Bruce Webster

The plaintiff insurer brought a summary judgment motion seeking repayment of over $100,000 in income replacement benefits (IRBs) paid to the defendant insured.

The overpayments occurred because the insured received retroactive long-term disability and Canada Pension Plan benefits that should have been deducted from the IRBs.

The court found that the insurer failed to provide proper statutory notice for most of the overpayments, limiting its recovery to a 12-month period.

The court also held that while it had jurisdiction to order repayment of the overpayments, it lacked jurisdiction to vary the existing Financial Services Commission of Ontario (FSCO) consent order governing the ongoing IRB payments.

The insurer was awarded $11,150 without costs.

The insurer, Aviva Canada Inc., sought expenses following an arbitration hearing where it was entirely successful on all substantive issues regarding the calculation of the applicant's pre-accident earning capacity and loss of earning capacity benefits.

The applicant also sought expenses, arguing that the arbitration involved a novel issue.

The arbitrator found that the issues were neither complex nor novel, as the law regarding the calculation of pre-accident earning capacity was well established.

Applying the criteria under the Expense Regulation, the arbitrator awarded the insurer $6,000.00 in expenses, based on a pragmatic approach and a ratio of two hours of preparation time to one hour of hearing time.

The appellant appealed an arbitration decision regarding the calculation of his loss of earning capacity benefits (LECB) and the denial of a special award following a motor vehicle accident.

The Director's Delegate found that the Arbitrator made no errors of law in calculating the pre-accident earning capacity by averaging the appellant's sporadic work history, nor in her assessment of the residual earning capacity based on the REC DAC reports.

The appeal was dismissed, as the issues raised primarily concerned the weighing of evidence rather than questions of law, and the Arbitrator properly applied the test for a special award.

The applicant sought statutory accident benefits following the death of her daughter in a motor vehicle accident.

The insurer disputed her entitlement to ongoing income replacement benefits (IRBs), alleging she failed to submit a disability certificate, a treatment plan, and failed to attend scheduled examinations.

The arbitrator found the applicant was not precluded from receiving IRBs, as her failure to attend examinations and pursue rehabilitation was reasonably explained by her severe mental illness related to the accident.

The arbitrator also determined the proper calculation of her pre-accident income, ruling that her self-employment benefits should be treated as Employment Insurance benefits.

Finally, the arbitrator granted a special award against the insurer, finding it acted unreasonably in calculating the quantum of her IRBs by relying on an accounting approach that contradicted established jurisprudence.

The applicant sought to add several issues to her arbitration for statutory accident benefits following the death of her daughter in a motor vehicle accident.

The arbitrator denied the request to add the issue of catastrophic impairment because the applicant unreasonably failed to attend section 42 assessments.

However, claims for a chronic pain treatment plan and related transportation expenses were added.

On the substantive preliminary issues, the arbitrator ruled that the applicant was not entitled to a death benefit under section 25(3) of the Schedule.

Furthermore, the arbitrator held that the applicant's pre-accident losses from self-employment should not be deducted from her income from other sources when calculating her gross income for income replacement benefits.

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

He later developed intense lower back pain and was diagnosed with herniated discs, which he claimed were caused by the accident.

He also sought to include an unpaid $30,000 management fee in his pre-accident income calculation.

The arbitrator found that the medical evidence did not support a causal link between the accident and the back injuries, preferring the opinions of the insurer's and court-appointed experts.

The arbitrator also accepted the insurer's accounting expert's evidence that the unpaid management fee should not be included in the applicant's income.

The applicant's claims for further benefits were dismissed, though he was awarded his arbitration expenses.

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

The arbitrator found that the applicant was substantially unable to perform the essential tasks of his self-employment in the video game business from the date of the accident until April 16, 1992.

However, because the applicant operated a cash business and failed to provide credible evidence of his pre-accident or post-accident income, his benefits were calculated at the statutory minimum of $185.60 per week.

As the insurer had already paid benefits exceeding the applicant's total entitlement, the applicant was ordered to repay the overpayment of $6,075.64.

The applicant was awarded the expenses of the arbitration.