Derek Adam

The applicant sought non-earner benefits (NEB) following a motor vehicle accident.

The insurer initially denied the claim but failed to provide sufficient medical or other reasons in its denial letter, violating s. 36(4)(b) of the Schedule.

The Tribunal found the applicant was entitled to NEB for the period between the application and the date a compliant notice was finally provided.

However, the applicant failed to prove a complete inability to carry on a normal life for the remainder of the period, as the medical evidence was largely subjective and inconsistent.

The Tribunal awarded a 10% special award under s. 10 of O. Reg 664 due to the insurer's unreasonable withholding of benefits through defective notice.

The Applicant sought statutory accident benefits following a motor vehicle accident.

The Insurer argued that a prior settlement was binding, but the Arbitrator found the Applicant's rescission letter valid despite lacking a fax cover page.

The Arbitrator declined to recuse himself after viewing the settlement documents.

The Applicant was precluded from arbitrating her claim for non-earner benefits because she failed to attend a mandatory section 44 medical examination.

The Arbitrator also found that the Applicant's injuries fell within the Minor Injury Guideline (MIG), as there was no compelling evidence linking her seizures to the accident, and multiple medical assessors concluded her injuries were minor.

Claims for a special award and interest were dismissed, and the Applicant was ordered to pay the Insurer's reasonable expenses.