Ian D. Kirby

The applicant was struck by a vehicle while crossing the street and claimed statutory accident benefits for income replacement, housekeeping, and travel expenses.

The insurer denied income replacement benefits after December 26, 1995, and housekeeping expenses.

At arbitration, the arbitrator found the applicant to be an unreliable historian whose testimony was contradicted by video surveillance showing him walking normally.

The medical evidence did not support the applicant's claims of debilitating physical or cognitive impairments preventing him from performing his job as a furniture assembler.

The claims for income replacement and housekeeping were dismissed, but the applicant was awarded $590 for uncontested travel expenses.

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

The insurer terminated her weekly income replacement benefits and housekeeping expenses in January 1997.

The applicant applied for arbitration, claiming ongoing entitlement to both benefits.

The arbitrator found that the applicant suffered from chronic pain in her left hip and low back, which prevented her from performing the essential duties of her pre-accident employment as a data entry clerk, as the job required prolonged sitting or standing.

The arbitrator relied on work simulations and medical evidence to conclude the applicant was substantially disabled.

However, the arbitrator dismissed the claim for housekeeping expenses, finding that the applicant's husband did not perform significantly more chores than before the accident and that the applicant retained the physical capacity to perform her housekeeping duties.

The applicant was awarded ongoing weekly income replacement benefits.

The applicant was severely traumatized in a motor vehicle accident and received extensive psychological treatment for post-traumatic stress disorder.

The insurer terminated payments for the treatments, arguing they were no longer reasonable in frequency or duration.

The arbitrator found that while ongoing psychotherapy was appropriate, the frequency of two to three visits per week over several years was excessive.

The insurer was ordered to pay 50 per cent of the outstanding accounts.

Additionally, the arbitrator granted a special award of $2,500 because the insurer violated the 'pay pending dispute' provision by withholding payments while the dispute was ongoing.

The applicant was injured in a motor vehicle accident while enrolled in a heavy duty equipment mechanic college program.

The insurer terminated his weekly education disability benefits.

The applicant sought arbitration, claiming he was physically and mentally unable to complete his education due to chronic pain and depression.

The arbitrator dismissed the claim, finding that the applicant's physical injuries were primarily soft tissue and had resolved, as evidenced by his subsequent employment in physically demanding jobs and his weight training.

The arbitrator also found no persuasive medical evidence of a disabling psychiatric condition or head injury, concluding the applicant failed to prove a substantial inability to complete his education or carry on a normal life.

The appellant insurer appealed an arbitration decision allowing the respondent insured to proceed with her claim for income replacement benefits (IRBs).

The insured had returned to work within 104 weeks of the onset of her disability but later worked for more than 90 days after the 104-week mark before resigning due to her injuries.

The Director's Delegate dismissed the appeal, holding that under section 14(1) of the SABS-1994, an insured who returns to work within 104 weeks preserves their right to resume receiving IRBs if they are subsequently unable to continue working due to the accident, regardless of how long they worked after the 104-week mark.

The applicant, a pedestrian, was struck by a car and sustained physical injuries and a traumatic brain injury.

He subsequently developed bipolar affective disorder.

The insurer terminated his weekly non-income benefits.

The arbitrator found that the applicant's psychiatric illness was caused by the accident and that he was substantially unable to perform his essential tasks for the period up to 156 weeks post-accident, entitling him to benefits under s. 13(1) of the Schedule.

However, the arbitrator concluded the applicant did not meet the stricter test under s. 13(8) for benefits beyond 156 weeks, as he was not continuously prevented from engaging in substantially all of his normal activities.

The claim for a special award was dismissed as the insurer's termination of benefits was not unreasonable.

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

She returned to work full-time for over a year before resigning due to her injuries.

The insurer argued her claim for resumed benefits was barred by section 14(2) of the Statutory Accident Benefits Schedule because she worked for more than 90 days.

The arbitrator held that section 14(1) governed because the applicant initially returned to work within 104 weeks of the onset of her disability.

Therefore, her entitlement to resume benefits was not affected by the duration of her return to work, and she was permitted to proceed to arbitration.

The applicants, a mother and son, sought statutory accident benefits following separate motor vehicle accidents.

The mother claimed ongoing caregiver benefits, housekeeping expenses, and medical benefits, including a Kenko mattress system.

The son claimed caregiver benefits, education disability benefits, and physiotherapy expenses.

The arbitrator dismissed all claims, finding both applicants lacked credibility.

The mother's evidence regarding her inability to perform caregiving and housekeeping duties was contradicted by objective medical assessments and home assessments.

The son's claim that he was the primary caregiver for his sisters was found to be frivolous and fabricated.

The arbitrator awarded the insurer one-fourth of its expenses in respect of the arbitration due to the son's application being frivolous and made in bad faith.

The applicant was struck by a motor vehicle as a pedestrian and claimed statutory accident benefits for an orthopaedic mattress, motorized wheelchair, attendant care, and housekeeping expenses.

The insurer terminated benefits, arguing the applicant's ongoing symptoms were due to a pre-existing dependent personality and inactivity rather than the accident.

The arbitrator found the applicant suffered from reflex sympathetic dystrophy (RSD) triggered by the accident.

The arbitrator awarded the wheelchair rental cost and ongoing attendant care and housekeeping benefits at a reduced rate (50%), reflecting the applicant's pre-existing reliance on his family, but denied the claim for an orthopaedic mattress.

The appellant appealed an arbitration order denying his claim for ongoing weekly income benefits and a higher benefit rate following a motor vehicle accident.

The insurer had terminated benefits after the appellant failed to attend a scheduled medical examination.

The Director's Delegate upheld the arbitrator's findings that the appellant lacked credibility, failed to prove substantial inability to perform his pre-accident employment as a roofer, and provided insufficient evidence to calculate a higher benefit rate.

The appeal was dismissed with no appeal expenses payable.

The appellant was injured in a motor vehicle accident and claimed caregiver benefits under the Statutory Accident Benefits Schedule.

The insurer paid a lower rate of disability benefits and later terminated them after an independent medical examination.

The appellant requested a Designated Assessment Centre (DAC) evaluation, which also concluded she was not disabled.

At arbitration, the arbitrator found the appellant was entitled to the higher caregiver benefit rate but only until the date of the first medical examination.

On appeal, the appellant argued that section 64 of the SABS required the insurer to pay benefits until the DAC report was issued.

The Director's Delegate dismissed the appeal, holding that section 64 governs the process for stopping benefits but does not create an absolute entitlement immune from a later finding that disability ended earlier.

The applicant was rendered a quadriplegic in a motor vehicle accident and applied for statutory accident benefits from the insurer.

The insurer denied coverage, arguing its policy on the leased vehicle had expired months prior, and thus it was not an 'insurer' under the Insurance Act or O. Reg. 283/95.

The applicant brought a motion for interim benefits.

The arbitrator held that because the applicant asserted a contractual nexus and the insurer admitted to previously insuring the vehicle, the insurer was required to respond.

Under O. Reg. 283/95, the first insurer to receive an application must pay benefits pending the resolution of any priority dispute through private arbitration.

Finding an urgent need, the arbitrator ordered the insurer to pay specified interim medical and rehabilitation benefits.

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

The applicant sought arbitration for ongoing income replacement benefits and the cost of an orthopaedic mattress.

The arbitrator found the applicant lacked credibility, noting significant inconsistencies between his reported disability and surveillance evidence showing him working and performing physical tasks.

Relying on independent medical assessments, the arbitrator concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The claims for ongoing benefits, the mattress, and arbitration expenses were dismissed.

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

The insurer terminated the benefits based on a medical report, providing notice to the applicant.

The applicant sought an interim order reinstating the benefits, arguing the insurer failed to comply with the technical requirements of section 64 of the Statutory Accident Benefits Schedule and failed to provide adequate reasons.

The arbitrator found that the insurer substantially complied with the notice requirements and provided adequate reasons for the termination.

The request for an interim order was dismissed.

The applicant was injured in a motor vehicle accident while a passenger in a vehicle insured by Allstate.

He applied for statutory accident benefits from Allstate, which refused payment on the basis that he was a dependant of his mother and should claim from her insurer, General Accident.

The arbitrator held a preliminary issue hearing to determine priority.

Finding that the applicant operated a cash business and was not principally dependent for financial support on his mother, the arbitrator concluded he was not a dependant.

Allstate was ordered to pay the benefits.

The applicant was denied his expenses due to his misrepresentations regarding his employment and income.

The appellant appealed an arbitration decision that dismissed his claim for weekly income benefits after he and his representative failed to present evidence at the hearing.

The appellant requested an extension of the 30-day appeal period, which was granted.

On the merits of the appeal, the appellant argued the arbitrator erred in refusing an adjournment to allow him to retain new counsel.

The Director's Delegate dismissed the appeal, finding that the arbitrator correctly refused the adjournment because the appellant provided no valid reason for being unprepared and had acted irresponsibly.

The appellant was denied his appeal expenses.

The applicant, on behalf of her minor daughter who suffered a spinal cord injury in a motor vehicle accident, sought statutory accident benefits for the purchase of a new home.

The insurer argued its obligation was limited under subsection 41(1) of the 1994 Schedule to the cost of renovating the daughter's 'existing home', which was a townhouse owned by her mother's estranged husband.

The arbitrator held that the townhouse was the 'existing home' despite the lack of ownership by the insured, and that the insurer's present obligation towards a new home was restricted to the value of the renovations that would have been required for the townhouse.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, including weekly income benefits.

The insurer terminated benefits after the applicant failed to attend a scheduled independent medical examination.

The arbitrator found that the applicant failed to prove a substantial inability to perform the essential tasks of his employment beyond the date of the missed examination, noting credibility issues and a lack of cooperation in subsequent assessments.

For the period prior to termination, the arbitrator awarded the minimum weekly benefit of $185.60 due to unexplained gaps and unreliability in the self-employed applicant's income evidence.

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

The insurer subsequently terminated the benefits and sought repayment, alleging the applicant had misrepresented his pre-accident employment and income.

The arbitrator found the applicant's evidence regarding his employment to be contradictory and unsubstantiated, determining his weekly income benefits should be based solely on his verifiable employment.

The arbitrator also accepted expert evidence that the applicant was malingering and feigning psychological injuries, concluding he was not entitled to ongoing benefits.

The applicant was ordered to repay $16,233.06 in overpaid benefits and $1,000 in arbitration expenses for advancing a frivolous claim.

The insurer moved for an order compelling the insured to attend a psychological examination pursuant to subsection 23(2) of the Statutory Accident Benefits Schedule.

The insured argued the insurer's right to require an examination expired after mediation.

The arbitrator held that the insurer was entitled to require the examination to assess the ongoing claim for weekly benefits.

However, the arbitrator concluded that she lacked the express or implied statutory authority under the Insurance Act or the Schedule to compel the insured to attend the examination.