personal vehicle (Citadel).

The insurers settled the applicant's claim but disputed priority.

The arbitrator found that despite the policy exclusion for carrying passengers for compensation, the Statutory Accident Benefits Schedule prevailed, making the applicant an 'insured person' under both policies.

Under the priority rules in section 268(5) of the Insurance Act, the applicant, as the spouse of a named insured under the Citadel policy, was required to claim benefits from Citadel.

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

After a partially successful mediation, the applicant commenced a court action against the insurer.

Subsequently, the applicant sought to arbitrate the issue of whether she was an 'insured person' under the policy.

The insurer argued the arbitration should be stayed to avoid a multiplicity of proceedings.

The arbitrator dismissed the arbitration application, finding that the court action began first, was more comprehensive, and would necessarily decide the 'insured person' issue.

The applicant was awarded her expenses for the arbitration as the application was not frivolous.

In a supplementary decision, the Arbitrator calculated the exact amount of weekly income benefits owing to the applicant following a motor vehicle accident.

The parties agreed on the base figures but disputed the calculation of the applicant's average gross weekly income from her business.

The Arbitrator determined the net business income for the 52 weeks preceding the accident, calculated the gross weekly income, and applied the statutory formula.

After deducting amounts paid by the insurer and post-accident earnings, the insurer was ordered to pay $27,460.78 plus interest.

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

The insurer terminated benefits thereafter.

The applicant sought ongoing weekly income benefits under section 12(5)(b) of the Statutory Accident Benefits Schedule, as well as rehabilitation and occupational training.

The arbitrator found that the applicant's physical restrictions prevented him from engaging in any occupation for which he was reasonably suited by education, training, or experience, and ordered ongoing weekly income benefits.

The arbitrator also ordered the insurer to pay for a comprehensive vocational rehabilitation assessment.

Finding that the insurer acted unreasonably in terminating benefits despite medical and functional capacity reports supporting the applicant's disability, the arbitrator ordered a special award of 35% of the outstanding weekly income benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for her inability to perform essential housekeeping and childcare tasks.

The insurer terminated her weekly benefits, arguing symptom exaggeration based on some medical assessments.

The arbitrator reviewed conflicting medical and psychological evidence, including diagnoses of severe post-traumatic stress disorder from multiple specialists.

The arbitrator concluded that the applicant suffered a substantial inability to complete her essential tasks as a homemaker and mother due to the psychological effects of the accident, and awarded weekly benefits, interest, and expenses.

The applicant suffered a closed head injury in a motor vehicle accident and received statutory accident benefits.

The insurer terminated weekly income benefits, and the parties disputed entitlement beyond the 156-week mark under s. 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant suffered from debilitating, unpredictable post-traumatic headaches that prevented her from consistently attending any employment for which she was reasonably suited.

The arbitrator ordered the insurer to pay weekly income benefits of $79.59 per week, plus interest and arbitration expenses.

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

The insurer paid benefits but later disputed the amount, seeking repayment.

The applicant and his representative failed to attend the arbitration hearing, though the representative sent a letter conceding the insurer's accounting evidence.

Proceeding in the applicant's absence, the arbitrator found the applicant had received collateral benefits that reduced his entitlement.

The insurer was awarded repayment of $4,916.30.

The arbitrator also ordered the applicant to pay the insurer's $1,000 assessment fee, finding the arbitration was frivolous, vexatious, and an abuse of process.