Dr. W.J. Horsey

The applicant sought interim payment of dental and chiropractic accounts under the 'pay pending dispute' provisions of the Statutory Accident Benefits Schedule following a 1993 motor vehicle accident.

The insurer moved to dismiss the arbitration as duplicitous with the applicant's civil action and sought to introduce defence medical reports obtained in that action.

The arbitrator admitted the medical reports, finding the interests of justice outweighed the deemed undertaking rule, but refused to dismiss the arbitration, holding the claims were distinct.

The arbitrator ordered the insurer to pay the medical accounts on an interim basis, finding the applicant had established the requisite de minimis connection between the accident and the treatment.

The applicant was injured in a motor vehicle accident and received weekly income benefits for 156 weeks.

The insurer terminated benefits at the 156-week mark, asserting the applicant no longer met the more onerous disability test of being continuously prevented from engaging in any reasonably suitable employment.

The applicant sought ongoing benefits and a special award.

The arbitrator found that while the applicant required a brief adjustment period to return to work, she did not suffer a continuous disability preventing her from engaging in suitable employment beyond June 1, 1994.

The arbitrator preferred the insurer's medical evidence, noting inconsistencies in the applicant's presentation and surveillance footage showing her performing physical tasks without apparent difficulty.

The claim for ongoing benefits after June 1, 1994, and the request for a special award were dismissed.

The applicant applied for caregiver benefits under the Statutory Accident Benefits Schedule, claiming he quit his job to provide full-time care for his son who was injured in a motor vehicle accident.

The insurer had paid some benefits but later sought repayment, arguing the payments were made in error.

The arbitrator found that the son's injuries did not require full-time care beyond normal parental duties and that the applicant had quit his jobs for economic reasons, not to provide care.

The arbitrator dismissed the claim for additional benefits and ordered the applicant to repay $36,295.00 to the insurer, finding that the applicant had misled the insurer about his employment and caregiving status.