Sam Kodsi

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 Applicant claimed statutory accident benefits following an alleged motor vehicle collision.

The Insurer denied the claim, arguing that the collision was staged and did not constitute an 'accident' under the Schedule.

At a preliminary issue hearing, the arbitrator reviewed expert engineering evidence and found numerous inconsistencies between the physical damage to the vehicles and the reported sequence of events.

The arbitrator concluded that the Applicant failed to prove on a balance of probabilities that he was involved in an accident, and dismissed the claim.

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

The insurer denied the claim on the basis that no 'accident' occurred.

At a preliminary issue hearing, the arbitrator considered engineering evidence regarding the physical damage to the vehicles, which was inconsistent with the reported mechanics of the collision.

The arbitrator also noted numerous suspicious circumstances, including pre-existing damage, the storage of the vehicle, and inconsistencies in the reporting of injuries.

The arbitrator concluded that the applicant failed to prove on a balance of probabilities that she was involved in an accident as defined in the Schedule.

The applicant sought statutory accident benefits following an alleged motor vehicle collision.

The insurer denied the claim, arguing that no 'accident' occurred.

At a preliminary issue hearing, the arbitrator reviewed engineering evidence and found significant inconsistencies between the physical damage to the vehicles and the reported mechanics of the collision.

Given these inconsistencies and other suspicious circumstances, including pre-existing vehicle damage and unsupported medical claims, the arbitrator concluded the applicant failed to prove on a balance of probabilities that she was involved in an accident as defined in the Schedule.

Following a preliminary issue hearing where the insured's application for arbitration was dismissed on the basis that he failed to prove he was involved in an 'accident', the insurer sought its legal expenses and disbursements.

The arbitrator found that the insurer was the successful party and was entitled to its expenses.

The arbitrator awarded the insurer $9,839.20, which included legal fees, disbursements, and the maximum allowable amounts for its expert witness's preparation and attendance, noting that the insurer's expert evidence was preferred because the expert inspected both vehicles closer to the date of the incident.

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

The insurer denied the claim, arguing that the collision did not occur as reported or was staged.

After hearing evidence from the parties, the investigating police officer, and accident reconstruction experts, the arbitrator found significant inconsistencies between the physical evidence and the applicant's testimony.

The arbitrator accepted the insurer's expert evidence that the vehicles' damage and final resting positions were inconsistent with the reported collision.

The application was dismissed as the applicant failed to prove on a balance of probabilities that an 'accident' occurred.

The appellant appealed an arbitrator's preliminary issue finding that she was not injured in an accident pursuant to section 2 of the Statutory Accident Benefits Schedule.

The arbitrator had accepted the respondent's accident reconstruction expert evidence that the damage to the vehicles was inconsistent with the appellant's description of the collision, and found the appellant's testimony not credible.

On appeal, the Director's Delegate found no error requiring a rehearing, concluding that the arbitrator was entitled to weigh the evidence and determine that the appellant had not met her burden of proof to establish that an incident occurred.

The applicant sought statutory accident benefits, claiming she was injured as a passenger in a rear-end motor vehicle collision.

The insurer denied the claim on the basis that the applicant's involvement in the accident was not credible.

Relying on expert accident reconstruction evidence that demonstrated the damage to the vehicles was entirely inconsistent with the reported collision, the arbitrator found the applicant's version of events lacked credibility.

The arbitrator concluded the applicant failed to prove she was involved in an 'accident' under section 2(1) of the Schedule and dismissed the arbitration.

Following a finding that the applicant failed to prove he was involved in a motor vehicle accident and made wilful misrepresentations, the insurer sought repayment of $16,855.58 and its arbitration expenses.

The arbitrator held that under s. 47(1)(a) of the Statutory Accident Benefits Schedule, an insured is only required to repay benefits actually 'paid to the person'.

Consequently, the applicant was ordered to repay only the $6,800.00 in income replacement benefits paid directly to him, and not the amounts paid to third-party service providers or for insurer's examinations.

The applicant was also ordered to pay the insurer's arbitration expenses of $13,292.73.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The insurer disputed the claim, raising the preliminary issue of whether an 'accident' actually occurred.

The arbitrator found the applicant's testimony to be highly inconsistent and lacking credibility, noting that the applicant had previously given a different sworn statement.

Expert evidence indicated the vehicle damage was inconsistent with the applicant's description and more consistent with being driven against a rough surface.

Furthermore, the other individuals allegedly involved in the accident had been convicted of fraud related to the same incident.

The arbitrator concluded the applicant failed to prove on a balance of probabilities that he was involved in an accident.

The insurer sought its expenses of the arbitration hearing after successfully defending a fraudulent claim for statutory accident benefits.

The arbitrator assessed the insurer's claim for legal fees and disbursements.

The arbitrator disallowed fees for preparing and attending mediation, noting that the Insurance Act only confers discretion to award expenses for the arbitration proceeding itself.

The arbitrator also reduced the disbursements claimed for two accident reconstruction experts, finding that calling both as witnesses was unnecessary and that the second expert's brief report did not justify the amount claimed.

The applicant was ordered to pay the insurer $4,911.80 in expenses.

The applicant applied for statutory accident benefits, claiming he was injured in a motor vehicle accident.

The insurer refused to pay, alleging the applicant wilfully misrepresented that he was involved in an accident.

At the arbitration hearing, the insurer presented expert evidence on physical damage, which concluded that the damage to the vehicles was inconsistent with a collision between them.

The arbitrator accepted the expert evidence, rejected the applicant's testimony, and found that the applicant wilfully misrepresented a material fact.

The application for benefits was dismissed pursuant to section 48(1) of the Statutory Accident Benefits Schedule, and the applicant was ordered to pay the insurer's expenses.

The applicant sought statutory accident benefits, claiming she was injured in a rear-end collision.

The applicant and her representative failed to attend the arbitration hearing.

The insurer presented expert forensic engineering evidence demonstrating that the physical damage to the vehicles was inconsistent with a collision having occurred.

The arbitrator accepted the expert evidence, found that no accident occurred, dismissed the claim for benefits, and ordered the applicant to pay the insurer's arbitration expenses.

The applicants claimed statutory accident benefits following an alleged motor vehicle accident on May 25, 2002.

The insurer denied the claims, arguing that no accident occurred.

At the preliminary issue hearing, the applicants requested an adjournment to obtain new representation, which was denied due to their failure to make reasonable efforts following a previous adjournment.

On the substantive issue, the insurer presented unrebutted expert evidence from two accident reconstruction specialists demonstrating that the physical damage to the vehicles was inconsistent with a collision.

The arbitrator found the applicants' evidence insufficient to rebut the physical evidence and concluded that no accident occurred.

The applications for arbitration were dismissed.

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.