Grant R. Dow

Following an arbitration decision regarding statutory accident benefits where the applicant was only successful in recovering $585 for an occupational therapy assessment, both parties sought their expenses of the proceeding.

The arbitrator considered the criteria under Rule 73.2 of the Dispute Resolution Practice Code.

Although the insurer had made an offer to settle that exceeded the applicant's recovery, the offer required a full and final release of all claims, which the arbitrator found to be a significant impediment to awarding expenses against the insured person.

Taking into account systemic considerations designed to facilitate access to speedy adjudication, the arbitrator ordered that each party bear its own expenses.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including caregiver benefits, housekeeping expenses, and the cost of an occupational therapy assessment.

The insurer denied the claims.

At arbitration, the arbitrator found that the applicant did not meet the "substantial inability" test for caregiver or housekeeping benefits, as she had returned to work and caregiving shortly after the accident with only minor residual complaints.

However, the arbitrator ordered the insurer to pay for the occupational therapy assessment, finding it was a reasonable expense and not subject to the conflict of interest disclosure provisions of section 38 of the Schedule.

The applicant's claim for a special award was dismissed.

The appellant appealed an arbitration decision that denied him ongoing weekly income benefits under subsection 12(5)(b) of the Statutory Accident Benefits Schedule.

The arbitrator had found that while the appellant could not return to his pre-accident work as a tile layer, he was capable of performing a customer service position at Goodwill Industries after completing a work conditioning program.

The Director's Delegate dismissed the appeal, finding no palpable or overriding error in the arbitrator's assessment of the evidence regarding the appellant's physical restrictions, educational limitations, and capacity for suitable employment.

The applicant was injured in a motor vehicle accident and received statutory accident benefits.

The insurer terminated benefits after 156 weeks, arguing the applicant was not continuously prevented from engaging in suitable employment.

The arbitrator found the applicant was substantially unable to perform his pre-accident work as a tile setter.

However, the arbitrator concluded there were suitable alternative occupations available, specifically a cashier position following a work conditioning program.

The arbitrator also allowed the applicant to recalculate his pre-accident income using the completion method of accounting, which increased his weekly benefit to the $600 maximum.

The applicant was awarded outstanding benefits up to the date he would have completed the work conditioning program, plus interest.

The appellant, a self-employed gas station owner, was injured in a motor vehicle accident and received weekly income benefits.

He appealed an arbitration decision denying his claim for reimbursement of costs incurred to hire replacement labour to run his business while he was disabled.

The appellant argued that section 12 of the Statutory Accident Benefits Schedule protects a source of income, or alternatively, that the costs were compensable as "economic rehabilitation" under paragraph 6(1)(f).

The Director of Arbitrations dismissed the appeal, holding that section 12 provides limited income loss compensation based on pre-tax earnings, not business revenue or replacement labour costs.

Furthermore, the "basket clause" in paragraph 6(1)(f) covers expenses related to personal rehabilitation, not the financial health of a business.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them in March 1992.

The insurer brought a preliminary issue motion arguing the applicant's March 1995 application for arbitration was barred by the two-year limitation period under s. 281(5) of the Insurance Act.

The arbitrator found the insurer had provided clear, unequivocal written notice of its refusal to pay further benefits by September 1992.

As the application was filed more than two years after this refusal, it was statute-barred.

The arbitrator declined to order the applicant to refund the insurer's $2,000 assessment fee, finding the applicant was confused by the process rather than acting frivolously.

The applicant was injured in a motor vehicle accident and received statutory accident benefits.

He signed an agreement and received a $7,200 lump sum from the insurer.

He later claimed the insurer misrepresented the document as a receipt and that he did not understand it due to limited English skills.

The arbitrator found the applicant's wife understood English, translated the negotiations, and that the applicant knowingly entered into a full and final settlement.

The claim for further weekly benefits was dismissed, though the applicant was awarded arbitration expenses.

The applicant was injured in a motor vehicle accident and received weekly statutory accident benefits from the insurer as a homemaker under section 13 of the Schedule.

The insurer terminated benefits on the basis that the applicant was fit to resume her household duties.

The arbitrator found that the applicant was primarily a homemaker at the time of the accident, but concluded based on medical records, functional abilities evaluations, and surveillance that she no longer suffered a substantial inability to perform her essential daily tasks.

The application for ongoing weekly benefits and a special award was dismissed, though the applicant was awarded her arbitration expenses.

The applicant, a self-employed gas station owner, was injured in a motor vehicle accident and claimed statutory accident benefits.

The insurer terminated his weekly income benefits on January 3, 1991.

The applicant sought reimbursement for expenses incurred in hiring replacement workers to run his business while he was disabled, as well as ongoing weekly income benefits.

The arbitrator held that the cost of replacement labour is a business expense and cannot be claimed as a rehabilitation expense under section 6(1)(f) of the Schedule, nor under section 12.

However, the arbitrator found that the applicant was substantially disabled from performing his essential tasks until February 1, 1991, and ordered the insurer to pay weekly income benefits of $211.98 until that date, plus interest and arbitration expenses.