Harry P. Brown

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

The insurer alleged that the applicant's request for arbitration was out of time.

The arbitrator found that the insurer's notices of refusal to pay benefits were not clear and unequivocal, lacked sufficient reasons, and were not properly communicated to the applicant.

Therefore, the limitation period did not begin to run, and the applicant's arbitration proceeding was commenced in time.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from Allianz.

Allianz paid benefits but later disputed its obligation, arguing that General Accident was the priority insurer.

The insurers disputed whether Ontario Regulation 283/95, which mandates private arbitration for priority disputes, applied retroactively to this case.

The arbitrator held that the Regulation does not apply retroactively to disputes where the application for benefits was received before the Regulation came into force.

On the priority issue, the arbitrator found that the applicant's representative had made a valid election under section 268(5) of the Insurance Act to claim benefits from Allianz, and therefore Allianz was required to pay the benefits.

The insured person committed suicide by carbon monoxide poisoning in his parked car.

His widow applied for death and funeral benefits under his automobile insurance policy.

The insurer denied the claim on the basis that suicide is not an 'accident' under the Statutory Accident Benefits Schedule.

The arbitrator found in favour of the widow, concluding that the definition of 'accident' in the Schedule was broad enough to include suicide.

On appeal, the Director's Delegate reversed the arbitrator's decision, holding that the definition of 'accident' restricts rather than expands the common law meaning, and does not include intentional acts such as suicide.

The appeal was allowed and the claim for benefits was dismissed.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them.

She applied for arbitration, claiming a substantial inability to perform the essential tasks of her pre-accident employment as a cook.

The arbitrator reviewed medical evidence, including functional capacity assessments and expert reports, which indicated she was capable of returning to work with minor restrictions.

Finding the applicant's testimony regarding her limitations lacked credibility and was inconsistent with her activities, the arbitrator concluded she did not suffer a substantial inability to perform her essential tasks and dismissed the claim for further benefits, though awarded her arbitration expenses.

The appellant appealed an arbitrator's preliminary motion decision which held that an insurer may require an insured person to attend a medical examination under s. 23(2) of the Statutory Accident Benefits Schedule even after terminating weekly income benefits.

The appellant also appealed the arbitrator's refusal to grant an interim order reinstating benefits pending the arbitration hearing.

The Director of Arbitrations dismissed the appeal, finding that the termination of benefits does not alter a claimant's status as an "insured person" subject to the examination requirement.

Furthermore, the Director held that under the Insurance Act as it stood prior to January 1, 1994, an arbitrator had no jurisdiction to make interim orders reinstating benefits.

The applicant sought to preclude the insurer from participating in the arbitration hearing, arguing that the insurer failed to serve its Response within the required 14-day period.

The arbitrator found that the insurer had attempted to serve its Response within the time period and was therefore not precluded from participating.

In the alternative, the arbitrator noted that he would have extended the time limit under section 42.3 of the Dispute Resolution Practice Code, as there was no indication of delay caused by the insurer.

The insurer was permitted to participate as a party in the arbitration hearing.

The applicant was injured in a motor vehicle accident and claimed weekly income benefits from the insurer.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of his self-employment in the video game business from the date of the accident until April 16, 1992.

However, because the applicant operated a cash business and failed to provide credible evidence of his pre-accident or post-accident income, his benefits were calculated at the statutory minimum of $185.60 per week.

As the insurer had already paid benefits exceeding the applicant's total entitlement, the applicant was ordered to repay the overpayment of $6,075.64.

The applicant was awarded the expenses of the arbitration.

The Applicant was injured in a motor vehicle accident and applied for weekly no-fault benefits.

He was already receiving no-fault benefits from a previous accident, long-term disability benefits, and Canada Pension Plan (CPP) disability benefits.

The Insurer argued these payments were deductible from his current no-fault benefits.

The arbitrator held that all three benefit payments were payments for loss of income and were therefore deductible from the Applicant's no-fault benefits.

The arbitrator declined to rule on whether the Applicant should have applied under section 12 or 13 of the No-Fault Benefits Schedule, as the deductibility issue rendered it moot.

The Applicant was awarded expenses for the deductibility issue but not for the disability issue, which he failed to object to in a timely manner.

The applicant's wife was murdered during an armed robbery while sleeping in their motor home.

The applicant sought funeral expenses and death benefits under the No-Fault Benefits Schedule.

The insurer denied the claim on the basis that the death was not an 'accident' as defined in the Schedule.

The arbitrator held that the incident did not involve the use or operation of an automobile, nor was it caused by such use or operation.

The vehicle was merely the location of the crime.

The application for benefits was dismissed.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and claimed weekly income benefits at the maximum rate of $600 per week.

The insurer disputed the calculation of his income, preferring to rely on his 1990 tax return rather than his daily run sheets.

The arbitrator accepted the run sheets as prima facie evidence of earnings but adjusted the expenses based on the 1990 tax return, concluding the applicant was entitled to a weekly benefit of $252.10.

The self-employed applicant was injured in a motor vehicle accident and claimed maximum weekly income benefits of $1050 under the No-Fault Benefits Schedule.

The insurer paid $755.23 based on incomplete financial records and later sought to reduce the amount to $523 based on a forensic accounting report.

The arbitrator accepted the insurer's accounting evidence, finding the applicant failed to produce adequate records and deliberately delayed the hearing.

The arbitrator set the weekly benefit at $523, ordered the applicant to repay the overpayment, and denied the applicant's claims for interest, a special award, and costs.