Shari L. Novick

Following an arbitration hearing where the applicant was largely successful in her claims for statutory accident benefits, the parties disputed her entitlement to expenses.

The insurer argued that the applicant's pursuit of an indexation issue and an evidentiary objection prolonged the hearing.

The arbitrator found that these matters did not unduly prolong the hearing and, given the applicant's relative success, ordered the insurer to pay the applicant's expenses of the arbitration.

The applicant was struck by a vehicle and sustained a fractured tibia.

She sought statutory accident benefits for chiropractic and active rehabilitation therapy.

The insurer disputed the reasonableness of the treatment and the fees charged by the clinics.

The arbitrator found that the treatment was reasonable and necessary to assist in the applicant's recovery, but determined that the frequency and duration of the treatments, as well as the fees charged by the clinics, were excessive.

The arbitrator reduced the compensable sessions and the hourly rates, awarding $1,080.50 for chiropractic expenses and $635 for rehabilitation expenses, plus interest.

The applicant's husband died after suffering a heart attack while driving his vehicle, which subsequently veered off the road and struck a planter and a pole.

The applicant sought death benefits and funeral expenses under the Statutory Accident Benefits Schedule.

The insurer denied the claim, arguing the death was not caused by an 'accident'.

The arbitrator found that the heart attack, stemming from a pre-existing condition, was an intervening force and the direct cause of death, not the use or operation of the vehicle.

The application for arbitration was dismissed.

The Applicant was injured in a motor vehicle accident during the course of his employment and initially elected to receive workers' compensation benefits.

After his condition worsened and he underwent spinal surgeries, he withdrew his election to pursue a tort claim and claim statutory accident benefits.

The Insurer raised preliminary objections that the application was out of time under subsection 32(1) of the Schedule and that the election to sue was made primarily to claim accident benefits under section 59.

The Arbitrator dismissed both objections, finding the Applicant had a reasonable explanation for the delay and that his re-election was motivated by a genuine belief he could achieve greater recovery through a tort action.

The applicant sought clarification of the amount owing by the insurer for physiotherapy treatments following a previous arbitration decision.

The arbitrator determined that the previous findings only applied to physiotherapy treatments, not other services provided by the clinic.

The arbitrator calculated that the insurer owed an additional $500 for the 48 approved sessions.

Furthermore, the arbitrator held that interest at 2% per month compounded was payable on the overdue amounts from June 30, 1999, as the determination that the expenses were reasonable implies they were reasonable all along.

The applicant, a truck driver, was assaulted and shot by unknown assailants after he exited his parked truck to ask for directions in Miami, Florida.

He applied for statutory accident benefits, which the insurer denied on the basis that the incident was not an 'accident' under the Schedule.

The arbitrator found that the assault was an intervening act from an independent source, breaking the chain of causation.

Therefore, the injuries were not directly caused by the use or operation of an automobile, and the application for benefits was dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them on June 25, 1997.

The applicant later attempted to return to school and work but was unable to continue.

He applied for arbitration on February 28, 2000, seeking reinstatement of IRBs from May 1999 onwards.

The insurer argued the application was time-barred under the two-year limitation period in the Insurance Act and the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant failed to request reinstatement of benefits after his temporary return to work, meaning there was no new refusal by the insurer to trigger a new limitation period.

The application was dismissed as time-barred.

The applicant was injured in a motor vehicle accident and sought payment from her insurer for a multidisciplinary assessment, including a medical assessment and a Functional Abilities Evaluation (FAE), after the insurer denied further treatment based on a prior Designated Assessment Centre (DAC) report.

The arbitrator found that the medical assessment was a reasonable expense as it provided necessary treatment recommendations that the DAC report lacked.

However, the FAE was deemed unreasonable as it duplicated a recent assessment without justification.

The arbitrator dismissed the applicant's claim for a special award, finding the insurer's conduct did not amount to unreasonably withholding benefits.

Due to the applicant's representative's unfounded allegations of bias and obstructive conduct, no expenses were awarded to the applicant despite her partial success.

The applicant, a visiting mental health nurse, was injured in a motor vehicle accident and received income replacement benefits.

She attempted a graduated return-to-work program coordinated by the insurer, but struggled with physical pain and psychological difficulties.

The insurer terminated her benefits based on assessments indicating she was no longer physically disabled.

The arbitrator found that while the applicant was physically capable of performing most tasks, the demanding and stressful nature of her job, which involved treating acutely psychotic patients alone in the community, meant she was substantially disabled by her accident-related depression.

The arbitrator awarded ongoing income replacement benefits, certain medical and rehabilitation expenses, but denied the applicant's claim for a special award and the insurer's claim for repayment of benefits.

The applicant was injured in a head-on motor vehicle collision and sought payment for physiotherapy treatment at Recovery Rehab.

The insurer refused to pay the full amount, arguing the treatment was excessive and relying on a DAC assessment that concluded the treatment was not reasonable or necessary.

The arbitrator found that the treatment was reasonable up to the date the DAC report was received, as the applicant's severe psychological symptoms warranted a halt in physiotherapy pending psychiatric treatment.

The arbitrator also found the clinic's $100 per session fee to be reasonable.

The insurer was ordered to pay the outstanding account for the reasonable sessions and the applicant's arbitration expenses.

The applicants were injured in a motor vehicle accident and received statutory accident benefits.

The insurer terminated the wife's income replacement benefits and denied the husband's non-earner benefits.

The insurer brought a motion requesting that the applicants attend an insurer's examination with an orthopaedic specialist.

The arbitrator found the request reasonable, noting that the applicants had not been assessed by the insurer's experts in three years and new medical information had recently been provided by the applicants' treating practitioners.

The applicant was seriously injured in a motor vehicle accident in India in 1994 that killed three family members.

He applied for statutory accident benefits in 1998, approximately three and a half years after the 30-day time limit.

The insurer refused to pay benefits due to the delay.

The arbitrator found that the applicant had a reasonable excuse for the delay under subsection 59(4) of the Schedule, as his father had reasonably relied on incorrect advice from an insurance agent that coverage did not extend to overseas accidents, and acted expeditiously once he received correct legal advice.

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

The applicant applied for arbitration.

Prior to the hearing, the applicant advised he had been laid off due to his injuries, prompting the insurer to request an Insurer's Examination (IE) with a new doctor.

The applicant refused to attend, arguing the request was unjustified and prejudicial.

On a preliminary motion, the arbitrator held that the insurer's request was reasonably necessary given the significant change in the applicant's employment status.

The arbitration was adjourned pending the applicant's attendance at the IE.

The applicant sought statutory accident benefits for physiotherapy expenses after allegedly being struck by a slow-moving vehicle while walking on a sidewalk.

The insurer denied the claim, arguing there was no contact between the vehicle and the applicant.

The arbitrator found the applicant's version of events credible, supported by her immediate actions and her family doctor's evidence, despite her misrepresentations regarding her employment status.

The arbitrator concluded the applicant sustained an impairment from the accident and awarded the physiotherapy expenses, but dismissed claims for a special award and the insurer's assessment fee.

The applicant sought statutory accident benefits, alleging she was injured when a public transit bus she was riding collided with another vehicle.

The insurer denied the claim on the basis that it had no record of the accident.

At the arbitration hearing, the applicant testified about the collision, but her evidence contained inconsistencies regarding the date, location, and route.

The insurer presented evidence from several employees detailing the transit authority's comprehensive accident reporting and vehicle tracking systems.

The tracking data demonstrated that the specific bus the applicant identified was across the city at the time, and no buses travelled the alleged route during the relevant timeframe.

The arbitrator concluded the applicant failed to prove on a balance of probabilities that the accident occurred and dismissed the claim.

The arbitrator issued a correction to a previous arbitration decision regarding a death benefit.

The original decision incorrectly awarded $10,250.46 under subsection 51(5) of the Statutory Accident Benefits Schedule.

The arbitrator corrected the amount to $10,000, which was the proper amount payable under Ontario Regulation 776/93 for an accident that occurred in 1994.

The applicant's two children were killed in a motor vehicle accident in India.

She applied for death benefits and funeral expenses over three years later.

The arbitrator held that territorial limits in the Insurance Act do not preclude accident benefits for out-of-country accidents.

The arbitrator also found that the applicant's profound grief, physical disability, and reliance on her deceased daughter constituted a reasonable excuse for the late notice.

The applicant was awarded death benefits for both children, having established she was dependent on her daughter for care and her son was financially dependent on her, along with $7,200 for funeral expenses.

The applicant sought expenses following a successful arbitration for statutory accident benefits.

The parties disputed the number of hours for preparation, the applicable hourly rate, the amount of disbursements, and the insurer's claim for costs thrown away due to an earlier adjournment.

The arbitrator reduced the applicant's claimed preparation time and disbursements, set the hourly rate at $100, and allowed the insurer to set off 20 hours of costs thrown away at $67 per hour.

The insurer brought a motion to require the insured to attend a medical assessment with a physiatrist under subsection 23(2) of the Statutory Accident Benefits Schedule.

The insured opposed the assessment, arguing it was scheduled to bolster the insurer's upcoming variation application and that there would be insufficient time to review the report before the hearing.

The arbitrator found the assessment reasonable, noting the insured had not been assessed in over two years and the insurer has a right to assess the claim.

The motion was granted and the insured was ordered to attend the examination.

The applicant was injured in a motor vehicle accident and sought ongoing caregiver benefits and housekeeping expenses after the insurer terminated them.

The arbitrator found that the applicant met the test for a partial inability to carry on a normal life and a substantial inability to engage in pre-accident caregiving activities for a period following the termination, entitling her to caregiver benefits until August 1997, at which point video surveillance demonstrated she had regained significant capacity.

The arbitrator also awarded housekeeping expenses for varying hours per week up to April 1998, but declined to order a special award against the insurer.