Shemin Manji

The applicant was injured in a motor vehicle accident and claimed income replacement benefits for his employment as a bus driver and for a separate arrangement where he provided landscaping services in exchange for free accommodation.

The insurer terminated benefits, arguing the applicant was not substantially disabled from his bus driver position and that the landscaping arrangement did not constitute employment.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of both jobs due to his back impairment and reduced tolerance for prolonged sitting.

The arbitrator also held that the barter arrangement for accommodation constituted employment under the Schedule.

The applicant was awarded income replacement benefits for both employments, subject to deductions for collateral benefits and post-accident income, as well as his arbitration expenses.

The applicant, a visiting homemaker, was struck by a motor vehicle and received income replacement benefits until the insurer terminated them, claiming she could return to work.

The applicant sought reinstatement of benefits, arguing she suffered from benign paroxysmal positional vertigo and soft tissue injuries preventing her from working.

The arbitrator found that while the soft tissue injuries did not prevent her from working, the vertigo caused a substantial inability to perform the essential tasks of her pre-accident employment.

The applicant was awarded ongoing income replacement benefits but denied the cost of a multidisciplinary assessment.

The applicant applied for arbitration of a dispute over statutory accident benefits but subsequently disappeared and failed to attend pre-hearing discussions or the arbitration hearing.

The arbitrator found that the applicant had constructively withdrawn his application and that his failure to pursue the claims amounted to an abuse of process.

The application was deemed withdrawn, and the applicant was ordered to pay the insurer's assessment fee of $3,000 and its arbitration expenses of $716.90.

The applicant sought her expenses for an arbitration proceeding regarding statutory accident benefits following the death of her common-law spouse.

The arbitrator denied the applicant's request for expenses, finding that her claim to be the sole spouse was without merit given overwhelming evidence of the deceased's prior undissolved marriage, and that her conduct and that of her counsel unreasonably prolonged the hearing.

The insurer's request for its assessment fee under subsection 282(11.2) of the Insurance Act was also dismissed because the applicant's claim was not entirely frivolous, as she had succeeded on a claim for interest.

The insurer brought a motion for interim expenses against the applicant due to the conduct of the applicant's counsel.

The applicant's counsel failed to attend a scheduled pre-hearing discussion without a reasonable excuse and failed to comply with undertakings to produce medical authorizations and an OHIP summary within the required timelines.

The arbitrator found that the counsel's conduct prejudiced the insurer and frustrated the Commission's mandate to facilitate settlement.

The arbitrator ordered the applicant to pay $300 in interim expenses to the insurer, noting that the award should ideally be paid personally by the counsel.

The applicant sought statutory accident benefits, claiming he was an occupant of an insured vehicle involved in a collision.

The insurer denied benefits on the basis that the applicant was not an occupant of the vehicle at the time of the accident.

The arbitrator found the applicant's evidence to be inconsistent and unreliable, and preferred the evidence of the third-party driver and the insurer's accident reconstruction experts.

The arbitrator concluded that the applicant was not an occupant of the vehicle and therefore not an insured person entitled to benefits.

The application was dismissed, and the applicant was ordered to pay $3,000 to the insurer for commencing a frivolous and vexatious arbitration.

The applicants were injured in a motor vehicle accident and sought statutory accident benefits for caregiving, housekeeping, and medical devices.

The insurer denied the claims.

At arbitration, the arbitrator found the applicants' evidence lacked credibility and was contradicted by medical certificates and school records.

The applicants failed to establish that they suffered impairments substantially preventing them from performing their pre-accident activities, or that the claimed expenses were reasonable, necessary, and actually incurred.

All claims for benefits and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

After failing to attend the arbitration hearing despite proper notice, the arbitrator proceeded in his absence.

Relying on the insurer's uncontradicted expert evidence that the claimed injuries could not have resulted from the minor impact, the arbitrator dismissed the claims.

Finding the applicant's failure to pursue his claims to be vexatious and an abuse of process, the arbitrator ordered the applicant to pay $1,000 in expenses to the insurer.

The applicant sought full death benefits and an additional dependant benefit following the death of her common-law spouse in a motor vehicle accident.

The insurer paid only half the death benefit, arguing the deceased was legally married to another woman in China in 1941.

The arbitrator found that a valid traditional Chinese marriage had occurred, meaning the deceased had two spouses at the time of the accident, and the applicant was therefore only entitled to half the death benefit.

The arbitrator also dismissed the claim for the dependant benefit, finding the applicant was not principally dependent on the deceased for financial support.

However, the insurer was ordered to pay statutory interest on the overdue benefit payments.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to weekly income benefits and rehabilitation expenses.

The insurer terminated benefits and sought repayment, alleging the applicant was not employed at the time of the accident and misrepresented his condition.

The arbitrator found the applicant lacked credibility, having concealed a pre-existing work-related knee injury and a prior severe head injury from both the insurer and medical assessors.

The arbitrator concluded the applicant was not employed at the time of the accident and did not suffer an ongoing disability caused by the accident.

The applicant's claims were dismissed, and the insurer was granted repayment of the weekly income benefits paid, as they were induced by the applicant's culpable error and failed to account for deductible workers' compensation benefits.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including weekly income replacement benefits.

The insurer refused to pay, and the applicant brought a motion for an interim order for payment of $185 per week pending arbitration.

The arbitrator dismissed the motion, finding that while the medical evidence established a substantial inability to perform pre-accident work, there was evidence the applicant had returned to modified work and received post-accident income.

The applicant failed to provide sufficient financial information to establish a prima facie case for entitlement to the minimum benefit after accounting for potential deductions.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from Wawanesa, who denied coverage alleging the policy was void due to misrepresentation and had been terminated prior to the accident.

The applicant then applied to Guarantee, the insurer of the other vehicle, who argued Wawanesa was responsible.

The arbitrator held that Ontario Regulation 283/95 did not apply retroactively to this dispute.

The arbitrator further found that Wawanesa failed to properly terminate the policy because the premium refund did not accompany the notice of termination as required by statutory condition 12 of the Insurance Act.

Additionally, the applicant's misrepresentations did not render the policy void ab initio for the purpose of statutory accident benefits.

Wawanesa was ordered to pay the benefits.

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

The insurer refused to pay, arguing the applicant failed to notify them of his intention to apply within 30 days as required by subsection 59(1) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant did not notify the insurer until 87 days after the accident and lacked a reasonable excuse for the delay.

The application for arbitration was dismissed.

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

The insurer subsequently terminated weekly income benefits, housekeeping services, and certain medical and rehabilitation benefits.

The applicant applied for arbitration to dispute the terminations and claim additional expenses, including treatment at a US medical centre.

The arbitrator found the applicant lacked credibility, having misrepresented her pre-accident income, employment activities, and health history.

The arbitrator concluded the applicant's soft tissue injuries had healed and she was not substantially unable to perform the essential tasks of her pre-accident employment.

All claims for ongoing benefits, medical expenses, transportation, a special award, and arbitration expenses were dismissed.

The applicant was injured in a motor vehicle accident and received weekly income benefits until she was released to return to work.

She later suffered a relapse and applied for reinstatement of benefits more than two years after the accident.

The insurer refused, arguing the new claim was time-barred under section 22 of the Statutory Accident Benefits Schedule and precluded by sections 12 and 16.

The arbitrator held that section 22 does not apply to a further claim where initial notice was properly given, and that sections 12 and 16 do not permanently terminate eligibility for benefits if the applicant can reestablish disability resulting from the accident.

The insurer's preliminary objection was dismissed.

The applicant applied for statutory accident benefits after a motor vehicle accident in his employer's parking lot.

The insurer denied the claim, arguing the applicant was entitled to workers' compensation benefits.

At mediation, the parties reached a tentative agreement, but the insurer later refused to pay upon learning the Workers' Compensation Board had allowed the applicant's claim for health care benefits while denying lost time benefits.

The Arbitrator held that the mediation agreement was based on a misunderstanding and was not binding.

Furthermore, because the applicant was entitled to receive some workers' compensation benefits, section 20 of the Statutory Accident Benefits Schedule precluded him from receiving accident benefits.

He was also not entitled to interim benefits under section 21 because he had elected to receive workers' compensation benefits and the WCB had already determined his entitlement.

The insurer sought to enforce a previous arbitration decision ordering the applicant to repay weekly benefits and physiotherapy payments, but the exact amounts were not specified.

The hearing was reconvened to determine the amounts.

The applicant did not dispute the amounts but requested the hearing be reopened to order her family physician and the physiotherapy clinics to repay the amounts instead, alleging they were responsible for the misrepresentations.

The arbitrator dismissed the request, finding no statutory authority to vary the final decision or to make orders against non-parties, and declined to exercise discretion to reopen the hearing.

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

The applicant applied for arbitration.

At a pre-hearing, the insurer requested that the applicant attend independent medical examinations by a psychiatrist and a physiatrist under section 23(2) of the Schedule.

The applicant refused, arguing the requests were unreasonable given previous examinations.

The arbitrator found the requests reasonable because the insurer had little current medical information, the applicant's condition was evolving, and over a year and a half had passed since her last insurer examinations.

The applicant was ordered to attend, and the insurer was ordered to provide the resulting reports at least four weeks before the arbitration hearing.

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

The insurer subsequently disputed his entitlement, arguing he was an employee entitled to workers' compensation benefits.

At a preliminary issue hearing, the arbitrator found the applicant failed to produce required corporate and financial documents, drawing adverse inferences against him.

The arbitrator concluded the applicant was entitled to workers' compensation benefits and had initiated a tort action primarily to claim accident benefits, thus excluding him from SABS coverage under s. 76.

The insurer's claim for repayment of over $109,000 in benefits was dismissed for lack of evidence of fraud or misrepresentation.

The applicant was ordered to pay the insurer's $2,000 assessment fee for commencing a frivolous arbitration.

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

The applicant commenced a court action and subsequently applied for mediation and arbitration at the Ontario Insurance Commission.

The insurer argued the applicant must elect a single forum.

The arbitrator held that the applicant cannot proceed in both forums for the same issue and must withdraw her court action to continue the arbitration for weekly benefits.

Additionally, the arbitrator ruled that the applicant's claim for post-156 week benefits did not require separate mediation, as it was part of the same matter already mediated.