Dr. A.I. Margulies

The applicant sought statutory accident benefits for rehabilitation and care services following a 1993 motor vehicle accident.

The insurer denied the claims, arguing the applicant's pervasive physical, cognitive, and psychological conditions were not caused by the accident.

The arbitrator dismissed the applicant's claims, finding she failed to prove on a balance of probabilities that the accident materially contributed to her impairments.

The arbitrator noted a complete absence of pre-accident medical records, relying solely on the applicant's unreliable self-reporting, and drew an adverse inference from her failure to call pre-accident treating physicians or lay witnesses to corroborate her pre-accident health and functional abilities.

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

The insurer terminated benefits after 104 weeks and sought repayment, alleging the applicant misrepresented his pre-accident income.

The arbitrator found the applicant was not completely disabled from working as a self-employed renovator, relying on medical evidence including the applicant's own treating surgeon.

The arbitrator also found the applicant lacked credibility and had falsified his tax returns to inflate his business expenses and hide income.

Consequently, the applicant failed to prove the quantum of his income replacement benefit.

The arbitrator ordered the applicant to repay $33,997.72 to the insurer due to wilful misrepresentation and ordered him to pay the insurer's arbitration expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits and supplementary medical expenses.

The insurer terminated her income replacement benefits, arguing she had recovered and could return to her pre-accident employment as a meat packer.

The arbitrator found that the applicant suffered from chronic pain syndrome and a major depressive disorder caused by the accident, rendering her substantially unable to perform the essential tasks of her employment.

The arbitrator preferred the evidence of the applicant's treating practitioners and experts over the insurer's assessors.

The applicant was awarded ongoing income replacement benefits, supplementary medical expenses, and interest on overdue benefits.

The appellant was struck by a car and received weekly benefits for a period.

After 156 weeks, the insurer terminated benefits.

The arbitrator found that while the appellant's psychiatric disorder was caused by the accident, he did not meet the strict post-156 week test of being continuously prevented from engaging in substantially all normal activities.

The appellant appealed, arguing the arbitrator defined his activities too narrowly and ignored the episodic nature of his disability.

The Director's Delegate dismissed the appeal, holding that the arbitrator's factual findings were supported by the evidence and she correctly applied the legal test.

A claim for a special award was also dismissed due to lack of evidence that the insurer withheld medical records.

The applicant was injured in a motor vehicle accident when struck as a pedestrian.

She received statutory accident benefits until the insurer terminated her weekly income benefits.

The applicant sought arbitration, claiming ongoing entitlement to weekly income benefits, supplementary medical benefits for expert reports, and a special award.

The arbitrator dismissed the claim for ongoing weekly income benefits, finding the applicant failed to establish on a balance of probabilities that her ongoing physical and psychological symptoms were causally related to the accident or that they substantially disabled her from returning to her pre-accident employment.

The claim for a special award was also dismissed.

However, the arbitrator awarded the applicant her expenses for the arbitration, including the costs of the medical reports.

The applicant was injured in two motor vehicle accidents and received statutory accident benefits until the insurer terminated them in January 1994.

The applicant sought ongoing weekly income benefits, medical and rehabilitation benefits, and a special award, claiming he was unable to return to his pre-accident job as a welder due to thoracic outlet syndrome and other injuries.

The arbitrator dismissed the application, finding that the applicant's ongoing difficulties were primarily related to pre-existing, work-related conditions rather than the motor vehicle accidents.

Surveillance evidence and the applicant's post-accident recreational activities demonstrated a level of functional ability inconsistent with his claims of severe disability.

The insurer's termination of benefits was deemed reasonable, and no special award was granted.

The applicant was injured in two motor vehicle accidents and sought ongoing statutory accident benefits, including weekly benefits and medical/rehabilitation expenses, after the insurer terminated them in August 1992.

The applicant claimed ongoing disability due to physical injuries, aggravated multiple chemical sensitivities, and chronic fatigue.

The arbitrator found that the applicant suffered from longstanding pre-accident psychiatric and physical problems, including somatization disorder, and that she had substantially returned to her pre-accident level of activity by the time benefits were terminated.

The claim for ongoing weekly benefits was dismissed, though certain medical, rehabilitation, and transportation expenses incurred prior to the termination date were allowed.

The arbitrator declined to make a special award but granted the applicant her arbitration expenses.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for university residence fees, arguing her injuries prevented her from commuting from home as originally planned.

The insurer paid for the first two years but disputed entitlement for subsequent years, alternatively arguing for a deduction of hypothetical commuting and meal costs.

The arbitrator found that the applicant's physical and psychological injuries, including whiplash and post-traumatic stress disorder, rendered her unable to commute daily.

The residence fees were deemed a reasonable rehabilitation expense under section 6 of the Statutory Accident Benefits Schedule.

The arbitrator also rejected the insurer's request to deduct hypothetical commuting costs, finding them speculative.