Chris T.J. Blom

The appellant appealed a decision regarding the limitation period for claiming no-fault benefits.

The insurer had terminated benefits but had not provided a clear and unequivocal refusal to pay.

The Court of Appeal held that the two-year limitation period under s. 281(5) of the Insurance Act applies, which commences only upon a refusal to pay.

The six-year limitation period under s. 45(1)(g) of the Limitations Act does not apply because the Insurance Act specially limits the time for bringing an action.

The appeal was allowed.

The applicant sought statutory accident benefits following an incident where a limousine he was riding in allegedly drove over a curb.

The insurer terminated his income replacement benefits and sought repayment of all benefits paid, alleging the accident never occurred or the applicant was not injured.

The arbitrator found that the accident did occur and the insurer was not entitled to repayment.

However, the arbitrator dismissed the applicant's claim for ongoing income replacement benefits and further treatment, finding that his injuries from the subject accident had largely resolved and his ongoing disability was attributable to a subsequent accident.

The insurer was ordered to pay for two medical reports.

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 applicant was injured in a motorcycle accident and received income replacement benefits of $185 per week.

He claimed entitlement to a higher benefit rate, arguing he had a legitimate contract of employment to start full-time work as a mechanic shortly after the accident, or alternatively, that he was employed on a casual basis in the four weeks preceding the accident.

The arbitrator dismissed both claims, finding that the applicant's pre-existing medical conditions rendered him incapable of full-time work, and that the alleged employment letter was created solely to secure a bank loan.

The arbitrator also found insufficient evidence to prove the applicant was employed in the four weeks prior to the accident.

Following an arbitration decision regarding statutory accident benefits where the applicant had mixed success, the parties sought a determination on expenses.

The insurer argued the applicant should only receive half his expenses because he was unsuccessful on the income replacement benefit claim.

The arbitrator awarded full expenses to the applicant, finding that the insurer's procedurally defective adjustment of the medical and rehabilitation claims justified a full award despite the applicant's lack of complete success.

The applicant, a 70-year-old pedestrian, was struck by a truck and sustained soft tissue injuries to her left shoulder and back.

The insurer terminated her statutory accident benefits in February 1997.

The applicant sought ongoing other disability benefits and rehabilitation benefits for case management services.

The arbitrator found that the applicant suffered a partial inability to carry on a normal life until March 1998, at which point her condition had stabilized such that she could perform most of her ordinary household tasks.

The arbitrator dismissed the claim for case management services, finding that the applicant's situation was not sufficiently complex to warrant a case manager given the support she already received from family, friends, and medical professionals.

The applicant was injured in a motor vehicle accident and received income replacement benefits until returning to heavy physical work.

Ten months later, he stopped working due to back pain and sought reinstatement of benefits, claiming the disability resulted from the accident.

The insurer denied the claim, arguing the new disability was a work-related repetitive strain injury.

The arbitrator agreed with the insurer on causation, dismissing the claim for income replacement benefits.

However, because the insurer unilaterally terminated payment for medical and rehabilitation treatments without following the mandatory dispute resolution procedures under the Statutory Accident Benefits Schedule, the arbitrator ordered the insurer to pay for those treatments up to the date it formally notified the providers of the negative assessment results, plus a 25% special award for unreasonable withholding.

The applicant was injured in a motorcycle accident, sustaining a severe closed-head injury and spinal fractures.

He applied for statutory accident benefits, including education disability benefits (EDBs).

The insurer terminated his weekly EDBs and paid one lump sum EDB.

The arbitrator found that the applicant was entitled to a further lump sum EDB for the January 1996 semester because he was unable to successfully complete it as a result of the accident.

The arbitrator also found that the applicant was entitled to weekly EDBs from March 1996 to August 1997 because he suffered a substantial inability to continue his education and a partial inability to carry on a normal life, specifically regarding mobility and cognitive activities.

The applicant sought statutory accident benefits following a single-vehicle accident.

The insurer disputed the claim, alleging the applicant was not a passenger in the vehicle at the time of the accident, relying on a police report that listed a different individual and a polygraph examination suggesting the applicant was deceptive.

The arbitrator found the polygraph evidence to be of no weight due to a lack of evidence regarding its reliability.

Concluding that the insurer's theory of a complex fraud was highly unlikely, the arbitrator held on a balance of probabilities that the applicant was indeed a passenger in the vehicle and awarded expenses to the applicant.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits until the Insurer terminated them.

The Applicant sought arbitration for ongoing weekly income benefits, medical and rehabilitation benefits, and a special award.

The arbitrator found that the Applicant suffered from chronic pain and soft tissue injuries that prevented her from returning to full-time work, entitling her to ongoing weekly income benefits and specific rehabilitation benefits, including ergonomic equipment for a home office.

The arbitrator denied the Insurer's request for repayment of chiropractic expenses and denied the Applicant's request for a special award, finding the Insurer's actions were not unreasonable.

The appellant insurer appealed an arbitrator's decision finding that the respondent suffered psychological injuries as a result of an "accident" under the Statutory Accident Benefits Schedule.

The respondent, a limousine driver, was forced at gunpoint by a passenger to drive his vehicle for 45 minutes before being ordered out.

The Director of Arbitrations applied the two-part test from Amos v. Insurance Corp. of British Columbia and found that the respondent was engaged in the ordinary use of his vehicle, and that the forced operation of the vehicle at gunpoint indirectly caused his psychological injuries.

The appeal was dismissed and the arbitration order confirmed.

The applicant was injured in a motor vehicle accident and sought ongoing weekly caregiver benefits, as well as costs for medical devices, housekeeping services, and a case manager.

The insurer had terminated caregiver benefits.

The arbitrator found that the applicant suffered a psychological impairment resulting from the accident, including depression and a driving phobia, which caused a partial inability to carry on a normal life.

The arbitrator awarded ongoing caregiver benefits, the costs of a massager and an orthopaedic mattress, and partial housekeeping expenses, but denied the claim for a case manager.

The applicant was injured in two motor vehicle accidents and claimed income replacement benefits based on an alleged written contract of employment as a sales representative, which he claimed was signed before the first accident.

The insurer terminated benefits, arguing the contract was not legitimate.

The arbitrator found that the alleged contract did not represent the true relationship between the parties, concluding the applicant was likely a subcontractor working on strict commission rather than a salaried employee.

Consequently, the claim for income replacement benefits under paragraph 7(1)3 of the Statutory Accident Benefits Schedule was dismissed.

The arbitrator also reduced a claim for a $1,670 psychovocational assessment to $400, finding the full amount unreasonable.

The applicant was injured in a motor vehicle accident and received rehabilitation assistance from Trauma Services.

A dispute arose over the outstanding account, and an application for arbitration was filed.

The insurer raised a preliminary issue, arguing that the Commission lacked jurisdiction because the arbitration was actually brought by Trauma Services rather than the insured person.

The Arbitrator found that the applicant had authorized Trauma Services to access the mediation and arbitration processes on her behalf, and that she had properly retained counsel to proceed with the application.

The Arbitrator concluded that the arbitration was properly instituted by the applicant and that the Commission had jurisdiction to hear the matter.

The applicant was injured in a rear-end motor vehicle accident and received statutory accident benefits, including caregiver and housekeeping benefits, which were subsequently terminated by the insurer.

The applicant sought ongoing caregiver benefits, housekeeping expenses, and the cost of medical reports.

The arbitrator found the applicant's testimony regarding her pre-accident and post-accident activity levels to be vague and contradictory, and noted inconsistencies with surveillance evidence.

Consequently, the arbitrator concluded that the applicant failed to establish on a balance of probabilities that she suffered a substantial inability to engage in caregiving activities or a partial inability to carry on a normal life.

The medical opinions were also deemed unreliable as they were based on the applicant's unreliable self-reporting.

The application for ongoing 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 rear-end motor vehicle accident and received weekly income benefits until the insurer terminated them, arguing she was capable of returning to work.

The applicant claimed ongoing entitlement, asserting she suffered from chronic pain syndrome.

The arbitrator found the applicant's family physician to be highly persuasive and accepted that the motor vehicle accident significantly contributed to the development of her chronic pain syndrome, rendering her substantially disabled.

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

The applicant was involved in six motor vehicle accidents, two of which (November 1990 and December 1991) were the subject of this arbitration for statutory accident benefits.

The insurer argued the arbitration for the November 1990 accident was time-barred, but the arbitrator found the limitation period did not begin until the insurer provided written notice of refusal with reasons.

On the merits, the arbitrator found the applicant was not entitled to weekly income benefits under section 12 because he had not worked the required 180 days prior to either accident.

Furthermore, the applicant failed to establish a substantial inability to perform his essential tasks as a result of the subject accidents, as his limitations were primarily due to psychological issues stemming from an earlier accident.

The claims for benefits and a special award were dismissed, but the applicant was awarded his arbitration expenses due to the complexity of the case and the insurer's initial acceptance and subsequent denial of the claim.

The applicant suffered a closed head injury in a motor vehicle accident and received statutory accident benefits.

The insurer terminated weekly income benefits, and the parties disputed entitlement beyond the 156-week mark under s. 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant suffered from debilitating, unpredictable post-traumatic headaches that prevented her from consistently attending any employment for which she was reasonably suited.

The arbitrator ordered the insurer to pay weekly income benefits of $79.59 per week, plus interest and arbitration expenses.

The applicant, a taxi driver, was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them based on a functional capacity evaluation.

The applicant sought ongoing benefits and disputed the calculation of his pre-accident income.

The arbitrator found that the applicant remained substantially disabled from his occupation, as the functional evaluation failed to account for the 12-hour shifts required for his work to be reasonably remunerative.

Regarding the calculation of benefits, the arbitrator held that the applicant's farm losses were investment losses and should not reduce his pre-accident income.

However, the arbitrator ruled that the applicant's pre-accident income should be averaged over 52 weeks, rather than the 47 weeks he actually worked, to account for his vacation period.