Donald Harvey

The insurer appealed an arbitrator's decision finding that the parties had reached a binding settlement of $17,000 for non-earner benefits following mediation.

The Director's Delegate allowed the appeal and rescinded the arbitrator's order, finding that the arbitrator erred in law by reversing the onus of proof, ignoring post-mediation conduct, and concluding there was a meeting of the minds despite a discrepancy in the settlement amount discussed by the parties.

The matter of arbitration expenses was remitted for reconsideration.

The parties settled all issues in dispute regarding statutory accident benefits except for the wording of the consent order for ongoing income replacement benefits.

The insurer requested a term limiting the order's effect to November 9, 2008, to avoid the burden of applying to vary or revoke the order under sections 284 and 287 of the Insurance Act when the test for entitlement changes at the 104-week mark.

The arbitrator declined to impose the requested time limitation, finding it inappropriate to deprive the applicant of the procedural benefits of the Insurance Act without evidence or agreement.

The consent order was issued on the terms agreed upon by the parties.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including income replacement benefits.

The insurer sought to deduct 80 per cent of post-accident payments made to the applicant by his pre-accident business, arguing they were employment income disguised as a loan.

The arbitrator found that the payments were a genuine loan and that the applicant was not engaged in post-accident employment.

Furthermore, a shareholder benefit in the form of a loan is not considered employment income under the Schedule.

The insurer was precluded from deducting the payments from the applicant's income replacement benefits.

Following a successful arbitration regarding statutory accident benefits, the applicant sought his legal expenses.

The insurer did not dispute entitlement or the hourly rate but challenged the number of hours claimed for preparation and correspondence.

The arbitrator found the claimed hours reasonable, noting the complexity of the case, the insurer's late concessions, and the insurer's failure to disclose its own counsel's docketed hours.

The insurer was ordered to pay the applicant's expenses in the amount of $42,456.87.

The appellant appealed a trial judge's decision regarding a direct claim under an insurance policy for damages arising from an accident.

The Court of Appeal dismissed the appeal, finding that the trial judge correctly interpreted the limitation provision in s. 8(3) of the schedule as it applied to the appellant's statement of claim.

The insurer brought an application to vary a consent order that required it to pay ongoing income replacement benefits to the insured.

The insurer argued that the change in the test for entitlement to income replacement benefits at the 104-week mark constituted a material change in circumstances justifying a variation of the order.

The arbitrator dismissed the application, finding that the change in the test for entitlement, in isolation, did not constitute a material change in circumstances, especially since the insurer had consented to the order shortly before the 104-week mark without insisting on a time limit and later conceded that the insured met the post-104-week test.

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

Following a consent order requiring the insurer to pay ongoing benefits, the insurer unilaterally terminated the benefits based on new medical information, arguing the test for entitlement had changed at the 104-week mark.

The arbitrator found that the insurer acted unreasonably by terminating benefits in contravention of the consent order and section 287 of the Insurance Act, which requires an insurer to continue payments until a variation order is obtained.

The arbitrator ordered the insurer to pay a special award of $6,000 for unreasonably withholding payments.

The applicant's claims for non-earner and attendant care benefits were previously dismissed.

The parties were unable to resolve the issue of expenses.

The arbitrator applied the criteria set out in the Expense Regulation and found that the insurer was entitled to its reasonable expenses, given its success in the proceeding and the applicant's failure to provide evidence supporting its claims.

The insurer was awarded expenses in the amount of $2,171.40.

The applicant, a 74-year-old pedestrian, was struck by a vehicle and sustained injuries including a fractured knee.

He later passed away from unrelated causes.

His Estate sought non-earner and attendant care benefits.

The arbitrator dismissed the claims, finding that the applicant did not suffer a complete inability to carry on a normal life, as he resumed most pre-accident activities after his cast was removed.

The claim for attendant care benefits was also dismissed due to a lack of evidence regarding the services provided, by whom, and for what period, as no Form 1 was submitted.

The Applicant was injured in a motor vehicle accident while receiving WSIB benefits for a prior workplace injury.

She applied for income replacement benefits (IRBs) from her auto insurer, claiming she had a prospective contract of employment to return to her pre-injury job once physically fit.

The Arbitrator found that her return to work was entirely contingent on her being physically capable of performing her pre-injury duties, which constituted a true condition precedent that was not satisfied at the time of the accident.

The Arbitrator concluded there was no reasonable prospect she would have returned to her prior employment within one year of the accident.

The claim for IRBs was dismissed.