James A. Forbes

The appellant appealed an arbitrator's decision denying his claim for income replacement benefits under the Statutory Accident Benefits Schedule.

The appellant claimed he had a legitimate contract of employment as a sales representative before the accident.

The Director's Delegate upheld the arbitrator's finding that the evidence did not establish a genuine employment contract, dismissing the income replacement claim.

However, the appeal was allowed in part to award the appellant the full $1,670 cost of a psycho-vocational assessment, finding it was a reasonable expense recommended by his treating doctors.

The insurer's cross-appeal for repayment of benefits was dismissed.

The applicant was injured in a motor vehicle accident while a passenger in a vehicle insured by State Farm.

He applied for and received statutory accident benefits from Wellington, his father's insurer, claiming to be a dependant.

Wellington disputed the dependency and argued State Farm was the priority insurer.

The arbitrator analyzed the applicant's financial situation, including his receipt of welfare and student loans, and rejected the theoretical reports of both insurers' accounting experts.

The arbitrator concluded that the applicant was not principally financially dependent on his parents at the time of the accident.

Consequently, State Farm was found responsible for paying the applicant's benefits.

The applicant, a self-employed restaurant owner, was injured in a motor vehicle accident and received weekly income benefits from the insurer until December 1992.

He applied for arbitration seeking ongoing benefits.

The arbitrator found that the applicant was no longer substantially disabled from performing the essential tasks of his occupation after December 1992, relying on extensive medical and rehabilitation evidence.

Furthermore, the arbitrator determined that the applicant had failed to prove his pre-accident income was higher than the deemed minimum, resulting in a finding that the insurer had significantly overpaid him.

The insurer was ordered to be repaid $28,593.60, and the applicant's claim for a special award was dismissed.