Shemin Manji

The applicant was injured in an automobile accident and applied for weekly disability benefits.

Prior to the accident, she was receiving a CPP disability pension, which she continued to receive.

The insurer deducted the CPP disability pension from her weekly disability benefits, arguing they were 'temporary disability benefits' under section 75(4)1 of the Statutory Accident Benefits Schedule.

The arbitrator held that CPP disability benefits are of long and indefinite duration and do not fall within the definition of 'temporary disability benefits'.

Therefore, the insurer was not entitled to deduct the CPP disability pension from the applicant's weekly disability benefits.

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

Allianz paid benefits but later disputed its obligation, arguing that General Accident was the priority insurer.

The insurers disputed whether Ontario Regulation 283/95, which mandates private arbitration for priority disputes, applied retroactively to this case.

The arbitrator held that the Regulation does not apply retroactively to disputes where the application for benefits was received before the Regulation came into force.

On the priority issue, the arbitrator found that the applicant's representative had made a valid election under section 268(5) of the Insurance Act to claim benefits from Allianz, and therefore Allianz was required to pay the benefits.

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

The applicant applied for arbitration more than two years after the insurer's refusal to pay ongoing benefits.

The applicant failed to attend the hearing.

The arbitrator proceeded in the applicant's absence and held that the applicant was barred from proceeding to arbitration for ongoing weekly income benefits due to the expiry of the two-year limitation period under the Insurance Act.

However, the applicant was not barred from arbitrating the quantum of the weekly benefits previously paid, as the insurer had not provided a proper notice of refusal regarding the amount.

The applicant sought statutory accident benefits after allegedly slipping and falling while exiting a bus.

The insurer denied the claim, arguing the incident was not an 'accident' under the Schedule and that the applicant failed to submit her application within 90 days.

The arbitrator found that the applicant fell while alighting from the bus, meaning the use or operation of an automobile caused the incident.

Furthermore, although the applicant failed to submit the application within 90 days, the insurer was estopped from relying on this defence due to the adjuster's representations that the claim was being processed.

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

The insurer had paid weekly benefits and physiotherapy expenses but terminated them, arguing the applicant no longer suffered a substantial inability to perform essential tasks, and sought repayment of benefits paid after March 1992.

The arbitrator found the applicant and her family physician lacked credibility, noting they had deliberately withheld information about significant pre-existing conditions and a prior work-related accident.

Concluding that the motor vehicle accident did not materially aggravate her pre-existing conditions, the arbitrator dismissed the claims for ongoing benefits and ordered the applicant to repay the weekly benefits and physiotherapy expenses received after March 16, 1992.

The applicant's claim for arbitration expenses was also denied.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until May 1992.

He sought further weekly benefits, rehabilitation expenses, and a special award.

The arbitrator found the applicant lacked credibility and that he was substantially able to perform his essential tasks after May 1992, dismissing the claim for ongoing weekly benefits.

Furthermore, the arbitrator found the applicant had attended school full-time between January and May 1992, precluding him from receiving benefits during that period, and ordered him to repay the benefits received.

The insurer was ordered to pay an outstanding rehabilitation account that had been pre-approved.

The insurer was also awarded $500 because the applicant's conduct unreasonably prolonged the proceedings and parts of the claim were without merit.

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

He sought a declaration at arbitration regarding his entitlement to payment for expenses incurred by his rehabilitation case manager for communicating with his solicitors, despite all accounts having been paid in full by the insurer.

The insurer objected on the basis that there was no substantive dispute.

The arbitrator dismissed the application, finding that an arbitrator has no jurisdiction under the Insurance Act to make pronouncements or issue guidelines in the absence of a specific dispute over entitlement or quantum of benefits.

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

The applicant sought arbitration, arguing that the benefits were terminated prematurely and that she met the post-156 week eligibility test.

The arbitrator held that the 156-week period in section 12(5)(b) of the Statutory Accident Benefits Schedule refers to 156 weeks of disability, meaning the benefits were not terminated prematurely.

Furthermore, the arbitrator found that the applicant was capable of returning to full-time employment with restrictions and had not made a bona fide effort to find suitable employment.

The application for ongoing weekly income benefits was dismissed.

The applicant was injured in a motor vehicle accident and received weekly benefits of $185 as an unemployed person.

He applied for arbitration, claiming he had a legitimate offer of employment at the time of the accident and was entitled to $600 per week.

The arbitrator found the applicant and his prospective employer lacked credibility and concluded there was no legitimate offer of employment at the time of the accident.

The application for increased benefits and expenses was dismissed.

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

After her benefits were terminated, she applied for arbitration to reinstate weekly income and housekeeping benefits.

During the arbitration hearing, the insurer moved to include claims for repayment of benefits previously paid, alleging they were paid in error.

The arbitrator allowed the insurer to add the repayment claims for weekly income and housekeeping benefits, finding they naturally flowed from the issues in dispute, but granted the applicant an adjournment to respond.

The applicant subsequently withdrew her application for arbitration and moved for her expenses.

The arbitrator awarded the applicant her expenses, finding the insurer failed to raise the repayment issues in a timely manner, which would have minimized expenses.

The applicants, parents of a 23-year-old who died in a motorcycle accident, applied for death benefits under the Statutory Accident Benefits Schedule.

The insurer denied the claim on the basis that the parents were not "dependants" of the deceased at the time of the accident.

The arbitrator found that the parents failed to establish that they were principally dependent for financial support on the deceased, as their income from social assistance and workers' compensation exceeded the financial contributions made by the deceased.

The claim for death benefits was dismissed.

The insurer's request for an award for a frivolous arbitration was denied, and the applicants were awarded their arbitration expenses.

The applicant was injured when he slipped on ice while exiting his van.

The insurer denied his claim for statutory accident benefits on the basis that the injury was not caused by an 'accident' as defined in section 2 of the Statutory Accident Benefits Schedule.

The arbitrator applied the broad interpretation from the Supreme Court of Canada's decision in Amos, finding that exiting a vehicle is an ordinary and well-known activity to which automobiles are put, and that the use of the van contributed to the injury.

The arbitrator concluded that the applicant was injured in an accident and is eligible for benefits.

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

The insurer terminated benefits, arguing she did not meet the post-156 week disability test under section 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator found that while the applicant was reasonably suited for light assembly work or her pre-accident work as a motor repair technician, she required a graduated work hardening program to build up her working tolerance before returning to full-time employment.

The arbitrator ordered the insurer to pay ongoing weekly income benefits until the completion of the recommended work hardening program.

The Applicant was struck by a car and claimed statutory accident benefits, including weekly income benefits and supplementary medical and rehabilitation benefits.

The Insurer terminated weekly income benefits, arguing the Applicant could return to work as a car salesman.

The Applicant claimed ongoing disability due to a head injury causing cognitive and psychological impairments.

The Arbitrator found that the Applicant's ongoing impairments were rooted in a severe pre-existing personality disorder and not the accident.

Claims for weekly income benefits and case management services were dismissed.

However, the Arbitrator awarded certain transportation expenses and a special award of $100 because the Insurer unreasonably withheld payment of transportation expenses pending the dispute.

The applicant was injured in a motor vehicle accident while a passenger on a bus.

She received weekly income benefits until they were terminated by the insurer.

The applicant sought reinstatement of weekly income benefits and payment for a secretarial course as a rehabilitation expense.

The arbitrator found that the applicant did not suffer a substantial inability to perform her pre-accident employment immediately following the termination of benefits, but that a subsequent brief return to work exacerbated her condition, entitling her to benefits thereafter.

The claim for the cost of the secretarial course was dismissed as the applicant failed to prove it was a reasonable and suitable rehabilitation expense given her physical limitations.

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

The parties subsequently met and the applicant signed a release in exchange for a $2,000 lump sum payment.

The applicant later sought to arbitrate her entitlement to further benefits, alleging she did not sign the release, or alternatively, that the settlement was vitiated by mistake, duress, or inequality of bargaining power.

The arbitrator found that the applicant did sign the release, relying on expert handwriting evidence, and that there were no vitiating factors.

The arbitration was deemed frivolous and an abuse of process, and the applicant was ordered to pay $1,000 to the insurer.

The applicant was injured in a motor vehicle accident while driving in her apartment building's parking lot.

She did not hold a valid driver's licence.

The insurer terminated her weekly benefits and sought repayment, arguing she was disqualified under section 17(1)(d) of the Statutory Accident Benefits Schedule because she was not authorized by law to drive.

The arbitrator held that the parking lot was not a 'highway' under the Highway Traffic Act, and therefore no licence was required to drive there.

As the law does not require authorization to drive off a highway, the applicant was not 'unauthorized by law' and was not disqualified from receiving benefits.

The insurer's claim for repayment was dismissed.

The applicant was injured while standing on a bus that stopped suddenly.

She received weekly income benefits until September 13, 1992, and sought further benefits up to February 28, 1993, along with a special award and expenses.

The arbitrator dismissed the claims, finding the applicant lacked credibility due to significant inconsistencies in her accounts of the accident and her failure to disclose prior injuries to assessing doctors.

The medical reports supporting her claim were deemed unhelpful as they relied on her inaccurate history.

The insurer's termination of benefits was found to be reasonable, and expenses were denied due to the applicant's lack of candour.

The applicant withdrew his application for statutory accident benefits but sought his legal expenses for the arbitration.

The insurer opposed and sought costs against the applicant and his representatives, arguing the proceeding was an abuse of process.

The arbitrator denied the applicant's request for expenses, finding his conduct unreasonably prolonged the proceedings.

The arbitrator awarded the insurer $1,000 against the applicant under section 282(11.2) of the Insurance Act due to his failure to comply with undertakings and production orders.

The insurer's request for costs against the applicant's representatives was denied for lack of statutory authority.

The applicant was injured in a motor vehicle accident and received weekly income benefits based on his part-time employment.

He claimed entitlement to increased benefits based on an alleged offer of full-time employment made prior to the accident.

The arbitrator found the evidence regarding the offer of employment to be confusing, inconsistent, and lacking sufficient written corroboration.

The claim for increased benefits was dismissed, and the applicant was denied his arbitration expenses.