Dr. G. Lloyd

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 sought statutory accident benefits following two motor vehicle accidents in June 1995 and July 1996.

The insurers disputed his claims for income replacement benefits, supplementary medical expenses, rehabilitation expenses, attendant care benefits, other pecuniary losses, and housekeeping expenses.

The first insurer also sought repayment of benefits.

The arbitrator found that the applicant was entitled to income replacement benefits from the second insurer for a specific period, as well as certain supplementary medical expenses, attendant care benefits, and other pecuniary losses.

The claims for rehabilitation and housekeeping expenses were dismissed.

The arbitrator also ordered the applicant to repay the first insurer for a period of income replacement benefits due to misrepresentation regarding his pre-accident abilities and receipt of short-term disability benefits.

The applicants claimed statutory accident benefits following an alleged motor vehicle accident with a taxi.

The insurer denied the claims, arguing the accident never occurred, and sought repayment of benefits already paid.

The arbitrator found the applicants' evidence regarding the events leading up to the accident and the accident itself to be implausible and riddled with inconsistencies.

Consequently, the applicants failed to prove on a balance of probabilities that the accident occurred, and their claims for benefits were dismissed.

However, the insurer's claim for repayment was also dismissed, as it failed to provide clear and convincing evidence of wilful misrepresentation or fraud.

The applicant was injured in two motor vehicle accidents and sought statutory accident benefits from her insurer.

The insurer terminated income replacement benefits based on DAC assessments.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of her employment due to a shoulder injury and a major depressive disorder caused by the accidents.

The arbitrator awarded income replacement benefits for the disputed periods until the applicant was found to be coping and able to return to work.

Claims for massage therapy were allowed, while claims for acupuncture and disability management services were dismissed as unreasonable.

The applicant, a passenger on a TTC bus involved in a collision, sought statutory accident benefits including weekly benefits, housekeeping expenses, and a special award.

The arbitrator found the applicant's evidence unreliable and fraught with misrepresentations, preferring the insurer's medical evidence that the applicant was malingering and did not suffer from chronic pain syndrome or a disabling disc injury.

The claims for benefits were dismissed.

Finding the arbitration to be an abuse of process due to the applicant's deliberate misrepresentations, the arbitrator ordered the applicant to pay $1,000 in expenses to the insurer.

The applicant was injured in a motor vehicle accident while a passenger on a bus, suffering a partial amputation of his right middle finger.

He received weekly income benefits until the insurer terminated them, prompting him to seek ongoing benefits, claiming he was substantially unable to perform his pre-accident job as a light assembler due to hypersensitivity and psychological issues.

The arbitrator found that the applicant was capable of performing his pre-accident job and other suitable employment, noting significant evidence of malingering and a lack of motivation to rehabilitate.

The application for ongoing benefits was dismissed, and the applicant was denied his arbitration expenses, though the insurer's request for a penalty for a frivolous proceeding was also denied.