Shady Attalla

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

The respondent insurer denied the claim, alleging the accident was staged and that the applicant made a material misrepresentation.

At a preliminary issue hearing, the adjudicator found the applicant credible and rejected the respondent's expert reconstruction evidence, concluding that an accident did occur and no material misrepresentation was made.

The applicant's request for costs was denied as the respondent's conduct in bringing the preliminary issue was not found to be unreasonable, frivolous, vexatious, or in bad faith.

The insured sought income replacement benefits following an alleged motor vehicle accident.

The insurer brought a preliminary issue motion arguing the insured made material misrepresentations regarding his primary residence when applying for the policy and regarding the circumstances of the accident.

The Tribunal found that the insured misrepresented his primary residence to obtain a lower premium and misrepresented the facts of the alleged accident.

As a result, the insured failed to meet his burden of proving he was involved in an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal dismissed the claim and ordered the insured to repay $10,857.14 in income replacement benefits previously paid by the insurer.

The Applicant sought statutory accident benefits following a motor vehicle collision.

The Insurer denied the claim, arguing the collision was staged and therefore not an 'accident' under the Statutory Accident Benefits Schedule.

The arbitrator accepted expert engineering evidence that the Applicant's vehicle accelerated into the collision without braking, supporting the Insurer's position that the crash was deliberate.

However, applying appellate jurisprudence, the arbitrator held that the statutory definition of 'accident' does not exclude intentional collisions, provided the use or operation of the vehicle directly caused the impairment.

The arbitrator concluded the Applicant was involved in an accident as defined by the Schedule.