Ian Boundy

The appellant insurer appealed an arbitrator's decision finding it responsible for paying the insured's statutory accident benefits.

The appellant also sought to vary the order to introduce fresh evidence regarding a commercial use exclusion, arguing the insured was carrying a passenger for compensation at the time of the accident.

The Director's Delegate dismissed the appeal and the application for variation, finding that the appellant failed to exercise due diligence in obtaining the evidence for the initial hearing and that the arbitrator reasonably concluded the insured had elected to claim benefits from the appellant.

The Applicant was injured in a motor vehicle accident while riding a bicycle and received weekly income benefits until July 18, 1994.

She applied for ongoing benefits under section 12(5)(b) of the Statutory Accident Benefits Schedule, claiming she was continuously prevented from engaging in any occupation reasonably suited to her education, training, or experience.

The arbitrator found that while the Applicant suffered a permanent moderate restriction in her right elbow, she had the necessary skills and physical ability to work as a retail sales clerk or restaurant hostess.

The claim for ongoing weekly income benefits and a special award was dismissed, but the Applicant was awarded her arbitration expenses.

The appellant was injured in a motor vehicle accident and developed severe fibromyalgia and chronic pain.

She appealed an arbitrator's decision denying her claims for various assistive devices, a hot tub, an electric bed, and replacement farm labour costs under the Statutory Accident Benefits Schedule.

The Director's Delegate upheld the arbitrator's denial of the hot tub, exercise equipment, and replacement farm labour, agreeing that the labour costs were a business expense rather than a rehabilitation need.

However, the Director's Delegate reversed the arbitrator's decision regarding the electric bed, finding it reasonably required for the appellant's rehabilitation to manage chronic pain.

The order was also varied to correct the calculation of CPP disability benefit deductions.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including weekly income and supplementary medical benefits, until April 1994.

She applied for arbitration to reinstate these benefits, claiming she suffered from chronic pain that prevented her from returning to her pre-accident job as a security guard.

The arbitrator reviewed medical evidence and video surveillance showing the applicant performing various physical activities, including shopping and shoveling snow.

The arbitrator preferred the evidence of the insurer's rehabilitation specialist and concluded the applicant no longer suffered a substantial inability to perform the essential tasks of her employment.

The claims for ongoing benefits were dismissed, though the applicant was awarded her arbitration expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from her insurer.

The parties disputed the calculation of weekly income benefits for a self-employed farmer, specifically regarding the deduction of ceasing expenses, Canada Pension Plan disability benefits, and post-accident farm income.

The arbitrator determined the appropriate weekly income benefit amounts for 1991-1993.

The arbitrator also reviewed claims for supplementary medical and rehabilitation expenses, granting the cost of an exercise bike, bench, and cane, but denying claims for a hot tub, electric bed, replacement farm labour, and future housekeeping and transportation expenses.

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

At mediation, the parties signed an agreement to be bound by the opinion of an orthopaedic specialist regarding the applicant's ability to work.

The specialist opined that the applicant was substantially unable to perform his essential tasks.

The arbitrator held that the mediation agreement was binding and ordered the insurer to pay weekly benefits in accordance with the specialist's opinion until the date the specialist no longer found the applicant disabled.

The claim for a special award was dismissed.

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

The insurer terminated the weekly benefits, arguing the applicant was no longer substantially unable to perform the essential tasks of her pre-accident employment as a sales clerk.

The arbitrator found that the medical evidence, including the insurer's own medical examination, supported the applicant's ongoing inability to work due to chronic pain and fibromyalgia.

The arbitrator ordered the insurer to pay ongoing weekly income benefits and outstanding rehabilitation expenses.

Furthermore, the arbitrator awarded a special award of $3,000 against the insurer for unreasonably withholding and delaying the payment of benefits, noting the insurer's refusal to share medical reports and its inappropriate reliance on a medical report that actually recommended further rehabilitation.

The applicant was injured in a motor vehicle accident and initially applied for accident benefits from her son's insurer, The Personal, who paid her expenses for a year before realizing she had her own policy with Zurich.

The applicant then applied to Zurich, who denied the claim due to the delay in notice.

On a preliminary issue hearing, the arbitrator found that under section 268 of the Insurance Act, Zurich was the priority insurer.

The arbitrator also found that the applicant had a reasonable excuse for the delay in notifying Zurich, as The Personal's error in sending the wrong claim form and subsequent payment of benefits caused the delay.

Zurich was ordered to pay the applicant's accident benefits.