Dr. R. Lexier

The applicant sought a non-earner benefit following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological impairments.

The respondent denied the benefit, relying on independent medical examinations and surveillance evidence that contradicted the applicant's reported limitations.

The Tribunal found the applicant's evidence inconsistent and preferred the respondent's medical reports, which were corroborated by surveillance showing the applicant driving, shopping, and socializing.

The application for the non-earner benefit was dismissed.

The applicant, a tow truck driver, was injured in a rear-end motor vehicle accident and sought income replacement benefits (IRBs).

The insurer terminated the IRBs after eight months, arguing that the applicant's ongoing pain was due to pre-existing degenerative disc disease rather than the accident.

The Tribunal found the applicant credible and preferred the evidence of his treating specialists over the insurer's expert, concluding that the accident aggravated his underlying condition and caused chronic pain and radiculopathy.

The Tribunal held that the applicant was substantially unable to perform the heavy physical duties of his pre-accident employment and was therefore entitled to ongoing IRBs.

The insurer appealed an Arbitrator's decision awarding the insured a special award for unreasonably withholding income replacement benefits.

The insurer argued it reasonably relied on its own medical experts who opined the insured did not meet the post-104-week disability test.

The Director's Delegate dismissed the appeal, finding no error of law in the Arbitrator's conclusion that the insurer failed to consider all available information, including contradictory reports from its own vocational expert and the insured's treatment providers.

The Delegate also upheld the quantum of the special award, noting that while expressed as a percentage, it was readily convertible to a lump sum of approximately $7,700, which was not disproportionate to the insurer's conduct.

The applicant was struck by a vehicle while walking home from work, sustaining injuries including to his right shoulder and lower back.

He applied for income replacement benefits, which the insurer terminated on the basis that he was no longer substantially unable to perform the essential tasks of his employment as a mattress builder.

The arbitrator found that the applicant's job required heavy physical labour, including frequently lifting mattresses weighing up to 115 lbs.

Relying on the medical evidence of the applicant's experts, the arbitrator concluded that the applicant suffered from accident-related bursitis in his right shoulder, which prevented him from performing these essential tasks.

The applicant was awarded ongoing income replacement benefits, and the insurer's claim for repayment of previously paid benefits was dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them after 104 weeks.

The applicant sought arbitration, claiming a complete inability to engage in any employment for which she was reasonably suited.

The arbitrator reviewed the applicant's education, training, and work history, noting she primarily worked part-time.

Relying on the consensus of the applicant's own medical experts that she could return to part-time sedentary work, the arbitrator found she did not meet the test for complete inability to work.

The application for income replacement benefits and a special award was dismissed.

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

Neither the applicant nor her representative attended the arbitration hearing.

The arbitrator proceeded in their absence.

The insurer presented evidence, including an independent medical examination, demonstrating that the applicant was capable of returning to her pre-accident employment.

The arbitrator dismissed the claims for income replacement benefits, medical benefits, and housekeeping expenses due to a lack of evidence from the applicant and her failure to attend a Designated Assessment Centre evaluation.

The insurer was awarded its expenses.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated weekly income benefits.

The applicant applied for arbitration, seeking ongoing weekly income benefits, transportation expenses, and a special award.

The arbitrator found that the applicant suffered from chronic pain and depression caused by the accident, which continuously prevented him from engaging in any suitable employment.

The arbitrator ordered the insurer to pay ongoing weekly income benefits and transportation expenses.

However, the arbitrator also ordered the applicant to repay an overpayment of income replacement benefits due to his receipt of collateral benefits, and denied the request for a special award.

The applicant claimed she was injured when a public transit bus braked sharply.

She received statutory accident benefits until July 1993, when the insurer terminated them.

The applicant sought ongoing weekly income benefits, claiming she was disabled by fibromyalgia and severe psychological problems caused by the accident.

The arbitrator found that while the applicant was involved in an accident and was disabled by psychological problems, she failed to establish on a balance of probabilities that the accident caused her psychological disability.

The claim for ongoing benefits and a special award was dismissed.

The appellant appealed an arbitrator's decision denying him continued weekly income benefits following a motor vehicle accident.

The appellant alleged that the arbitrator demonstrated bias against him and erred in excluding two psychiatric reports submitted late in the hearing.

The Director of Arbitrations found no reasonable apprehension of bias, noting the arbitrator accommodated the unrepresented appellant and conducted the hearing fairly.

The Director also upheld the exclusion of the late medical reports due to lack of timely notice to the insurer.

The arbitrator's findings that the appellant lacked credibility and was not disabled from performing his essential tasks were supported by the evidence.

The appeal was dismissed.