Susan Naylor

The appellant was injured in a motor vehicle accident and received weekly income benefits for three years until the insurer terminated them.

An arbitrator upheld the termination, finding the appellant could work in a clerical setting.

On appeal, the Director's Delegate found the arbitrator failed to address key medical evidence from the insurer's own orthopaedic specialist, who considered the appellant completely unfit to work.

The arbitrator also failed to explicitly rule on the period between the termination date and the hearing, and did not sufficiently analyze the appellant's pre-accident employment.

The appeal was allowed, the arbitration order rescinded, and the matter remitted for a new hearing.

The appellant was injured in a motor vehicle accident and received weekly income benefits for approximately two years before the insurer terminated them.

The arbitrator found that the appellant was not eligible for further benefits, concluding that his failure to resume employment was due to an unreasonable refusal to work rather than a genuine psychological disability.

On appeal, the appellant argued the arbitrator failed to give due weight to his psychiatrist's report and was biased.

The Director's Delegate dismissed the appeal, finding that the arbitrator's assessment of the evidence was reasonable and supported by the record.

The Delegate also refused to admit new medical evidence on appeal and upheld the arbitrator's decision to award the appellant only one-third of his arbitration expenses.

The respondent was injured when he rode his bicycle into a pothole after being distracted by the sound of a car engine starting.

He claimed statutory accident benefits under an automobile insurance policy.

The arbitrator found that the starting of the car engine constituted the use or operation of an automobile and was the precipitating cause of the injury.

The insurer appealed.

The Director's Delegate dismissed the appeal, holding that the phrase 'causes, directly or indirectly' in the Schedule allows for a more remote causal link than proximate cause, and that the starting of the engine triggered the sequence of events leading to the fall.

The appellant appealed an arbitrator's order allowing the respondent insurer to set off an award of arbitration expenses against an overpayment of statutory accident benefits owed by the appellant.

The appellant argued that the arbitrator lacked jurisdiction to order a set-off because it required the exercise of equitable jurisdiction.

The Director's Delegate dismissed the appeal, finding that the authority to order a set-off arises by necessary implication from the dispute resolution provisions of the Insurance Act, allowing the arbitrator to determine the ultimate balance to be paid between the parties.

The appellant was injured in a motor vehicle accident and developed severe fibromyalgia and chronic pain.

She appealed an arbitrator's decision denying her claims for various assistive devices, a hot tub, an electric bed, and replacement farm labour costs under the Statutory Accident Benefits Schedule.

The Director's Delegate upheld the arbitrator's denial of the hot tub, exercise equipment, and replacement farm labour, agreeing that the labour costs were a business expense rather than a rehabilitation need.

However, the Director's Delegate reversed the arbitrator's decision regarding the electric bed, finding it reasonably required for the appellant's rehabilitation to manage chronic pain.

The order was also varied to correct the calculation of CPP disability benefit deductions.

The insurer appealed an arbitrator's decision awarding the insured her arbitration expenses and refusing to order her to reimburse the insurer's assessment, despite finding that the insured was not entitled to further benefits and lacked credibility.

The Director's Delegate dismissed the appeal, holding that the arbitrator did not exercise her discretion unreasonably in finding that the application was not frivolous, vexatious, or an abuse of process.

The appellant applied for arbitration regarding accident benefits but withdrew her application shortly after the pre-hearing discussion.

The arbitrator found the application was entirely without merit, denied the appellant her arbitration expenses, and ordered a global penalty of $2,700 against the appellant and two other applicants under section 282(11.2) of the Insurance Act.

On appeal, the Director's Delegate upheld the denial of expenses and the finding that the application was frivolous and an abuse of process.

However, the Delegate amended the penalty order to impose individual liability of $900 on each applicant, rather than a global amount.

The appellant appealed an arbitrator's decision denying his claim for further statutory accident benefits and refusing to award him his arbitration expenses.

The appellant argued that under the McCormick criteria, expenses should only be denied if the application was manifestly frivolous or vexatious, which the arbitrator explicitly found it was not.

The Director's Delegate dismissed the appeal, holding that the McCormick criteria are not rigid rules and that an arbitrator has broad discretion to deny expenses where a claim lacks merit and the applicant's testimony lacks credibility, even if the conduct does not rise to the level of frivolous or vexatious.

The appellant appealed an arbitrator's decision denying her claim for weekly income benefits and refusing to award her arbitration expenses.

The arbitrator found that the appellant had deliberately withheld information from her doctors about a previous back injury.

On appeal, the appellant argued that under the McCormick principles, she should be awarded expenses because her claim was not found to be frivolous or vexatious, nor did her conduct unreasonably prolong the proceedings.

The Director's Delegate dismissed the appeal, holding that the arbitrator's discretion to deny expenses was exercised reasonably given the appellant's deliberate misrepresentation of her pre-accident health, which went to the heart of her evidence.

The appellant sought to appeal an arbitration order that dismissed his claim for statutory accident benefits after he failed to attend the arbitration hearing.

The notice of appeal was filed almost five months after the order, well beyond the 30-day limit.

The appellant requested an extension of time under section 283(3) of the Insurance Act, claiming he missed the hearing because he was misinformed about an adjournment and subsequently suffered a breakdown.

The Director's Delegate rejected the appellant's explanation as not credible and found no apparent grounds for granting relief on the merits of the claim.

The motion to extend the time was denied and the appeal was dismissed.

The appellant was injured in a motor vehicle accident but did not submit an application for statutory accident benefits until more than two years later.

The insurer denied the claim as out-of-time.

The appellant argued the insurer waived or was estopped from relying on the time limits because it failed to provide an application form, investigated the late claim, and obtained medical information without a non-waiver agreement.

The Director's Delegate upheld the arbitrator's decision, finding no intentional relinquishment of rights by the insurer and no detrimental reliance by the appellant.

The appeal was dismissed and expenses were denied.

The appellant insurer appealed an arbitration decision finding it responsible for paying the respondent pedestrian's accident benefits.

The pedestrian was struck by a vehicle insured by the appellant.

She applied for benefits under a policy held by her former common-law partner, insured by the respondent insurer.

The arbitrator found that the pedestrian and the named insured were not spouses at the time of the accident because they had ceased cohabiting for over a year.

On appeal, the Director's Delegate upheld the decision, finding that a temporal connection is implicit in the definition of "spouse" under the Insurance Act and the standard automobile policy, and that non-married spousal status ends when the parties cease to cohabit in a relationship of some permanence.

The appellant appealed an arbitration decision that denied his claim for ongoing weekly income benefits following a motor vehicle accident.

The appellant argued he was self-employed at the time of the accident or, alternatively, that his occupational tasks should be considered under the 'benefits if no income' test.

The Director's Delegate upheld the arbitrator's findings that the appellant had not resumed his self-employment at the time of the accident and that his previous occupational tasks were properly excluded from his normal tasks given the length of time since he last worked.

The appeal was dismissed.

The appellant was injured in a motor vehicle accident and received weekly income benefits based on her part-time factory job.

She appealed the arbitrator's decision, arguing her benefits should be higher because she was also self-employed as a street vendor at the time of the accident.

The Director's Delegate dismissed the appeal, finding that the appellant failed to prove she earned any actual income from her self-employment prior to the accident, and that claims for lost business opportunities or future loss of income are not payable under the Schedule.

The appellant appealed an arbitration order that terminated his weekly income benefits, ordered him to repay $16,233.06 in overpaid benefits, and required him to pay the insurer's $1,000 assessment fee.

On appeal, the appellant sought to introduce new evidence regarding his pre-accident employment and challenged the arbitrator's credibility findings and preference for the insurer's medical experts.

The Director's Delegate dismissed the appeal, denying the admission of new evidence because it could have been obtained with due diligence and would not have affected the outcome.

The Delegate found no basis to interfere with the arbitrator's findings of fact, credibility assessments, or the conclusion that the appellant deliberately misled the insurer about his employment.

The appellant's husband, a taxi driver, was found murdered in his taxi cab.

The appellant claimed statutory accident benefits, including funeral and death benefits, from the respondent insurer.

The insurer denied the claim on the basis that the death was not an 'accident' as defined in the Statutory Accident Benefits Schedule.

The arbitrator agreed, finding no causal connection between the death and the use or operation of the vehicle.

On appeal, the Director's Delegate applied the Supreme Court of Canada's causation test from Amos and upheld the arbitrator's decision, concluding that the available evidence did not establish that the murder was directly or indirectly caused by the use or operation of the taxi cab.

The appellant, a taxi driver, appealed an arbitration decision denying him additional weekly income benefits following a motor vehicle accident.

The arbitrator had found that the appellant's back pain was due to a pre-existing condition and that his evidence regarding his inability to work and his pre-accident income was not credible.

On appeal, the Director's Delegate upheld the arbitrator's findings, noting there was ample evidence to support the conclusions on credibility and the weight given to the medical evidence.

The appeal was dismissed, and claims for a special award and expenses were denied.

The applicant was rendered a paraplegic in a motorcycle accident.

He held a valid Class G licence for a car but did not hold a Class M licence for a motorcycle.

The insurer denied weekly benefits under s. 17(1)(d) of the Statutory Accident Benefits Schedule, which excludes coverage if the driver was not authorized by law to drive the automobile.

The arbitrator held that the exclusion applied because the applicant lacked the specific licence required to operate a motorcycle, despite his competence to drive one.

The applicant was disqualified from receiving weekly benefits.

The appellant appealed an arbitration order that denied him statutory accident benefits after his request for an adjournment was refused.

The appellant had retained new counsel shortly before the hearing, but his former counsel refused to release the file without an unconditional guarantee of his account.

The arbitrator, unaware of these specific efforts and the former counsel's refusal, denied the adjournment and dismissed the claim when no evidence was presented.

On appeal, the Director's Delegate found that the arbitrator had exercised his discretion based on misapprehended facts.

The appeal was allowed, the arbitration order was rescinded, and the matter was remitted for a new hearing.

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

The applicant sought ongoing benefits, claiming substantial inability to perform the essential tasks of his employment in the music production industry due to physical and psychological injuries, including chronic pain syndrome.

The arbitrator found that while the applicant was employed at the time of the accident and suffered soft tissue injuries, the medical evidence from orthopaedic and psychiatric specialists did not support a finding of substantial disability beyond the termination date.

The claim for ongoing weekly income benefits was dismissed, but the applicant was awarded his reasonable arbitration expenses.