Morris J. Winer

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRB) and medical benefits.

The insurer terminated the IRB claim, alleging the applicant wilfully misrepresented her employment status by working after the accident while claiming to be disabled.

The arbitrator found that while the applicant did wilfully misrepresent that she had not worked on several specific days, the misrepresentation was not 'material' enough to justify terminating all benefits, as the insurer could simply deduct the earnings from the IRB.

The arbitrator awarded the IRB (less a deduction for days worked) and a medical benefit, but denied an attendant care assessment.

A special award of $2,000 was also ordered against the insurer for unreasonably withholding benefits, though the amount was tempered due to the applicant's own deceitful conduct.

The applicants sought various statutory accident benefits following a motor vehicle incident that was previously determined to be a staged accident.

At the arbitration hearing, the self-represented applicants attended but declined to give evidence or participate.

Consequently, their claims for benefits were dismissed.

The insurer sought repayment of over $78,000 in benefits previously paid, arguing that because the crash was fraudulent, all benefits were paid as a result of wilful misrepresentation or fraud under s. 52 of the SABS.

The arbitrator dismissed the insurer's claim for repayment, finding no evidence was provided of wilful misrepresentation or fraud regarding the legitimacy of the injuries, treatments, and expenses for the actual benefits claimed.

The Applicant sought a non-earner benefit following a motor vehicle accident.

At the commencement of the arbitration hearing, the Applicant requested to withdraw from the proceeding.

The Insurer agreed to the withdrawal but sought its expenses, citing the Applicant's delay in productions and a meritless preliminary issue.

The Arbitrator permitted the withdrawal and awarded the Insurer $6,000 in expenses, finding that the Insurer was successful in having the claim withdrawn and was entitled to reasonable costs, though the amount claimed was reduced due to excessive hours and the Insurer's own missteps.

The Applicant sought statutory accident benefits following a motor vehicle collision.

The Insurer denied the claim, arguing the collision was staged and therefore not an 'accident' under the Statutory Accident Benefits Schedule.

The arbitrator accepted expert engineering evidence that the Applicant's vehicle accelerated into the collision without braking, supporting the Insurer's position that the crash was deliberate.

However, applying appellate jurisprudence, the arbitrator held that the statutory definition of 'accident' does not exclude intentional collisions, provided the use or operation of the vehicle directly caused the impairment.

The arbitrator concluded the Applicant was involved in an accident as defined by the Schedule.

The applicants sought accident benefits following two motor vehicle accidents.

The insurer scheduled examinations under section 44 of the Statutory Accident Benefits Schedule, but the applicants failed to attend, insisting on the presence of a Ministry of the Attorney General accredited interpreter.

The arbitrator held that there is no requirement for a MAG accredited interpreter, only a competent and independent one.

Because the applicants failed to attend the required examinations, they were precluded by section 55.2 of the Schedule from mediating and arbitrating their claims.