Dr. J.D. Salmon

Following an arbitration decision on the merits of a statutory accident benefits claim, the applicant sought expenses including expert witness fees, legal fees, and disbursements.

The arbitrator assessed the claimed amounts under the Insurance Act and the Dispute Resolution Practice Code.

The arbitrator awarded reduced amounts for expert witness preparation and attendance, approved an increased hourly rate of $125 for lead counsel based on experience and complexity, and applied a 3:1 ratio of preparation to hearing time for legal fees.

The issue of photocopying expenses was deferred to allow the parties to exchange supporting documentation.

The applicant was injured in a motor vehicle accident and sought income replacement and housekeeping benefits from his insurer.

The insurer terminated benefits, arguing the applicant failed to attend an insurer's examination and was no longer disabled.

The arbitrator found the applicant had a reasonable excuse for missing the examination due to confusing correspondence and language barriers.

The arbitrator awarded income replacement benefits for the initial period and up to February 17, 2004, finding insufficient evidence of disability beyond that date, as the applicant's leg numbness was likely a benign condition.

Housekeeping benefits were awarded at a reduced rate of $20 per week based on an in-home assessment, as the applicant's evidence regarding his pre-accident housekeeping was vague and unsupported.

The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits and housekeeping expenses from her insurer.

The insurer had terminated benefits based on a Designated Assessment Centre report.

The arbitrator found the DAC report unreliable due to internal inconsistencies and miscommunication between its authors.

Based on the applicant's post-accident employment record as a television extra, the arbitrator determined she was entitled to income replacement benefits until October 2004, when she returned to her pre-accident earning capacity.

The arbitrator also awarded $640 for housekeeping expenses incurred before the two-year post-accident mark, plus interest and $100 in expenses.

The insurer appealed an arbitrator's decision finding that the claimant was catastrophically impaired due to a crack cocaine addiction caused by a motor vehicle accident, and awarding ongoing income replacement and attendant care benefits.

The insurer argued that the arbitrator erred in finding catastrophic impairment under the mental/behavioural disorder criteria when the claimant failed the whole person impairment criteria, erred in finding causation, and erred in awarding attendant care benefits that were not actually incurred.

The Director's Delegate dismissed the appeal, holding that the catastrophic impairment definitions are alternative, that the addiction was a direct consequence of the accident injuries, and that an insurer cannot rely on a claimant's inability to incur expenses when the insurer has denied the claim.