M. Kaye Joachim

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The insurer denied the claim, arguing the accident did not occur as described and the applicant suffered no injuries.

The arbitrator found that while the arbitration application was not time-barred, the applicant had no reasonable excuse for filing her benefits application late.

Furthermore, based on expert engineering evidence, inconsistencies in witness statements, and the applicant's lack of credibility, the arbitrator concluded the applicant did not sustain injuries in the alleged accident and was pursuing a fraudulent claim.

The application for benefits was dismissed.

The Applicant was injured in a motor vehicle accident while riding her bicycle and applied for statutory accident benefits, specifically caregiver benefits.

The Insurer denied the claim.

At arbitration, the Applicant argued she suffered a partial inability to carry on a normal life due to hip pain, balance problems, and anxiety about bicycling.

The Arbitrator found that while the Applicant could perform most household activities, her inability to walk long distances initially and her ongoing inability to ride a bicycle constituted a substantial inability to engage in her pre-accident mobility activities.

The Arbitrator awarded caregiver benefits for the two-year period following the accident, plus interest and expenses.

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

The insurer subsequently terminated benefits and sought repayment, arguing the applicant knew or ought to have known he was driving an uninsured vehicle.

The arbitrator found that the applicant's wife had cancelled the insurance policy prior to the accident and that the applicant was aware of this cancellation.

Consequently, the applicant was disqualified from receiving benefits under section 30(1)(a) of the Statutory Accident Benefits Schedule.

The applicant was ordered to repay $6,357.02 in income replacement benefits pursuant to section 47(1)(b), but was not required to repay other benefits as the insurer failed to prove fraud or misrepresentation under section 47(1)(a).

The applicant failed to attend a scheduled preliminary hearing regarding his entitlement to caregiver benefits following a motor vehicle accident.

The insurer sought to have the application dismissed.

The arbitrator found that the applicant's failure to attend was excusable due to his undisputed psychiatric condition and lack of a fixed address, which likely resulted in him not receiving actual notice of the hearing.

The application was not dismissed, and the preliminary hearing was adjourned.

The issue of expenses was deferred to the hearing arbitrator.

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

The insurer terminated caregiver benefits and scheduled a medical examination.

The applicant attended but refused to proceed unless she could tape record the examination, alleging the doctor had been rude previously.

The doctor refused to proceed with the tape recorder.

On a preliminary motion, the arbitrator applied the principles from Bellamy v. Johnson and held that the applicant's refusal to submit to the examination without a tape recorder was unreasonable, as she failed to demonstrate a bona fide concern or propose safeguards to ensure the recording's reliability.

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

The insurer denied benefits and argued that the applicant was precluded from proceeding to mediation and arbitration because she filed her application late, failed to provide requested medical information, and failed to attend medical examinations and assessments.

The arbitrator found that the applicant had a reasonable excuse for the late application, as her doctor failed to complete it promptly.

The arbitrator also found that the applicant had provided the necessary authorizations for medical records and was not responsible for third-party delays in producing them.

Furthermore, the applicant did not fail to make herself reasonably available for examinations, as the insurer failed to provide reasonable notice.

The insurer's preliminary objections were dismissed, and the applicant was permitted to proceed to arbitration.

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

Following a preliminary decision that barred her claim for other disability benefits due to a missed limitation period, the insurer requested that the remainder of the arbitration be dismissed.

The arbitrator found that the applicant had not provided details or documentation for any other outstanding claims, nor had they been properly mediated.

Consequently, the application for arbitration was dismissed as there were no remaining issues in dispute.

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

The insurer argued the applicant was not substantially disabled and had misrepresented his pre-accident income and post-accident earnings.

The arbitrator found the applicant's evidence regarding his symptoms and finances to be highly unreliable, noting deliberate misrepresentations.

However, objective medical evidence of a large disc herniation, materially related to the accident, established that he was physically incapable of returning to the essential duties of his pre-accident employment.

The arbitrator ordered ongoing income replacement benefits and granted a $10,000 special award because the insurer had unreasonably reduced benefits earlier in the claim based solely on the applicant's receipt of unemployment insurance.

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

The insurer terminated her weekly income replacement benefits and housekeeping expenses in January 1997.

The applicant applied for arbitration, claiming ongoing entitlement to both benefits.

The arbitrator found that the applicant suffered from chronic pain in her left hip and low back, which prevented her from performing the essential duties of her pre-accident employment as a data entry clerk, as the job required prolonged sitting or standing.

The arbitrator relied on work simulations and medical evidence to conclude the applicant was substantially disabled.

However, the arbitrator dismissed the claim for housekeeping expenses, finding that the applicant's husband did not perform significantly more chores than before the accident and that the applicant retained the physical capacity to perform her housekeeping duties.

The applicant was awarded ongoing weekly income replacement benefits.

The applicant was injured in a motor vehicle accident while enrolled in a heavy duty equipment mechanic college program.

The insurer terminated his weekly education disability benefits.

The applicant sought arbitration, claiming he was physically and mentally unable to complete his education due to chronic pain and depression.

The arbitrator dismissed the claim, finding that the applicant's physical injuries were primarily soft tissue and had resolved, as evidenced by his subsequent employment in physically demanding jobs and his weight training.

The arbitrator also found no persuasive medical evidence of a disabling psychiatric condition or head injury, concluding the applicant failed to prove a substantial inability to complete his education or carry on a normal life.

The applicant was injured in a motor vehicle accident and inquired about other disability benefits.

The insurer clearly refused the benefits on October 4, 1995, on the basis that collateral benefits reduced her entitlement to zero.

The applicant did not apply for mediation until March 1998, more than two years after the refusal.

The arbitrator held that the claim for other disability benefits was barred by the two-year limitation period under s. 281(5) of the Insurance Act and s. 72(1) of the Statutory Accident Benefits Schedule.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them at the three-year mark.

The applicant sought ongoing weekly income benefits, claiming total disability due to chronic pain and restricted neck movement.

The arbitrator found the applicant's subjective complaints of pain and limitation to be unreliable, noting significant discrepancies between her presentation to doctors and her fluid movements captured on video surveillance.

Relying on objective functional capacity evaluations, the arbitrator concluded the applicant was capable of returning to sedentary work and had unreasonably resisted rehabilitation efforts.

The claim for ongoing benefits was dismissed, save for a six-week period of benefits awarded for recovery following a related ear surgery.

The applicant was injured in a motor vehicle accident and sought payment for a functional capacity evaluation and a surface EMG under section 24 of the Statutory Accident Benefits Schedule.

The insurer refused payment, arguing the expenses were medical services subject to section 38 requirements or were experimental.

The arbitrator held that diagnostic assessments obtained to assist in preparing a treatment plan fall under section 24 and are not subject to section 38.

However, the arbitrator reduced the claimed amount by 50% because the quality and value of the reports were questionable due to missing pre-accident information and unexplained test results.

The applicant was awarded $637.50 plus interest and arbitration expenses.

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

The insurer terminated benefits on the basis that the applicant no longer suffered from a disability.

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

The arbitrator found that the applicant suffered from chronic pain in her neck and shoulders that prevented her from returning to her pre-accident employment as a stamp examiner or any other suitable factory work.

The arbitrator ordered the insurer to pay ongoing weekly income benefits and interest, but declined to order a special award, finding that the insurer's decision to terminate benefits to test the applicant's subjective complaints of pain was not unreasonable.

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

The insurer terminated weekly income benefits, child care supplement, and housekeeping expenses at the 156-week mark.

The applicant sought arbitration, claiming she was continuously prevented from engaging in substantially all of her normal activities due to chronic pain and cognitive difficulties.

The arbitrator reviewed extensive video surveillance evidence showing the applicant engaging in various physical activities, including driving, shopping, bending, lifting, and dancing.

The arbitrator concluded that while the applicant experienced pain, she was not continuously prevented from performing her normal housekeeping, child care, and recreational activities.

The claims for weekly benefits, child care supplement, and housekeeping expenses were dismissed, but $164 for babysitting expenses during pain flare-ups was awarded.

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

She applied for statutory accident benefits, including caregiver benefits, housekeeping expenses, and various medical and rehabilitation expenses.

The insurer terminated weekly income replacement benefits and denied several medical expenses.

The arbitrator found that the applicant had significant pre-existing medical conditions and exaggerated her symptoms, concluding she was capable of performing her pre-accident activities by October 1996.

Claims for ongoing caregiver and housekeeping benefits beyond that date were dismissed.

However, the arbitrator allowed claims for indexation, limited housekeeping expenses prior to October 1996, and certain psychological, massage, and acupuncture treatments deemed reasonable and necessary.

The claim for a special award was dismissed.

The applicant was injured in three motor vehicle accidents in 1995 and sought ongoing income replacement, caregiver, and medical benefits.

The arbitrator found the applicant's evidence regarding his pre-accident income and ongoing disability to be highly exaggerated and unreliable.

However, the arbitrator concluded the applicant was physically disabled from working as a paralegal for a closed period until January 1996 and awarded income replacement benefits for that period.

A special award was also granted because the insurer unreasonably required the self-employed applicant to prove a negative (that he was not earning post-accident income) before paying benefits.

As the total awarded was less than a $15,000 settlement previously paid and rescinded, the awarded amounts were set off against the settlement, and the applicant was ordered to repay the balance to prevent an abuse of process.

The applicant sought statutory accident benefits following a single-vehicle accident.

The insurer disputed the claim, alleging the applicant was not a passenger in the vehicle at the time of the accident, relying on a police report that listed a different individual and a polygraph examination suggesting the applicant was deceptive.

The arbitrator found the polygraph evidence to be of no weight due to a lack of evidence regarding its reliability.

Concluding that the insurer's theory of a complex fraud was highly unlikely, the arbitrator held on a balance of probabilities that the applicant was indeed a passenger in the vehicle and awarded expenses to the applicant.

The applicants, a mother and son, sought statutory accident benefits following separate motor vehicle accidents.

The mother claimed ongoing caregiver benefits, housekeeping expenses, and medical benefits, including a Kenko mattress system.

The son claimed caregiver benefits, education disability benefits, and physiotherapy expenses.

The arbitrator dismissed all claims, finding both applicants lacked credibility.

The mother's evidence regarding her inability to perform caregiving and housekeeping duties was contradicted by objective medical assessments and home assessments.

The son's claim that he was the primary caregiver for his sisters was found to be frivolous and fabricated.

The arbitrator awarded the insurer one-fourth of its expenses in respect of the arbitration due to the son's application being frivolous and made in bad faith.

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

The insurer terminated weekly income replacement benefits, and the applicant requested a Designated Assessment Centre (DAC) assessment.

The applicant later cancelled the assessment with insufficient notice, incurring a cancellation fee, and applied for mediation and arbitration.

The arbitrator held that the applicant failed to establish a bona fide change of mind regarding his election to proceed by way of a DAC assessment.

Consequently, the applicant is precluded from proceeding to mediation and arbitration until he completes the requested DAC assessment.