Susan Naylor

The appellant appealed an arbitrator's decision denying him continued weekly benefits, care benefits, and medical and rehabilitation benefits following a motor vehicle accident.

The appellant, who represented himself, alleged fraud and misconduct by the insurer and its representatives.

The Director's Delegate found no merit in the fraud allegations and upheld the arbitrator's finding that the appellant was no longer substantially unable to perform his essential tasks by February 1994, relying in part on the testimony of the appellant's own family doctor.

The appeal was dismissed, and the appellant was ordered to pay the insurer's assessment fee of $500 for advancing vexatious allegations and abusing the Commission's process.

The insurer appealed an arbitrator's decision awarding the respondent ongoing weekly income benefits beyond the 156-week mark.

The respondent, a student at the time of the accident, suffered from chronic pain syndrome and post-traumatic headaches.

The Director's Delegate upheld the arbitrator's refusal to grant an adjournment for late-requested medical assessments, finding the request untimely.

The Delegate also upheld the finding that the respondent was continuously prevented from engaging in any suitable occupation or employment, noting the uncontradicted medical evidence supporting her severe limitations.

The appeal was dismissed.

The appellant, the sole voting shareholder of a family business, appealed an arbitrator's decision finding him to be self-employed rather than an employee for the purpose of calculating his weekly income replacement benefits.

The appellant argued that a salary scheme implemented shortly before his motor vehicle accident established an employer-employee relationship, which would have entitled him to higher benefits based on a four-week period.

The Director's Delegate upheld the arbitrator's finding that the salary arrangement was a tax management strategy rather than a true employment contract, noting the lack of a consistent pattern of salary payments and the company's financial history.

The appeal was dismissed, and the arbitrator's disallowance of expenses for the appellant's accountant was also upheld.

The Director's Delegate issued a correction to an appeal decision dated February 27, 1997.

The correction amended a typographical error in the first paragraph of the reasons for decision, changing the stated date of the appellant's automobile accident from September 1, 1993, to the correct date of September 10, 1993.

The appellant insurer appealed an arbitrator's decision finding it responsible for paying the insured's statutory accident benefits.

The appellant also sought to vary the order to introduce fresh evidence regarding a commercial use exclusion, arguing the insured was carrying a passenger for compensation at the time of the accident.

The Director's Delegate dismissed the appeal and the application for variation, finding that the appellant failed to exercise due diligence in obtaining the evidence for the initial hearing and that the arbitrator reasonably concluded the insured had elected to claim benefits from the appellant.

The appellant insurer appealed an arbitrator's decision finding it liable to pay statutory accident benefits to the respondent, who was injured while driving a rented taxicab.

The respondent had a personal vehicle insured with the appellant but was not a named insured on the taxicab's fleet policy.

The appellant argued that its policy excluded coverage for vehicles used as taxicabs.

The Director's Delegate dismissed the appeal, holding that the broad definition of 'insured person' in the Statutory Accident Benefits Schedule prevailed over the exclusions in the standard owner's policy.

Furthermore, the respondent was not a named insured under the taxicab's policy for the purposes of the priority rules in section 268 of the Insurance Act.

The claimant was injured while driving a taxicab insured by Simcoe & Erie.

He also owned a personal vehicle insured by State Farm.

State Farm argued it was not liable to pay statutory accident benefits because its policy excluded coverage while the automobile was used as a taxicab.

The Director's Delegate held that the broad definition of 'insured person' in the Statutory Accident Benefits Schedule prevailed over the exclusionary language in the standard Owner's Policy.

Under the priority rules in section 268(2) of the Insurance Act, the claimant was required to claim benefits from State Farm, the insurer of his personal vehicle, despite the accident involving a taxicab.

The appellant appealed an arbitrator's decision denying her ongoing weekly benefits following a motor vehicle accident.

The arbitrator had found that the appellant's ongoing pain did not substantially disable her from performing her normal and essential tasks, basing this largely on an unfavourable assessment of her credibility.

On appeal, the Director's Delegate held that there was no basis to interfere with the arbitrator's credibility findings or evaluation of the evidence.

The appeal was dismissed, and the appellant was denied her appeal expenses.

The appellant was injured in a motor vehicle accident in the course of his employment.

He initially received statutory accident benefits, then elected to receive workers' compensation benefits, and later re-elected to pursue a tort action and re-applied for accident benefits.

The arbitrator held that the appellant did not meet the conditions for receipt of statutory accident benefits under section 21 of the Statutory Accident Benefits Schedule because he had already received workers' compensation benefits.

The Director's Delegate dismissed the appeal, confirming that the appellant was excluded from receiving further accident benefits.

The Delegate also rejected the appellant's argument that a binding settlement had been reached, finding that the insurer's settlement offer expired when the arbitrator's decision was issued.

The Director's Delegate issued a correction to an appeal order dated May 2, 1997.

The correction amended a sentence in the first paragraph to clarify that the arbitrator granted the appellant his arbitration expenses, rather than his appeal expenses.

The appellant appealed an arbitrator's decision denying him weekly income benefits following a motor vehicle accident.

The appellant, who was self-represented on appeal, argued that he was denied a fair hearing because of inadequate interpretation services during the arbitration, particularly during his lawyer's closing submissions.

The Director's Delegate found that while there were minor interpretation issues, they did not affect the fairness of the hearing or result in an injustice.

The insurer's request for a special award on the basis that the appeal was frivolous or vexatious was denied, as the appellant's concerns were not groundless.

The appeal was dismissed and no expenses were awarded.

The appellant appealed an arbitrator's order denying him continued weekly income benefits following a motor vehicle accident.

The arbitrator had found the appellant's medical evidence compromised due to his failure to disclose prior accidents to his treating physicians and discrepancies between his reported limitations and surveillance footage.

The Director's Delegate dismissed the appeal, holding that the arbitrator's credibility findings and assessment of the medical evidence were supported by the record and should not be interfered with.

The appellant's request for appeal expenses was also denied as the appeal did not raise a significant issue.

The insurer appealed a preliminary arbitration order that refused to stay or adjourn the main hearing after the insured refused to attend requested neuropsychological and psychiatric examinations.

The Director's Delegate dismissed the appeal regarding the neuropsychological assessment, finding the insurer's late request amounted to trial brinkmanship.

However, the appeal was allowed regarding the psychiatric examination.

The Director's Delegate found the insurer acted reasonably and without undue delay in requesting the psychiatric assessment after new medical evidence suggested a mood disorder, and ordered the hearing adjourned if the insured failed to attend.

The appellant, a registered nurse working on an 'as-needed' basis for home-care agencies, was injured in a motor vehicle accident.

The insurer re-classified her weekly income benefits from section 12 (employment-related) to section 13 (non-earner) because she was not on an active assignment at the time of the accident.

The arbitrator upheld this re-classification.

On appeal, the Director's Delegate rescinded the arbitrator's order, finding that the appellant maintained an ongoing employment relationship with the agencies despite the fluctuating nature of her assignments.

The appeal was allowed, and the appellant was found to qualify for weekly income benefits under section 12(2) of the Schedule.

The appellant, who was injured in a motor vehicle accident, appealed an arbitration order limiting his weekly income benefits to the minimum rate of $185.60.

He claimed entitlement to the maximum $600 per week based on his self-employment income from a moving business.

The Director's Delegate dismissed the appeal, upholding the arbitrator's finding that the appellant's business records were unreliable and his testimony lacked credibility.

The appellant failed to meet the onus of establishing his pre-accident income and expenses on a balance of probabilities.

The appellant appealed an arbitration order denying her additional weekly income benefits following a motor vehicle accident.

The arbitrator had found that the appellant was not substantially unable to perform the essential tasks of her pre-accident employment, relying on a Functional Capacities Assessment and the opinions of several medical specialists.

On appeal, the Director's Delegate held that the arbitrator's findings were supported by the evidence and declined to interfere with his assessment of the medical reports and witness credibility.

The appeal was dismissed, and no appeal expenses were awarded.

The respondent pedestrian was struck and injured by a backhoe in a construction zone.

She claimed statutory accident benefits under her personal automobile insurance policy with the appellant.

The appellant denied coverage, arguing the backhoe was not an 'automobile' under the Insurance Act or the Statutory Accident Benefits Schedule.

The arbitrator found the backhoe was an automobile.

On appeal, the Director's Delegate upheld the decision, finding that the broad definition of 'automobile' in section 1 of the Insurance Act, which includes self-propelled vehicles, applied and was not ousted by section 224(1).

The respondent was seriously injured in a stock car racing accident at Mosport International Speedway.

He sought statutory accident benefits under his personal motor vehicle liability policy with the appellant insurer, arguing that the uninsured stock car was an "automobile" under the Insurance Act.

The arbitrator allowed the claim.

On appeal, the Director's Delegate rescinded the arbitrator's decision, holding that a custom-built stock car used exclusively for racing on a closed track is not an "automobile" for the purposes of the Statutory Accident Benefits Schedule.

The appeal was allowed and the claim for accident benefits was denied.

The appellant was severely injured in a motor vehicle accident and received weekly income benefits for three years.

After 156 weeks, the insurer terminated benefits on the basis that she was no longer continuously prevented from engaging in any occupation or employment for which she was reasonably suited.

The arbitrator found that while the appellant could not return to her pre-accident work as a self-employed computer consultant, she was capable of working in less complex roles within the computer industry.

On appeal, the Director's Delegate upheld the arbitrator's decision, finding no error in the conclusion that suitable, flexible employment was available to the appellant.

The claimant was injured while preparing to unload his transport truck when a forklift dropped a steel plate on his feet.

He claimed statutory accident benefits.

The arbitrator found that the injuries were caused by the use or operation of the truck, and that the claimant's personal auto insurer (Royal), rather than the truck's fleet insurer (Markel), was liable to pay the benefits because the claimant was a 'named insured' under his personal policy but not under the fleet policy.

Royal appealed.

The Director's Delegate dismissed the appeal, confirming that the injuries arose from the use or operation of the vehicle and that Royal was the priority insurer under section 268(2) of the Insurance Act.

Royal was ordered to repay Markel the benefits it had already paid.