Altor Shields

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

The insurer terminated benefits, and the applicant sought ongoing benefits under section 12(5)(b) of the Statutory Accident Benefits Schedule, claiming she was continuously prevented from engaging in any suitable employment due to back, shoulder, and psychiatric issues.

The arbitrator found that the applicant's pre-existing osteoarthritis and deconditioning were the primary causes of her ongoing complaints, and that she had recovered sufficiently from her accident-related soft tissue injuries to return to her pre-accident employment as a cleaner.

The application for ongoing benefits and a special award was dismissed, though the applicant was awarded her expenses for the arbitration.

The appellant was injured in a motor vehicle accident and received weekly income benefits until they were terminated.

He subsequently signed a release and received a settlement cheque, but later applied for arbitration seeking further benefits.

The arbitrator found that while the release document was deficient, the parties had reached a binding final settlement.

On appeal, the appellant argued the arbitrator exceeded her jurisdiction by deciding the broader issue of settlement rather than strictly the validity of the release as framed in the pre-hearing letter.

The Director of Arbitrations dismissed the appeal, holding that the arbitrator was not strictly bound by the pre-hearing letter and had jurisdiction to determine the real issue in dispute based on the evidence presented.

The appellant, a martial arts instructor injured in a motor vehicle accident, appealed an arbitration decision that terminated his weekly income benefits and ordered repayment of amounts paid above the statutory minimum.

The Director of Arbitrations dismissed the appeal, finding the arbitrator did not misinterpret the test for 'substantial inability to perform essential tasks' and reasonably relied on surveillance and medical evidence.

Furthermore, the arbitrator correctly awarded only the minimum benefit because the appellant's financial evidence regarding his pre- and post-accident income was unreliable and contradictory.

The Applicant was injured in a motor vehicle accident and sought ongoing weekly income benefits under section 13 of the Statutory Accident Benefits Schedule after the Insurer terminated them.

The arbitrator found that the Applicant was capable of returning to her pre-accident activities by October 7, 1994, and was therefore entitled to benefits up to that date.

However, because the Applicant received Canada Pension Plan and Workers' Compensation benefits that exceeded her accident benefits entitlement, she was not owed any further payments.

Furthermore, the arbitrator ordered the Applicant to repay $1,100.00 in overpaid benefits to the Insurer and denied her costs of the arbitration due to her exaggeration of her pre- and post-accident condition.

The appellant, a homemaker injured in a motor vehicle accident, appealed an arbitrator's decision denying her ongoing weekly benefits under section 13 of the Statutory Accident Benefits Schedule.

The appellant argued the arbitrator applied an overly strict test, improperly relied on surveillance evidence showing her visiting a grave, and erred in considering her lack of cooperation with rehabilitation.

The Director's Delegate dismissed the appeal, finding the arbitrator correctly assessed whether the appellant was substantially unable to perform her essential tasks, and reasonably considered her ability to modify tasks, the surveillance evidence, and her failure to pursue rehabilitation.

The appellant was awarded her appeal expenses.

The insurer appealed an arbitration order granting the insured weekly benefits and housekeeping expenses following a motor vehicle accident.

The insurer argued the arbitrator misconstrued medical evidence regarding the insured's ability to perform essential tasks and erred in awarding housekeeping expenses for services provided by family members.

The Director of Arbitrations dismissed the appeal, finding the arbitrator's conclusions on disability were supported by the evidence.

The Director also upheld the housekeeping award, confirming that paragraph 6(1)(f) of the Schedule allows compensation for reasonable services provided by family members when required for the insured's care or rehabilitation.

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 insurer appealed an arbitration order finding that the insured's application for arbitration was not statute-barred.

The insurer argued that it had mailed a notice of refusal to pay benefits, triggering the two-year limitation period under the Insurance Act.

The Director of Arbitrations dismissed the appeal, finding insufficient evidence that the notice of refusal ever left the insurer's internal mail system or was received by the insured.

As a result, the limitation period had not commenced, and the insured's application was allowed to proceed.

The applicant sought to withdraw his second application for arbitration regarding statutory accident benefits after an unsuccessful appeal on his first application.

The insurer opposed the withdrawal unless awarded $2,000 for expenses, arguing the second application was frivolous, vexatious, or an abuse of process under section 282(11.2) of the Insurance Act.

The arbitrator found the application was not frivolous, vexatious, or an abuse of process, as there was some chance of success when it was commenced and the applicant was attempting to correct an oversight from the first proceeding.

The applicant was permitted to withdraw the application without terms.

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 applicant, a taxi driver, was injured in a motor vehicle accident and received weekly income benefits until January 1994.

He applied for reinstatement of benefits, claiming ongoing physical and psychological injuries rendered him substantially unable to perform his essential tasks.

The arbitrator found the applicant's evidence contradictory and unsupported by the medical reports, which largely recommended a return to work.

The claims for ongoing weekly income benefits and a special award were dismissed, though the applicant was awarded his arbitration expenses.

The appellant was involved in two motor vehicle accidents and claimed weekly income benefits and supplementary medical benefits.

The arbitrator terminated weekly income benefits as of October 1, 1992, and denied the medical benefits.

Both the appellant and one of the insurers appealed the decision.

The Director's Delegate dismissed the appeals, finding that the arbitrator's conclusions were supported by the evidence, including the finding that the appellant's fibromyalgia was not significantly contributed to by the accidents.

In a supplementary decision, the Arbitrator calculated the exact amount of weekly income benefits owing to the applicant following a motor vehicle accident.

The parties agreed on the base figures but disputed the calculation of the applicant's average gross weekly income from her business.

The Arbitrator determined the net business income for the 52 weeks preceding the accident, calculated the gross weekly income, and applied the statutory formula.

After deducting amounts paid by the insurer and post-accident earnings, the insurer was ordered to pay $27,460.78 plus interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for her inability to perform essential housekeeping and childcare tasks.

The insurer terminated her weekly benefits, arguing symptom exaggeration based on some medical assessments.

The arbitrator reviewed conflicting medical and psychological evidence, including diagnoses of severe post-traumatic stress disorder from multiple specialists.

The arbitrator concluded that the applicant suffered a substantial inability to complete her essential tasks as a homemaker and mother due to the psychological effects of the accident, and awarded weekly benefits, interest, and expenses.

The applicant sought to arbitrate a claim for statutory accident benefits after her benefits were terminated.

The insurer raised a preliminary issue, arguing the application was barred by the two-year limitation period under s. 281(5) of the Insurance Act.

The arbitrator found that the insurer failed to provide clear and unequivocal written notice of its refusal to pay benefits as required by s. 24(8) of the Statutory Accident Benefits Schedule.

Consequently, the limitation period was not triggered, and the applicant was permitted to proceed to arbitration on the merits.

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

The applicant applied for arbitration but failed to attend the hearing or produce required medical and financial documentation.

The arbitrator dismissed the applicant's claim due to lack of evidence.

Finding the applicant's pursuit of the claim to be vexatious and an abuse of process, the arbitrator ordered the applicant to pay the insurer $1,000 for the arbitration assessment fee.

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 was injured in a motor vehicle accident and received statutory accident benefits under section 13 of the Schedule until October 1993.

He applied for arbitration seeking further weekly benefits under section 12 or 13, and a special award.

The arbitrator found that the applicant was not entitled to section 12 income benefits because he was not self-employed at the time of the accident, having ceased his freelance editing business after his wife's death.

The arbitrator also denied further section 13 benefits, finding that medical evidence, including from the applicant's own doctors, established he was capable of performing the essential tasks of daily living by October 1993.

The claim for a special award was dismissed as the insurer did not act unreasonably in failing to provide a computer and chair.

The applicant was awarded expenses.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits, as well as private disability insurance benefits.

The Insurer terminated her weekly income benefits 156 weeks after the accident, arguing that the 156-week period under section 12(5) of the Statutory Accident Benefits Schedule ran continuously from the date of the accident.

The arbitrator held that the 156-week period refers to 156 weeks of payments made by the Insurer, not 156 weeks from the accident or 156 weeks of disability.

Because the Insurer had not yet paid 156 weeks of benefits (due to the private insurance payments), the Applicant was entitled to further weekly income benefits.

The claim for a special award was dismissed, as the Insurer's interpretation was not unreasonable in this case of first impression.

The applicants, family members of a deceased motor vehicle accident victim residing in Ethiopia, brought a motion for an interim award of expenses to fund their travel to Ontario for an arbitration hearing regarding death benefits.

The arbitrator applied the criteria for interim expenses, requiring the applicants to demonstrate a case of sufficient merit.

Finding that the applicants provided minimal and unsupported evidence regarding their dependency on the deceased, the arbitrator concluded they failed to establish a bona fide issue.

The motion for interim expenses was dismissed.