Robert Seaton

Following a preliminary issue hearing where it was determined that no motor vehicle accident had occurred, the insurer sought repayment of accident benefits paid to the applicants and its expenses for the arbitration.

The applicants did not participate in the written expense hearing.

The arbitrator ordered the applicants to repay the benefits they received, finding the claims were made under a misrepresentation.

The arbitrator also ordered the applicants to pay the insurer's reasonable expenses for the arbitration, reducing the claimed amount of $24,973.36 to $9,242.96 after finding the claimed legal fees and disbursements were excessive.

The applicants sought accident benefits following an alleged motor vehicle collision.

The insurer denied the claims, alleging the accident was staged and the applicants made material misrepresentations.

At a preliminary issue hearing, the arbitrator heard evidence from the applicants, the occupants of the other vehicle (who confessed to participating in a staged accident scheme), and accident reconstruction experts.

The arbitrator found the applicants' version of events highly improbable, noting inconsistencies between their testimony and the physical damage to the vehicles, the lack of independent witnesses, and the improbable behaviour of the passengers.

The arbitrator concluded the reported accident did not occur and dismissed the claims.

The appellants appealed an Arbitrator's decision dismissing their claims for statutory accident benefits on the basis that they were not involved in an 'accident' as defined in the SABS.

The Arbitrator had relied on expert accident reconstruction evidence and found the appellants' testimony lacked credibility, concluding the accident was staged.

The Director's Delegate found no error in the Arbitrator's qualification of the expert or his credibility assessments.

The appeal was dismissed and the insurer was awarded its expenses.

The insurer sought repayment of $14,557.94 in accident benefits and its expenses following an arbitration where the applicant failed to prove he was involved in a motor vehicle accident.

The arbitrator dismissed the claim for repayment, finding the insurer failed to prove the applicant wilfully misrepresented material facts or that the amounts claimed were actually benefits paid to the applicant.

However, as the insurer was completely successful in the preliminary issue hearing, the arbitrator awarded the insurer its arbitration expenses, fixed at $7,000.00 inclusive of disbursements for its accident reconstruction experts.

The applicants sought statutory accident benefits following a reported motor vehicle collision.

The insurer terminated benefits and sought repayment, alleging the collision did not occur as reported.

At a preliminary issue hearing, the arbitrator weighed competing accident reconstruction expert evidence and the applicants' testimony.

Finding the applicants' evidence credible and the applicant's expert persuasive, the arbitrator concluded on a balance of probabilities that the applicants were involved in an 'accident' as defined in section 2(1) of the Schedule.

The applicant claimed statutory accident benefits following an alleged rear-end motor vehicle collision.

The insurer disputed the claim, raising the preliminary issue of whether an "accident" actually occurred as defined in the Statutory Accident Benefits Schedule.

The arbitrator found the applicant's testimony lacked credibility due to numerous inconsistencies regarding the time, location, weather, and vehicle condition.

Furthermore, two accident reconstruction specialists concluded that the physical damage to the vehicles was inconsistent with the reported collision.

The arbitrator concluded the applicant failed to prove on a balance of probabilities that he was involved in an accident, and dismissed the claims for accident benefits.

The appellant appealed a trial decision dismissing his claim for damages arising from an incident where he came into contact with a transit bus.

The Divisional Court dismissed the appeal, finding no palpable and overriding error in the trial judge's conclusion that the bus driver was not negligent.

The court held that the trial judge did not err by failing to explicitly reference the reverse onus provision in s. 193(1) of the Highway Traffic Act, as the evidence of the accident reconstruction expert supported the finding that the appellant walked or ran into the side of the bus and the driver could not have prevented the accident.

The trial judge's alternative assessment of damages was also upheld.

The applicants claimed statutory accident benefits following two alleged motor vehicle accidents on July 15 and July 30, 2002.

The insurer denied the claims, arguing that the incidents did not meet the definition of an "accident" under section 2(1) of the Statutory Accident Benefits Schedule.

At a preliminary issue hearing, the arbitrator heard evidence from the applicants and three accident reconstruction experts retained by the insurer.

The arbitrator found the applicants' accounts of both incidents to be unreliable and implausible.

Relying on the expert evidence, which demonstrated that the vehicle damage was inconsistent with the applicants' descriptions, the arbitrator concluded that the applicants were not involved in accidents within the meaning of the Schedule and were therefore precluded from proceeding to arbitration.