Fiona E. Porter

The applicants were injured in a motor vehicle accident and sought statutory accident benefits for caregiving, housekeeping, and medical devices.

The insurer denied the claims.

At arbitration, the arbitrator found the applicants' evidence lacked credibility and was contradicted by medical certificates and school records.

The applicants failed to establish that they suffered impairments substantially preventing them from performing their pre-accident activities, or that the claimed expenses were reasonable, necessary, and actually incurred.

All claims for benefits and a special award were dismissed.

The applicant sought statutory accident benefits after allegedly slipping and falling while exiting a bus.

The insurer denied the claim, arguing the incident was not an 'accident' under the Schedule and that the applicant failed to submit her application within 90 days.

The arbitrator found that the applicant fell while alighting from the bus, meaning the use or operation of an automobile caused the incident.

Furthermore, although the applicant failed to submit the application within 90 days, the insurer was estopped from relying on this defence due to the adjuster's representations that the claim was being processed.