Dr. Hamilton Hall

The applicant was injured when the TTC bus she was riding stopped suddenly.

She claimed ongoing income replacement benefits, medical benefits for physiotherapy and massage, and rehabilitation benefits for increased auto insurance premiums.

The insurer argued the claim was time-barred.

The arbitrator found the claim was not time-barred because the insurer's termination letters did not constitute a valid refusal under the Smith v. Co-operators standard.

However, on the merits, the arbitrator dismissed all claims.

Medical evidence, including from the applicant's own treating practitioners, indicated her ongoing symptoms were related to pre-existing chronic conditions rather than the accident, and she did not suffer a substantial inability to perform the essential tasks of her employment.

The applicants were injured in a motor vehicle accident and sought payment for chiropractic and rehabilitation expenses from their insurer under the Statutory Accident Benefits Schedule.

The insurer refused to pay the full amounts billed by the treatment facilities, arguing the treatments were excessive and the fees unreasonable.

The arbitrator found that the frequency and duration of treatments for the husband were excessive, while the wife's treatments were largely reasonable.

The arbitrator also significantly reduced the hourly rates and block fees charged by the facilities, finding them unsupported by professional guidelines or market rates.

The applicants were awarded partial payment of the claimed expenses plus interest, but their claim for a special award was dismissed.