M. Kaye Joachim

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

In a previous decision, the arbitrator found that the applicant knew he was operating an uninsured vehicle and ordered him to repay income replacement benefits.

Both parties sought expenses for the arbitration proceeding.

The arbitrator found that the applicant's evidence regarding his knowledge of the lack of insurance was untruthful and fraudulent.

Consequently, the applicant was denied his expenses, and the insurer was awarded its reasonable expenses of $2,712.50 plus $59 in disbursements.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for ongoing chiropractic, physiotherapy, and massage treatments, as well as the costs of various assessments.

The insurer disputed the ongoing treatments and assessments.

The arbitrator found that the initial treatments were reasonable and necessary, but denied ongoing treatments due to a lack of medical evidence supporting their therapeutic benefit.

The arbitrator allowed the costs of some assessments but reduced the amounts claimed.

The arbitrator denied the applicant's request for a special award, finding the insurer's actions reasonable given the applicant's lack of cooperation.

Due to the poor conduct of the applicant's representative, the applicant was ordered to pay the insurer's expenses for a half-day of an expert witness's attendance.

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

The applicant sought arbitration for ongoing weekly income benefits, housekeeping, babysitting, and occupational training expenses.

The arbitrator found the applicant was entitled to weekly income benefits up to June 30, 1998, as she was physically capable of performing suitable full-time work by that date.

The arbitrator also awarded partial housekeeping and babysitting expenses, but denied the claim for occupational training expenses.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including weekly benefits under section 13 of the Schedule.

The insurer denied the weekly benefits.

The arbitrator found that the applicant suffered a substantial inability to perform his essential tasks due to chronic pain resulting from the accident, entitling him to weekly benefits until May 1, 1995.

The arbitrator also held that vocational rehabilitation benefits received by the applicant were not deductible from the weekly benefits, as they were not payments for loss of income.

Finally, the applicant was awarded interest on the overdue benefits from July 24, 1993, as the insurer had received a completed application and sufficient medical information to adjust the claim.

The applicant sought to vary a special award of $6,500 previously ordered by another arbitrator on a motion for interim benefits.

The hearing arbitrator held that she lacked jurisdiction to vary the amount of the special award, as the prior decision was final with respect to the insurer's conduct leading up to the motion.

The arbitrator further noted that even if jurisdiction existed, she would not vary the amount, as the facts were identical to those considered in the prior decision.

The applicant was injured in two motor vehicle accidents in November 1997 and received statutory accident benefits until the insurer terminated his income replacement benefits in September 1998.

The applicant sought arbitration, claiming ongoing disability due to a severe psychiatric condition, including post-traumatic stress disorder and depression with psychotic features.

The insurer argued the condition was pre-existing and not caused by the accidents.

The arbitrator found that while the applicant had a pre-existing personality disorder, he had reached a functional equilibrium prior to the accidents.

The accidents materially contributed to the deterioration of his mental condition, rendering him completely unable to engage in any employment.

The arbitrator ordered the insurer to pay ongoing income replacement benefits.

The applicant was injured in a motor vehicle accident and claimed ongoing weekly income replacement benefits and medical expenses.

The insurer terminated benefits, arguing the applicant could return to his pre-accident employment as a bricklayer's assistant.

The arbitrator found that the applicant suffered from chronic right shoulder tendinitis caused by the accident, which prevented him from performing his pre-accident heavy labour duties.

Furthermore, the applicant's limited English language skills and lack of transferable skills rendered him continuously prevented from engaging in any suitable employment.

The arbitrator ordered the insurer to pay ongoing weekly income benefits at $600 per week and certain medical expenses.

The applicant sought expenses following an arbitration hearing regarding statutory accident benefits.

The arbitrator found that the applicant was largely successful in his claims, raised legitimate concerns about the reliability of the REC DAC assessment, and presented his case efficiently.

Applying the criteria under section 12(2) of O.Reg. 464/96, the arbitrator awarded the applicant his reasonable expenses and denied the insurer's request for expenses.

The applicant sought reimbursement for disbursements incurred during an arbitration proceeding for statutory accident benefits.

The insurer had paid a portion of the claimed disbursements but disputed several items, including hotel stays, meals, expert witness fees, and medical assessments.

The arbitrator reviewed the disputed items under the Expense Regulation, allowing some travel and expert report fees while disallowing expenses that were more properly characterized as medical benefits or were deemed unreasonable.

The applicant was awarded an additional $180.26 in disbursements.

Following a decision denying the applicant statutory accident benefits due to an unexcused delay in notifying the insurer, the arbitrator considered the issue of expenses.

The arbitrator declined to award expenses to the applicant because he was unsuccessful and his evidence was unreliable.

The arbitrator also declined to award expenses to the insurer, noting that the applicant's position was not unreasonable, he had limited financial resources, and an award of expenses could deter meritorious claims.

Both parties were ordered to bear their own expenses.

Following a decision ordering the insured to repay income replacement benefits due to misrepresentation, the insurer sought its expenses for the arbitration hearing.

The arbitrator found the insured's position was manifestly unfounded and an abuse of process.

The insurer was awarded $16,107.21 in legal fees, disbursements, and assessment fees.

The applicant was injured in a motor vehicle accident and sought payment for in-home physiotherapy expenses and a special award for unreasonable withholding of benefits.

The arbitrator found that the in-home physiotherapy was reasonable and necessary, but the fees charged were not reasonable.

The arbitrator awarded $3,847.50 based on the Physiotherapists Fees Guideline.

The claim for a special award was dismissed as the insurer's refusal to pay was based on conflicting medical opinions and was not unreasonable.

The applicant was injured in a motorcycle accident and received income replacement benefits.

The insurer terminated these benefits, and the parties disputed the applicant's residual earning capacity.

Following a residual earning capacity assessment, the arbitrator determined the applicant was capable of working full-time as an electronics assembler, setting his residual earning capacity at $268.49 per week.

The arbitrator also held that the insurer was required to pay income replacement benefits until 14 days after the issuance of a valid assessment report, as the initial report was invalid and did not establish a failure to co-operate.

The applicant's request for a special award due to delayed payment of interim benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits, alleging he had a legitimate contract of employment to commence work as a truck driver shortly after the accident.

The insurer disputed the existence of the contract.

The arbitrator reviewed the evidence, including the financial viability of the alleged guaranteed weekly wage in a seasonal industry, and found the applicant's evidence improbable.

The arbitrator concluded the applicant failed to establish the existence of a legitimate contract of employment entered into prior to the accident, and dismissed the claim.

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

The insurer terminated benefits in October 1994, stating the applicant did not meet the post-156 week disability test.

The applicant did not dispute the termination at the time.

In 1998, the applicant claimed a relapse and sought benefits from September 1997 onwards.

The arbitrator held that the applicant was precluded from proceeding to arbitration because the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule had expired following the initial clear and unequivocal refusal in 1994.

The arbitrator rejected the argument that a relapse could trigger a new limitation period without continuity of disability.

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

The insurer argued the applicant was barred from receiving benefits because he failed to notify the insurer within 30 days and failed to submit an application within 90 days under section 59 of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant had provided sufficient notice to his broker within 30 days, which constituted notice to the insurer.

Furthermore, the applicant had substantially complied with the 90-day application requirement by submitting partially completed forms and providing detailed information to the adjuster.

Alternatively, the arbitrator found the applicant had a reasonable excuse for any delay, and the insurer suffered no prejudice.

The applicant was not barred from receiving benefits.

The applicant was injured in a motor vehicle accident when struck as a pedestrian.

He failed to notify the insurer of his intention to claim statutory accident benefits until over two years after the accident.

The insurer refused to pay benefits on the basis of the delay.

The arbitrator found that the applicant did not have a reasonable excuse for the delay, noting his prior experience as a process server, the weakness of his excuse regarding the delayed realization of his injuries' severity, and the prejudice to the insurer's ability to participate in early rehabilitation and verify post-accident earnings.

The claim for accident benefits was dismissed.

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

The insurer terminated benefits and sought repayment, alleging the applicant wilfully misrepresented his employment status and income, and continued to operate his drywall business post-accident.

The arbitrator found the applicant was self-employed, had submitted a false income confirmation, and was capable of performing his essential duties.

The applicant's claims for ongoing benefits and a special award were dismissed.

The insurer's claim for repayment was granted, and the applicant was ordered to repay $51,761.86 due to wilful misrepresentation.

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

The applicant applied for arbitration, seeking ongoing weekly income benefits, transportation expenses, and a special award.

The arbitrator found that the applicant suffered from chronic pain and depression caused by the accident, which continuously prevented him from engaging in any suitable employment.

The arbitrator ordered the insurer to pay ongoing weekly income benefits and transportation expenses.

However, the arbitrator also ordered the applicant to repay an overpayment of income replacement benefits due to his receipt of collateral benefits, and denied the request for a special award.

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

The applicant sought ongoing weekly income benefits and medical expenses, arguing the accident materially contributed to her severe, ongoing disabilities, including multi-focal cranial dystonia and Sjogren's Syndrome.

The arbitrator found that while the accident exacerbated pre-existing neck and back pain, the applicant had recovered from the accident-related injuries by May 1994.

Her ongoing disabilities were attributed to the natural progression of pre-existing conditions and a severe adverse reaction to medication.

The arbitrator also excluded surveillance evidence obtained by investigators who entered the applicant's home under false pretenses, finding it unduly invasive of her privacy.

The claims for ongoing benefits were dismissed, but the applicant was awarded her arbitration expenses.