Catherine L. Coplea

The insurer appealed an arbitration order requiring it to pay ongoing income replacement benefits and a special award to the respondent, a self-employed home daycare provider injured in a motor vehicle accident.

The insurer argued the arbitrator erred in assessing the physical demands of the respondent's job and in rejecting the evidence of the Designated Assessment Centre (DAC) assessors, who concluded she could return to work.

The Director's Delegate dismissed the appeal, finding no error of law in the arbitrator's preference for the respondent's medical evidence over the DAC assessment, nor in the finding that the insurer acted unreasonably in terminating benefits on multiple occasions.

The applicant was successful in an arbitration for statutory accident benefits and was awarded her expenses.

In this expense assessment, the arbitrator determined the quantum of legal fees and disbursements payable by the insurer.

The arbitrator allowed a 3:1 ratio for preparation to hearing time, resulting in 260 hours for lead counsel.

The arbitrator also awarded an enhanced hourly rate of $150, noting that the insurer had unreasonably refused a settlement offer.

Additional fees were awarded for previous counsel, an articling student, and law clerks, along with disbursements including expert witness fees and court reporting services.

The applicant, a child care provider, was injured in a rear-end motor vehicle accident and claimed statutory accident benefits.

The insurer terminated her weekly income replacement benefits on multiple occasions.

The arbitrator found the applicant credible and accepted medical evidence that she developed chronic pain syndrome as a result of the accident, rendering her substantially disabled from performing the essential tasks of her employment.

The arbitrator ordered the insurer to pay income replacement benefits for the disputed periods and ongoing.

Additionally, the arbitrator found the insurer acted unreasonably in prematurely terminating benefits and awarded a special award of $3,500, along with interest and arbitration expenses.

The applicant, a 70-year-old pedestrian, was struck by a vehicle and sustained orthopaedic injuries.

She sought statutory accident benefits for attendant care and other services provided by her daughter.

The insurer disputed the quantum and causation, arguing the applicant's progressive dementia was not accident-related.

The arbitrator found the dementia was not caused by the accident but awarded attendant care and housekeeping benefits based on the applicant's accident-related orthopaedic impairments, increasing from 7 to 14 hours per week over time, payable at the minimum wage rate.

Claims for a special award were dismissed due to the applicant's misrepresentations regarding her daughter's lost income.

This document contains two separate decisions by the Director's Delegate.

In the first, the applicant was ordered to produce clinical notes and records of her doctor to the insurer.

In the second, an appeal regarding a priority dispute between two insurers, the Director's Delegate upheld the arbitrator's finding that an elderly couple living together for over a decade were not 'spouses' under the Statutory Accident Benefits Schedule, as they did not live in a conjugal relationship.

The applicant sought weekly income replacement benefits following a motor vehicle accident, claiming he was employed at an auto parts business at the time.

The insurer terminated benefits and sought repayment, alleging misrepresentation.

The arbitrator found the applicant's evidence regarding his employment to be contradictory and not credible, noting that pre-accident medical records contradicted his claims of performing heavy labour.

The arbitrator concluded the applicant was not employed at the time of the accident and had wilfully misrepresented his employment status.

The applicant was ordered to repay $25,050.69 in benefits plus interest, and his claim for hearing expenses was denied as the case lacked merit.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The Insurer terminated income replacement benefits on the basis that the Applicant was a resident of Ontario at the time of the accident but only held a Quebec driver's licence, and was therefore not authorized by law to drive under section 32 of the Highway Traffic Act.

The Arbitrator found that the Insurer presented substantial objective evidence proving the Applicant had been a resident of Ontario since 1993.

The Applicant's evidence to the contrary was found not credible.

Consequently, the Applicant was precluded from receiving income replacement benefits pursuant to section 58(1)(d) of the Schedule.

Despite this, the Arbitrator awarded the Applicant two-thirds of his arbitration expenses because the Insurer unnecessarily prolonged the hearing.

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

The applicant applied for arbitration, claiming ongoing entitlement under section 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant suffered from chronic pain syndrome resulting from the accident, which continuously prevented him from engaging in any employment for which he was reasonably suited by education, training, or experience, including the alternative position of a service advisor.

The arbitrator ordered the insurer to pay weekly income benefits from the date of termination, along with interest and arbitration expenses.

The applicant sought to withdraw his application for arbitration two weeks before the scheduled hearing date, intending to proceed through the court system instead.

The applicant had failed to produce numerous required documents prior to the hearing.

The arbitrator found the late withdrawal to be an abuse of process under Rule 66.3 of the Commission Rules of Procedure, as the insurer had been put to considerable wasted time and expense.

The applicant was permitted to withdraw the application on the condition that he pay the insurer $2,000, representing the maximum amount the insurer was required to pay the Commission to participate in the hearing.