Altor Shields

The Applicant was injured in a motor vehicle accident and received caregiver benefits for her elderly mother, who resided with her at the time of the accident.

The mother subsequently suffered a stroke and was moved to a nursing home, ceasing to reside with the Applicant.

The Insurer terminated the caregiver benefits on the basis that the mother no longer resided with the Applicant.

The Arbitrator held that under the plain meaning of sections 13(4) and 13(6) of the No-Fault Benefits Schedule, the requirement to reside together applies only at the time of the accident, and none of the termination conditions in section 13(6) applied.

The Insurer was ordered to continue paying the caregiver benefits.

The Applicant was injured in a motor vehicle accident and received no-fault benefits until the Insurer terminated them after he twice failed to attend an independent medical examination.

The Applicant applied for mediation and then arbitration.

The Insurer brought a preliminary motion arguing the arbitrator lacked jurisdiction because the Applicant failed to make himself reasonably available for the medical examination, which is a prerequisite for mediation under section 25 of the No-Fault Benefits Schedule.

The arbitrator found that the Applicant did not have a reasonable excuse for missing the appointments and was therefore barred from mediation and arbitration.

The Insurer's motion was granted, the application was dismissed for lack of jurisdiction, and the Insurer was entitled to a refund of its arbitration assessment fee.

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 applicants were injured in two motor vehicle accidents and claimed no-fault benefits from their insurer.

They sought reimbursement for $6,000 paid to their son for housekeeping, transportation, and care services, as well as $1,300 for two medical reports obtained after the insurer delayed paying weekly income benefits.

The arbitrator found that the son's services for housekeeping, meal preparation, and transportation to medical appointments were compensable under the No-Fault Benefits Schedule, awarding $2,880.

The arbitrator also ordered the insurer to pay for the medical reports, finding the applicants were justified in obtaining them due to the insurer's gross delay in paying benefits.

The applicant sought weekly income benefits following a motor vehicle accident, claiming physical and psychological injuries, including post-traumatic stress disorder.

The arbitrator found that the applicant's physical injuries had resolved to the point where he was no longer substantially unable to perform the essential tasks of his employment.

The arbitrator rejected the diagnosis of post-traumatic stress disorder, preferring the evidence of the insurer's physiatrist.

Although the insurer improperly interfered with the applicant's physiotherapy treatment, no penalty could be assessed because no benefits were found to be owing.

The applicant's claim for weekly income benefits was dismissed, but he was awarded the expenses of the arbitration.

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.