29 total
Claims for weekly accident benefits dismissed as applicant failed to prove substantial inability to perform essential tasks.
The applicant was involved in six motor vehicle accidents, two of which (November 1990 and December 1991) were the subject of this arbitration for statutory accident benefits.
The insurer argued the arbitration for the November 1990 accident was time-barred, but the arbitrator found the limitation period did not begin until the insurer provided written notice of refusal with reasons.
On the merits, the arbitrator found the applicant was not entitled to weekly income benefits under section 12 because he had not worked the required 180 days prior to either accident.
Furthermore, the applicant failed to establish a substantial inability to perform his essential tasks as a result of the subject accidents, as his limitations were primarily due to psychological issues stemming from an earlier accident.
The claims for benefits and a special award were dismissed, but the applicant was awarded his arbitration expenses due to the complexity of the case and the insurer's initial acceptance and subsequent denial of the claim.
Claim for weekly accident benefits dismissed as applicant failed to prove accident caused ongoing disability.
The applicant was injured in a motor vehicle accident and received statutory accident benefits from the insurer.
The insurer terminated her weekly benefits, and the applicant sought arbitration to claim benefits for the period between December 1991 and May 1993.
The arbitrator found that the applicant had a pre-existing disability and failed to prove that the accident caused or significantly contributed to her inability to perform her homemaking tasks during the disputed period.
The arbitrator accepted the insurer's medical evidence that the applicant was substantially able to perform her essential tasks.
The claim for weekly benefits was dismissed, but the applicant was awarded her arbitration expenses.
Applicant ordered to repay $14,086.40 in overpaid accident benefits after failing to prove ongoing disability or claimed income.
The applicant was injured in a motor vehicle accident and received weekly income benefits from the insurer until the insurer stopped payments, alleging an overpayment.
The applicant sought arbitration to reinstate benefits and determine the proper quantum.
The arbitrator found that the applicant suffered only soft tissue injuries and, relying on surveillance evidence and orthopaedic opinion, concluded he was not substantially unable to perform his pre-accident employment.
The arbitrator also found the applicant failed to prove his pre-accident income exceeded the minimum threshold.
Consequently, the arbitrator ordered the applicant to repay $14,086.40 in overpaid benefits, as the overpayment resulted from error or fraud regarding his income.
Claim for further weekly income benefits dismissed; partial supplementary medical and rehabilitation expenses awarded.
The Applicant was injured in a motor vehicle accident and received statutory accident benefits.
The Insurer terminated weekly income benefits on March 31, 1993.
The Applicant sought arbitration for further weekly income benefits, supplementary medical and rehabilitation expenses, and housekeeping and child care expenses.
The arbitrator found that the Applicant was not substantially unable to perform her essential tasks and dismissed the claim for further weekly income benefits.
The arbitrator awarded certain supplementary medical and rehabilitation expenses, including transportation and a club membership, but denied the claim for housekeeping and child care expenses due to insufficient evidence.
Applicant awarded ongoing weekly income benefits for post-traumatic fibromyalgia; special award denied.
The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them.
The applicant sought ongoing benefits, claiming she was unable to perform her occupation as a housecleaner due to post-traumatic fibromyalgia.
The insurer argued she was exaggerating her symptoms and could return to work.
The arbitrator preferred the evidence of the applicant's treating physicians, finding her pain genuine and her inability to work through it justified.
The arbitrator awarded ongoing weekly income benefits, interest, and expenses, but denied a special award, finding the insurer's termination was not unreasonable given the conflicting medical opinions and the applicant's exaggerated behaviours.
Taxi driver entitled to ongoing weekly income benefits; pre-accident income averaged over 52 weeks without deducting farm losses.
The applicant, a taxi driver, was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them based on a functional capacity evaluation.
The applicant sought ongoing benefits and disputed the calculation of his pre-accident income.
The arbitrator found that the applicant remained substantially disabled from his occupation, as the functional evaluation failed to account for the 12-hour shifts required for his work to be reasonably remunerative.
Regarding the calculation of benefits, the arbitrator held that the applicant's farm losses were investment losses and should not reduce his pre-accident income.
However, the arbitrator ruled that the applicant's pre-accident income should be averaged over 52 weeks, rather than the 47 weeks he actually worked, to account for his vacation period.
Weekly income benefits terminated; surveillance evidence demonstrated applicant was capable of pre-accident employment tasks.
The applicant sought ongoing benefits, claiming a substantial inability to perform the essential tasks of his employment as a vegetable produce trimmer due to low back pain.
The arbitrator reviewed medical evidence and surveillance footage showing the applicant performing strenuous physical activities, such as shovelling heavy snow and rolling a steel drum.
The arbitrator concluded that the applicant's injuries had resolved sufficiently by September 16, 1991, to allow him to return to his pre-accident employment.
Ongoing benefits were denied after that date, but the applicant was awarded arbitration expenses.
Claims for ongoing accident benefits dismissed as applicant had returned to pre-accident state of health.
The applicant was injured in a motor vehicle accident and received weekly income benefits until April 1991, when the insurer terminated them.
She applied for arbitration seeking ongoing weekly income benefits, childcare benefits, and supplementary medical expenses.
The arbitrator found that the accident aggravated a pre-existing fibromyalgia condition, but that by April 1991, the applicant had largely returned to her pre-accident state of health.
The claims for ongoing income benefits, childcare benefits, and supplementary medical expenses were dismissed due to the applicant's recovery and a lack of evidentiary foundation.
Accident benefits claim dismissed; applicant ordered to repay overpayment after financial records found to be fabricated.
The applicant, a pedestrian struck by a motor vehicle, applied for statutory accident benefits, claiming ongoing substantial inability to perform his pre-accident work as a heavy manual labourer.
The insurer terminated weekly income benefits and disputed the quantum of the applicant's pre-accident income.
The arbitrator found that the applicant's financial records were fabricated after the accident and relied on forensic accounting evidence to limit his weekly income benefits to the statutory minimum.
The arbitrator also accepted medical evidence that the applicant's ongoing back issues were due to pre-existing degenerative disc disease, concluding he was no longer substantially disabled.
The applicant was ordered to repay an overpayment of benefits to the insurer, though the insurer was ordered to fund a four-week rehabilitation program.