K. Julaine Palmer

The applicant, who was injured in a motor vehicle accident, sought a determination of the quantum of weekly income benefits payable by the insurer.

The arbitrator found that the applicant, as president of a closely-held corporation, had structured his financial affairs to minimize his income, receiving only director's fees and dividends rather than a salary.

Consequently, his gross weekly income from employment was insufficient to qualify for more than the minimum weekly benefit.

After deducting post-accident income received and available from the corporation, the arbitrator concluded the applicant was not entitled to any further benefits and ordered him to repay $6,496 that the insurer had overpaid.

The applicant was awarded his arbitration expenses.

The applicants' daughter was killed in a motor vehicle accident.

They applied for death benefits under the No-Fault Benefits Schedule, which the insurer denied on the basis that the daughter was not 'principally dependent for financial support' on her parents.

The arbitrator found that although the parents generously supplemented their daughter's income, she was employed full-time, lived in her own apartment, and was financially able to provide for herself.

The application for death benefits was dismissed, but the applicants were awarded their arbitration expenses.

The applicant was injured in a motor vehicle accident while driving a van owned by his employer.

He applied for weekly income benefits under the No-Fault Benefits Schedule.

The insurer denied the claim on the basis that the applicant knew or ought reasonably to have known he was operating the vehicle without the owner's consent.

The arbitrator found that the applicant had abused his position of trust by appropriating the van for personal use during off-hours without permission.

The application for weekly income benefits was dismissed, though the applicant was awarded his arbitration expenses.

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

The Insurer terminated benefits on November 24, 1991.

The Arbitrator found that the Applicant failed to prove a substantial inability to perform the essential tasks of his employment after that date.

Furthermore, the Arbitrator determined that the Applicant attempted to defraud the Insurer by claiming to be the beneficial owner of a business to inflate his pre-accident income.

The correct weekly income benefit was calculated based solely on his actual employment income.

As a result, the Applicant was ordered to repay an overpayment of $12,682.82 plus interest to the Insurer, and his claim for arbitration expenses was denied due to his fraudulent conduct.

The applicant, a pedestrian struck by a motor vehicle, applied for statutory accident benefits, claiming ongoing substantial inability to perform his pre-accident work as a heavy manual labourer.

The insurer terminated weekly income benefits and disputed the quantum of the applicant's pre-accident income.

The arbitrator found that the applicant's financial records were fabricated after the accident and relied on forensic accounting evidence to limit his weekly income benefits to the statutory minimum.

The arbitrator also accepted medical evidence that the applicant's ongoing back issues were due to pre-existing degenerative disc disease, concluding he was no longer substantially disabled.

The applicant was ordered to repay an overpayment of benefits to the insurer, though the insurer was ordered to fund a four-week rehabilitation program.

The applicant was injured in a motor vehicle accident and received weekly income benefits until April 1991, when the insurer terminated them.

She applied for arbitration seeking ongoing weekly income benefits, childcare benefits, and supplementary medical expenses.

The arbitrator found that the accident aggravated a pre-existing fibromyalgia condition, but that by April 1991, the applicant had largely returned to her pre-accident state of health.

The claims for ongoing income benefits, childcare benefits, and supplementary medical expenses were dismissed due to the applicant's recovery and a lack of evidentiary foundation.

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

During the arbitration process, the pre-hearing arbitrator ordered the insured to produce documentation regarding his pension income.

The insured refused to comply with the order.

The insurer brought a preliminary motion to summarily dismiss the application.

The arbitrator declined to initiate complex contempt proceedings under the Statutory Powers Procedure Act, and instead drew an adverse inference against the insured.

The arbitrator deemed the insured to be in receipt of pension income sufficient to reduce his weekly income benefit to zero dollars.

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

The Insurer denied the claim on the basis that the Applicant failed to submit a completed application within 90 days of giving notice, as required by section 22(1) of the No-Fault Benefits Schedule.

The arbitrator found that the Insurer was estopped from relying on the time limit due to its own delay in providing the forms, and that the Applicant's personal circumstances provided a reasonable excuse.

The arbitrator held that the Applicant suffered a substantial inability to perform her essential tasks for three weeks following the accident, entitling her to weekly income benefits for that period.

However, the arbitrator concluded that the Applicant's CPP and Bell Canada disability pensions were payments for loss of income that must be deducted from the weekly benefits under section 13(3), resulting in no net weekly benefits payable.

The Applicant was awarded $1,557.00 for supplementary medical and rehabilitation expenses, plus related transportation costs.

The applicant was injured in a motor vehicle accident and claimed weekly income benefits under the No-Fault Benefits Schedule.

The insurer disputed his employment status at the time of the accident, his medical eligibility, and the quantum of benefits, noting the applicant had failed to report significant income on his tax returns.

The arbitrator found the applicant was employed as a real estate salesperson and was substantially disabled from performing his essential tasks until November 14, 1991.

However, because the applicant failed to provide reliable proof of his pre-accident income, his benefits were calculated based on the statutory minimum gross weekly income.

The arbitrator rejected the insurer's argument that the applicant's claim should be barred on public policy grounds due to his false tax returns.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, alleging he could return to work.

The arbitrator found the applicant remained substantially unable to perform the heavy physical tasks of his pre-accident employment as a sheeter-decker, relying on the court-appointed medical expert.

However, the arbitrator also found the applicant had fraudulently concealed temporary employment as a tow truck operator while receiving benefits.

Consequently, the applicant was ordered to repay the benefits received during those weeks and was denied his expenses for the arbitration proceeding.

The applicant was injured when the public transit bus he was riding braked suddenly.

He received weekly income benefits until the insurer terminated them, alleging he was not substantially unable to perform his essential tasks and had defrauded the insurer.

The arbitrator found that an accident had occurred and caused injury, but that the applicant failed to prove a substantial inability to perform his essential tasks after June 1991, as his inability to pursue his ambitions was due to a pre-existing depressive illness rather than the accident.

The insurer's claim of fraud was dismissed, and the applicant was awarded the expenses of the arbitration.

The Applicant was injured in a motor vehicle accident and received caregiver benefits for her elderly mother, who resided with her at the time of the accident.

The mother subsequently suffered a stroke and was moved to a nursing home, ceasing to reside with the Applicant.

The Insurer terminated the caregiver benefits on the basis that the mother no longer resided with the Applicant.

The Arbitrator held that under the plain meaning of sections 13(4) and 13(6) of the No-Fault Benefits Schedule, the requirement to reside together applies only at the time of the accident, and none of the termination conditions in section 13(6) applied.

The Insurer was ordered to continue paying the caregiver benefits.

The applicant, a self-employed driving instructor, was injured in a rear-end motor vehicle collision and claimed ongoing weekly income benefits and rehabilitation expenses.

The insurer terminated income benefits in May 1991, arguing the applicant could return to work.

The arbitrator found the applicant was capable of returning to work by early June 1991, granting only three additional weeks of income benefits and ordering the applicant to repay a significant overpayment resulting from collateral benefits.

However, the arbitrator ordered the insurer to pay for a functional interdisciplinary rehabilitation program, finding the expense reasonable and necessary to support the applicant's return to the workforce.

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

The insurer had terminated benefits and claimed an overpayment, arguing the applicant was no longer substantially disabled and had received collateral income.

The applicant failed to attend the arbitration hearing or provide required documentation.

Relying on the insurer's medical evidence and the applicant's lack of proof, the arbitrator determined the correct weekly benefit amount, upheld the termination of benefits, and ordered the applicant to repay $26,088.76 in overpaid benefits.

The applicant, a full-time master's student and teaching assistant, was injured in a motor vehicle accident.

She applied for weekly income benefits under the No-Fault Benefits Schedule.

The insurer disputed whether she should claim under section 12 (employed) or section 13 (non-earner).

The arbitrator found that the applicant was employed as a teaching assistant at the time of the accident and suffered a substantial inability to perform the essential tasks of her occupation.

The arbitrator awarded weekly income benefits under section 12 from November 1990 to December 1991, deducting a portion of her teaching assistant salary and a summer bursary.

The applicants were injured in two motor vehicle accidents and claimed no-fault benefits from their insurer.

They sought reimbursement for $6,000 paid to their son for housekeeping, transportation, and care services, as well as $1,300 for two medical reports obtained after the insurer delayed paying weekly income benefits.

The arbitrator found that the son's services for housekeeping, meal preparation, and transportation to medical appointments were compensable under the No-Fault Benefits Schedule, awarding $2,880.

The arbitrator also ordered the insurer to pay for the medical reports, finding the applicants were justified in obtaining them due to the insurer's gross delay in paying benefits.

The applicant sought weekly income benefits following a motor vehicle accident, claiming physical and psychological injuries, including post-traumatic stress disorder.

The arbitrator found that the applicant's physical injuries had resolved to the point where he was no longer substantially unable to perform the essential tasks of his employment.

The arbitrator rejected the diagnosis of post-traumatic stress disorder, preferring the evidence of the insurer's physiatrist.

Although the insurer improperly interfered with the applicant's physiotherapy treatment, no penalty could be assessed because no benefits were found to be owing.

The applicant's claim for weekly income benefits was dismissed, but he was awarded the expenses of the arbitration.

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

The applicant sought reinstatement of the benefits and compensation for his family's suffering due to the dispute.

The arbitrator found that surveillance evidence showed the applicant performing activities such as re-shingling a roof, contradicting his claim of substantial inability to perform essential tasks.

The application for weekly income benefits was dismissed, and the claims for family compensation were also denied as they did not fall within the statutory definitions.

The Applicant, a self-employed taxicab driver, was injured in a motor vehicle accident and applied for weekly income benefits.

The Insurer initially paid benefits based on the Applicant's verbal declaration but later reduced payments to the minimum statutory amount when the Applicant failed to provide satisfactory documentary proof of his gross weekly income.

The arbitrator found that the Applicant failed to establish a gross weekly income exceeding the statutory minimum of $232.00 per week.

The Applicant was awarded the minimum benefit of $185.60 per week, and the Insurer was ordered to be repaid $1,695.60 for the initial overpayment.

The applicant, a construction contractor, was injured in a rear-end motor vehicle accident and claimed weekly income benefits.

The insurer terminated benefits, arguing the applicant was no longer substantially unable to perform the essential tasks of his occupation, relying in part on surveillance evidence.

Following an arbitration hearing, the arbitrator found that the applicant was substantially unable to perform his essential tasks during the disputed period.

The arbitrator relied on the applicant's testimony, corroborating evidence from tradesmen, and medical reports, noting that the applicant's brief visits to a job site did not demonstrate an ability to work.

The applicant was awarded entitlement to benefits and arbitration expenses.