Stewart M. McMahon

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

The parties disputed her entitlement to weekly benefits beyond the 104-week mark.

Following an arbitration hearing, the arbitrator delivered oral reasons finding that the applicant remained continuously prevented from engaging in any occupation for which she was reasonably suited by education, training, or experience.

The applicant was awarded weekly benefits from June 23, 1995 onwards, along with interest and expenses.

The applicant sought statutory accident benefits after allegedly being struck by a school bus door.

The insurer denied she was involved in an accident and terminated benefits.

The arbitrator found that the applicant was indeed struck a glancing blow by the bus door, constituting an accident.

While the physical injuries were minor, the psychological response and exacerbation of pre-existing migraines resulted in a partial inability to carry on a normal life.

The arbitrator awarded caregiver benefits for a limited period, ongoing housekeeping expenses, physiotherapy, psychological counselling, and related travel expenses, but denied a special award and the cost of sunglasses.

The applicant was struck by a car while walking on a sidewalk, sustaining a head injury that resulted in chronic severe headaches.

The insurer paid weekly income benefits and medical benefits until November 1994, when it terminated benefits on the basis that the applicant was physically capable of returning to work.

The applicant applied for arbitration, seeking ongoing weekly income benefits and payment for chiropractic treatments.

The arbitrator found the applicant's subjective complaints of severe headaches to be credible and concluded that he was continuously prevented from engaging in any occupation for which he was reasonably suited, entitling him to ongoing weekly income benefits.

The arbitrator remained seized of the issue regarding the reasonableness of the chiropractic expenses due to insufficient evidence.

A post-hearing request by the insurer to reopen the proceedings to admit fresh evidence was dismissed, as the evidence could have been produced with due diligence and would not have changed the outcome.

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

The parties reached a settlement agreement for $3,500 in exchange for a full and final release.

The Applicant subsequently attempted to rescind the agreement by faxing a notice to the Ontario Insurance Commission, rather than the Insurer, and later cashed the settlement cheque.

The Arbitrator found that the Applicant failed to validly rescind the settlement within the two-day cooling-off period required by Regulation 664, as she did not deliver written notice to the Insurer and her actions confirmed the settlement.

The application for arbitration was dismissed.

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

The insurer terminated the weekly income benefits, arguing the applicant was no longer substantially unable to perform the essential tasks of his pre-accident employment as a videographer and newspaper worker.

The applicant applied for arbitration to reinstate the benefits and determine the proper quantum.

The arbitrator found that the applicant failed to prove a substantial inability to perform his essential tasks beyond the termination date, dismissing the claim for ongoing benefits.

However, the arbitrator determined the proper quantum of the weekly benefit was the maximum $600 per week, and therefore dismissed the insurer's claim for repayment of alleged overpayments.

The applicant was injured in a motor vehicle accident and received weekly income benefits until he returned to work.

After working for over a year, he left his employment due to chronic pain and substance abuse, and sought reinstatement of his benefits.

The arbitrator held that returning to work for more than 90 days under section 16(2) of the Schedule merely shifts the onus to the insured to re-establish disability, rather than acting as a complete bar.

The arbitrator also interpreted the 156-week period in section 12(5)(b) as 156 weeks of disability, not consecutive weeks from the accident.

Finding that the applicant's poor psychological health and substance abuse rendered him disabled, the arbitrator awarded weekly income benefits for the claimed period.

The applicant was injured in a motor vehicle accident and received statutory accident benefits before signing a full and final release in exchange for a lump sum settlement.

He later sought further benefits, arguing the settlement should be set aside due to misrepresentation, unconscionability, and undue influence.

The arbitrator held that while arbitrators can determine if a settlement agreement exists as a defence to a claim for benefits, they lack the equitable jurisdiction to set aside an otherwise valid agreement.

The applicant is precluded from proceeding with the arbitration until a court of competent jurisdiction sets aside the settlement agreement.

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

The applicant sought arbitration for continued benefits, claiming she remained substantially unable to perform the essential tasks of her employment as a store manager.

The arbitrator found the applicant's evidence unreliable and preferred the results of a functional capacity evaluation which indicated she was capable of returning to work.

The arbitrator concluded the applicant was not substantially disabled and dismissed the claim for further income benefits, but awarded the applicant her expenses for the arbitration.

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

The Insurer terminated weekly income benefits, and the Applicant applied for arbitration.

The Insurer argued that the parties had entered into a binding settlement prior to the arbitration hearing.

The Arbitrator held that under section 9.1 of the Settlement Regulation, the delivery of a written notice by the insurer is a pre-condition to entering into a settlement.

Because the cooling-off period had not commenced or expired before the Applicant rescinded the agreement, no binding settlement was entered into.

The Applicant was permitted to proceed with the arbitration.

The Applicant was injured in two motor vehicle accidents occurring four months apart.

The Insurer paid statutory accident benefits after the first accident but later terminated them.

Following the second accident, the Insurer resumed paying benefits, which the Applicant argued were a reinstatement of benefits for the first accident.

The Applicant applied for mediation more than two years after the initial termination.

The Arbitrator found that the Insurer's termination letter was clear and unequivocal, and the subsequent payments were attributable to the second accident.

Consequently, the Applicant's claim for benefits relating to the first accident was barred by the two-year limitation period under section 281(5) of the Insurance Act.