Al Jenkins

The insurer appealed an arbitrator's decision finding that the claimant was involved in a motor vehicle accident, arguing that the accident was staged and that the arbitrator failed to provide sufficient reasons for rejecting its expert and circumstantial evidence.

The Director's Delegate dismissed the appeal, holding that the arbitrator's reasons were adequate, that she properly assessed the claimant's credibility, and that her factual findings were entitled to deference.

The arbitrator was not required to engage in a detailed analysis of every piece of evidence, and there was no error of law in her preference for the claimant's direct evidence over the insurer's expert theories.

The Applicant applied for statutory accident benefits following an alleged motor vehicle accident.

The Insurer denied the benefits, alleging that the accident was staged and that the Applicant's vehicle was struck while stationary.

The Insurer relied on the reports of an investigator and two accident reconstruction experts who concluded the collision did not occur as described.

The Arbitrator found the Applicant to be a credible witness and accepted her version of events.

The Arbitrator gave little weight to the Insurer's expert reports because the experts did not examine the vehicles or interview the drivers, and relied on inaccurate information.

The Arbitrator concluded that the Applicant was involved in an accident as defined in section 2 of the Schedule.

The insurer sought its expenses of the arbitration hearing after successfully defending a fraudulent claim for statutory accident benefits.

The arbitrator assessed the insurer's claim for legal fees and disbursements.

The arbitrator disallowed fees for preparing and attending mediation, noting that the Insurance Act only confers discretion to award expenses for the arbitration proceeding itself.

The arbitrator also reduced the disbursements claimed for two accident reconstruction experts, finding that calling both as witnesses was unnecessary and that the second expert's brief report did not justify the amount claimed.

The applicant was ordered to pay the insurer $4,911.80 in expenses.

The applicant sought accident benefits following an alleged motor vehicle accident on December 31, 2000.

The insurer denied the claim, arguing the accident did not occur.

At the arbitration hearing, the insurer presented expert evidence from an accident investigator who testified that the physical damage to the vehicles was inconsistent with the reported collision and matched pre-existing damage from 1997.

The arbitrator accepted the expert's unrebutted evidence, found that the applicant was not involved in the alleged accident, and dismissed the claim for accident benefits.