Dr. R. Jain

The applicant was injured in a motor vehicle accident and sought interim income replacement and housekeeping and home maintenance benefits after the insurer terminated them.

The arbitrator found that the applicant established financial need, having exhausted his savings and borrowed money to meet living expenses.

The arbitrator also found that the applicant established a prima facie case for entitlement to the benefits based on medical evidence of his inability to perform his pre-accident job as a janitor and his housekeeping duties.

The motion for interim benefits was granted.

The applicant was seriously injured in a motor vehicle accident in India in 1994 that killed three family members.

He applied for statutory accident benefits in 1998, approximately three and a half years after the 30-day time limit.

The insurer refused to pay benefits due to the delay.

The arbitrator found that the applicant had a reasonable excuse for the delay under subsection 59(4) of the Schedule, as his father had reasonably relied on incorrect advice from an insurance agent that coverage did not extend to overseas accidents, and acted expeditiously once he received correct legal advice.

The applicant sought income replacement benefits (IRBs) and other expenses following a 1995 motor vehicle accident.

The insurer reduced and then terminated the IRBs, and sought repayment of all benefits paid, alleging fraud.

The arbitrator found that the applicant had fabricated his employment history, concealed a previous disabling car accident, and grossly exaggerated his injuries, with medical evidence suggesting malingering.

The applicant's claims were dismissed in their entirety.

The arbitrator ordered the applicant to repay $37,879 in IRBs and rehabilitation expenses obtained through fraudulent misrepresentation, and awarded the insurer its arbitration expenses and assessment fee, finding the application frivolous and an abuse of process.