Casey Van Moorlehem

In an arbitration for statutory accident benefits, the parties disputed the production of certain documents.

The insurer sought production of insurer's medical examinations from the applicant's two prior motor vehicle accidents to address causation.

The applicant objected, citing the implied undertaking rule.

The arbitrator held that under section 22 of the Insurance Act, arbitrators have the same powers as a court to grant relief from the implied undertaking rule under Rule 30.1.01(8).

Finding that the documents were relevant to causation and that the interests of justice outweighed any prejudice to the applicant, the arbitrator ordered their production.

The arbitrator also ordered the insurer to produce certain adjuster correspondence created prior to the mediation application, finding no litigation privilege attached.

The applicant, who was injured in a motor vehicle accident, brought a motion for interim income replacement benefits and an interim special award pending arbitration.

The insurer had terminated his benefits and argued he was unemployed at the time of the accident and failed to request a designated assessment centre evaluation in a timely manner.

The arbitrator dismissed the motion, finding the applicant failed to establish a prima facie case for entitlement to benefits, as there was insufficient objective evidence of his employment at the time of the accident and credibility issues remained to be determined at a full hearing.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer terminated.

The applicant sought arbitration for income replacement benefits, housekeeping services, cost of examinations, a special award, and expenses.

At the hearing, the applicant elected not to call any evidence.

Consequently, the arbitrator found that the applicant failed to establish entitlement to any of the claimed benefits.

The arbitration was dismissed, and on agreement of the parties, no expenses were awarded.

The applicant sought statutory accident benefits for physiotherapy expenses after allegedly being struck by a slow-moving vehicle while walking on a sidewalk.

The insurer denied the claim, arguing there was no contact between the vehicle and the applicant.

The arbitrator found the applicant's version of events credible, supported by her immediate actions and her family doctor's evidence, despite her misrepresentations regarding her employment status.

The arbitrator concluded the applicant sustained an impairment from the accident and awarded the physiotherapy expenses, but dismissed claims for a special award and the insurer's assessment fee.

The insured was injured in a motor vehicle accident while driving a rental van insured by American Home.

He submitted his first completed application for statutory accident benefits to American Home, which denied the claim.

He later submitted an application to State Farm, his spouse's insurer, and sought to arbitrate against State Farm when it refused to pay.

State Farm appealed a preliminary arbitration decision that allowed the insured to proceed against it.

The Director's Delegate allowed the appeal, holding that under O.Reg. 283/95, the first insurer to receive a completed application (American Home) is responsible for paying benefits pending any priority dispute.

The insured could not proceed against State Farm because it was not the first insurer to receive a completed application, and the evidence did not support the insured's claim that State Farm had improperly deflected the initial application.

The insured was injured in a motor vehicle accident while driving a rented van.

He initially applied for accident benefits from the van's insurer, which denied the claim.

He then applied to his wife's insurer, State Farm, which also denied the claim.

State Farm brought a preliminary issue motion to dismiss the arbitration as an abuse of process and a multiplicity of proceedings, arguing the insured was obligated to pursue the first insurer.

The arbitrator dismissed the motion, finding no legal basis to bar the insured from applying to State Farm, and noting that any priority dispute should be resolved between the insurers under O. Reg. 283/95.

The insured was awarded his expenses for the preliminary hearing.

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.

Prior to the hearing, the applicant's counsel was removed from the record after losing contact with her.

The applicant failed to attend the scheduled arbitration hearing.

The arbitrator proceeded in her absence pursuant to Rule 34.5 of the Dispute Resolution Practice Code.

As the applicant failed to present evidence or discharge her onus of proof, the application for ongoing weekly income benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits.

The central dispute was whether he was an employee of his wholly-owned corporation or self-employed, and how his pre-accident income should be calculated given a seasonal layoff and recent business startup.

The arbitrator found the applicant was self-employed.

Interpreting section 9(3) of the Statutory Accident Benefits Schedule, the arbitrator held that the applicant's income should be extrapolated only over the 22 weeks he actually earned income, excluding the seasonal layoff.

The applicant was found entitled to the minimum weekly benefit of $185, which the insurer had already paid, plus $2,409.53 for post-accident business losses.

The applicant was injured in a motor vehicle accident and received weekly benefits of $185 as an unemployed person.

He applied for arbitration, claiming he had a legitimate offer of employment at the time of the accident and was entitled to $600 per week.

The arbitrator found the applicant and his prospective employer lacked credibility and concluded there was no legitimate offer of employment at the time of the accident.

The application for increased benefits and expenses was dismissed.