Susan Naylor

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

The applicant failed to attend the arbitration hearing, and his agent requested an adjournment.

The arbitrator denied the adjournment request because the agent had made inadequate efforts to contact the applicant and had not notified the insurer or the Commission in advance.

As no evidence was presented to support the claim, the application for benefits and expenses was dismissed.

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

The applicant sought ongoing benefits, claiming a substantial inability to perform the essential tasks of his employment as a vegetable produce trimmer due to low back pain.

The arbitrator reviewed medical evidence and surveillance footage showing the applicant performing strenuous physical activities, such as shovelling heavy snow and rolling a steel drum.

The arbitrator concluded that the applicant's injuries had resolved sufficiently by September 16, 1991, to allow him to return to his pre-accident employment.

Ongoing benefits were denied after that date, but the applicant was awarded arbitration expenses.

The Applicant was injured in a motor vehicle accident and claimed no-fault benefits.

A priority dispute arose between State Farm (the father's insurer) and Pilot (the insurer of the vehicle the Applicant occupied).

The issue was whether the 20-year-old Applicant, who lived at home and contributed his full-time earnings to a family pool controlled by his father, was "principally dependent for financial support" on his parents under section 3(2) of the No-Fault Benefits Schedule.

The arbitrator found that the Applicant's financial contributions exceeded his share of household expenses, making him essentially self-supporting.

Despite his social and cultural dependence on his father, the statutory test requires financial dependence.

The arbitrator concluded the Applicant was not principally dependent on his parents and must seek benefits from Pilot.

The Applicant sought weekly income benefits following a motor vehicle accident, claiming it caused a disabling psychological injury (panic disorder).

The Insurer had reduced and then disputed his entitlement to benefits, arguing his anxiety was caused by severe alcohol and substance abuse rather than the minor accident.

The arbitrator found that the Applicant's ongoing incapacity was the result of his long-standing alcohol dependence and withdrawal, compounded by personal stressors, rather than the accident.

The arbitrator also determined that for the purpose of calculating pre-accident income, real estate commissions are earned on the date of closing, not the date of the agreement of purchase and sale.

The claim for ongoing benefits and a special award was dismissed.

The Applicant was injured in a snowmobile accident and sought ongoing weekly disability benefits, caregiver benefits, and rehabilitation expenses under the No-Fault Benefits Schedule.

The arbitrator found that the Applicant did not suffer a substantial inability to perform his essential tasks, relying on his own testimony that he continued to engage in activities such as gardening, fishing, and driving, albeit with pain.

Claims for caregiver benefits and child care benefits were dismissed as the statutory criteria were not met.

The arbitrator also rejected claims for expensive equipment, including a truck and tractor, as unreasonable and not medically required, but allowed transportation expenses for a horticultural therapy consultation.

The applicant was injured in a motor vehicle accident and received no-fault benefits, which were later terminated by the insurer.

The applicant applied for mediation.

The mediator issued a report stating the dispute was settled, but the applicant maintained no settlement was reached and applied for arbitration.

The insurer raised a preliminary objection, arguing the matter was settled and could not be arbitrated under section 281(2) of the Insurance Act.

The arbitrator found that the parties were never ad idem regarding the purported settlement, as evidenced by the applicant's immediate actions to clarify the misunderstanding and proceed with mediation.

The preliminary objection was dismissed, allowing the applicant to proceed to arbitration.

The Applicant was injured in a motor vehicle accident and received weekly disability benefits until September 28, 1991.

He applied for ongoing weekly benefits, claiming a substantial inability to perform his essential tasks due to chronic pain in his neck, shoulder, and arm.

The arbitrator reviewed medical evidence and surveillance video showing the Applicant performing strenuous physical activities, such as lifting heavy wooden skids, without apparent difficulty.

The arbitrator concluded the Applicant failed to establish a substantial inability to perform his normal tasks and denied ongoing benefits.

The arbitrator also held that the Applicant's pre-existing permanent workers' compensation pension was not a payment for loss of income and therefore not deductible from no-fault benefits.

The Applicant was awarded his arbitration expenses.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and sought no-fault income replacement and transportation benefits.

The insurer disputed the applicant's pre-accident income, arguing that self-generated trip sheets and GST returns were unreliable and that benefits should be based on his prior year's tax return.

The arbitrator found the applicant's evidence regarding his income to be contradictory and unreliable, and calculated his weekly benefits based on his 1990 tax return, ordering him to repay overpaid amounts.

The arbitrator also found that a second motor vehicle accident constituted an intervening cause, requiring the applicant to repay benefits received from the first insurer after the second accident.

Finally, the arbitrator dismissed the claim for taxi fares due to lack of credibility, awarding only the cost of a monthly public transit pass, and declined to award the applicant his arbitration expenses.

The Applicant was injured in a rear-end motor vehicle accident and received weekly accident benefits until they were terminated by the Insurer.

The Applicant sought arbitration, claiming ongoing entitlement to weekly benefits due to upper and mid-back pain, as well as a special award for unreasonably withheld payments.

The arbitrator found that the Applicant failed to establish that his ongoing back problems were caused or aggravated by the accident, noting a significant pre-existing history of symptomatic degenerative disc disease.

Furthermore, the arbitrator concluded that the Applicant did not suffer a substantial inability to perform his essential tasks, as he remained able to perform some property maintenance and actively campaign for municipal office.

The claims for weekly benefits and a special award were dismissed, but the Applicant was awarded his arbitration expenses as he had acted in good faith.

The applicant was injured in a motor vehicle accident and received weekly disability and caregiver benefits.

He sought reimbursement for housekeeping and babysitting expenses, as well as pre-arbitration legal fees, under section 6(1)(f) of the No-Fault Benefits Schedule.

The arbitrator held that receipt of section 13 weekly benefits does not preclude a claim for specific expenses under section 6.

The arbitrator awarded $3,720 for housekeeping and babysitting services, finding them necessary for the applicant's rehabilitation, but denied the claim for legal fees.

The applicant was injured in a motor vehicle accident and received no-fault benefits.

The insurer subsequently required her to attend independent orthopaedic and psychiatric examinations to verify her medical condition, as her family doctor's report was ambiguous regarding the cause of her chronic pain and depression.

The applicant failed to attend both examinations, arguing through counsel that the insurer was not entitled to two examinations and expressing concern over the potential use of the medical reports in other tort actions.

The arbitrator held that the insurer reasonably required both examinations under s. 23(2) of the No-Fault Benefits Schedule, and that the applicant failed to attend without reasonable justification.

The arbitrator found that the insurer was not made aware of any medical reasons preventing the applicant's attendance at the time the examinations were scheduled.

The applicant was seriously injured in a motor vehicle accident in which her husband was killed.

She claimed care benefits under the No-Fault Benefits Schedule for the gross income lost by her son, who took time off work to visit and care for her in the hospital.

The arbitrator found that the son's attendance to provide reassurance, support, and translation services constituted 'caring for the insured person' under s. 7(1)(a).

The arbitrator awarded $2,030.34 for the income reasonably lost by the son during the first month, but denied the claim for the subsequent period.

The applicant's claim for a special award for unreasonably withheld payments was dismissed.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, arguing she was no longer disabled.

The applicant, a real estate agent, claimed she could not work the long and unpredictable hours required by her occupation due to ongoing neck and back pain.

The arbitrator preferred the medical evidence of the applicant's treating specialist over the insurer's expert, finding that the ability to perform essential tasks must incorporate the ability to perform them in a manner that renders the work remunerative.

The arbitrator concluded the applicant suffered a substantial inability to perform the essential tasks of her occupation and ordered the reinstatement of weekly income benefits.

The applicant was injured in a motor vehicle accident and claimed no-fault weekly benefits.

The insurer deducted the applicant's pre-existing workers' compensation pension and a private disability insurance benefit from the weekly benefit amount.

The arbitrator held that the workers' compensation pension for a permanent disability was not a payment for loss of income and therefore not deductible.

However, the private disability insurance benefit was found to be a payment for loss of income received under an income continuation benefit plan, and was therefore deductible from the no-fault weekly benefit.

The Applicants were injured in a motor vehicle accident and applied for no-fault weekly income benefits.

They argued that the value of their unpaid services in renovating a cottage for their business should be included in calculating their pre-accident gross weekly income, and alternatively, that their partnership agreement constituted an offer of employment.

The arbitrator held that the statutory definition of income does not include the imputed value of unpaid services.

The arbitrator further held that the partnership agreement did not constitute a legitimate offer of employment under the No-Fault Benefits Schedule.

The Applicants were entitled only to the minimum statutory benefit.

The applicant was injured in a motor vehicle accident two days after starting a new job.

The insurer calculated his weekly income benefits by averaging his income over the full 52 weeks prior to the accident, resulting in a benefit of $304.53 per week.

The applicant argued his benefits should be based on his regular weekly rate at the time of the accident.

The arbitrator held that under Section 12(7) of the No-Fault Benefits Schedule, the applicant's gross weekly income should be calculated by averaging his income over the weeks he was actually employed in the 52 weeks before the accident, disregarding periods of unemployment.

This resulted in the applicant being entitled to the maximum weekly benefit of $600.00.

The applicant, a university student, was injured in a motor vehicle accident and missed the first week of her third year.

She returned to school but claimed she was substantially unable to perform her essential tasks due to pain, lack of concentration, and lower grades.

The insurer paid no-fault weekly benefits until April 1991, then terminated them and sought repayment, arguing she was not disabled and had failed to cooperate with medical assessments.

The arbitrator found the applicant was only disabled for the first six weeks after returning to school, as her academic performance did not demonstrate a substantial inability to perform her essential tasks as a student.

The arbitrator ordered the applicant to repay the benefits received after October 16, 1990, finding they were paid through error materially caused by the applicant's failure to provide medical releases or attend an independent medical examination.

The applicant was injured in a motor vehicle accident and received no-fault weekly income benefits from the insurer, as well as disability income benefits from a third-party group policy.

The third-party insurer deducted income tax at source and remitted the net amount to the applicant.

The insurer deducted the gross amount of the disability benefits when calculating the applicant's no-fault benefits.

The applicant disputed this, arguing only the net amount should be deducted.

The arbitrator held that the gross amount of the disability benefits is a payment 'available to the insured person' under Section 12(4)(b)(i) of the No-Fault Benefits Schedule and is therefore deductible in full.

The applicant was injured in a motor vehicle accident and applied for arbitration regarding her continuing entitlement to weekly income and care benefits after they were terminated.

The insurer sought to raise additional issues, including repayment of care benefits already paid, repayment of transportation expenses, and a ruling that it was not required to pay rehabilitation expenses.

The arbitrator held that she had jurisdiction to determine issues related to the specific benefits raised by the applicant, including the insurer's claim for repayment of those benefits.

However, the arbitrator lacked jurisdiction to determine disputes over entirely different benefits (transportation and rehabilitation expenses) that the applicant had not referred to arbitration.

The applicant was injured in a motor vehicle accident shortly after being terminated from his employment.

He received a severance package, including a $22,700 lump sum transferred to an RRSP.

The insurer deducted this amount from his no-fault weekly income benefits, arguing it was a payment for loss of income.

The arbitrator held that the severance payment was not a payment for loss of income under s. 12(4)(b) of the No-Fault Benefits Schedule because it was payable regardless of whether the applicant obtained re-employment.

The arbitrator also dismissed the insurer's preliminary motion for disqualification based on apprehension of bias, and denied the applicant's request for a special award, finding the insurer's position was based on a legitimate legal dispute.