James R. Townsend

The applicant was injured in a motor vehicle accident and received income replacement benefits until they were terminated by the insurer in September 2003.

The applicant returned to work shortly after but went off work again in March 2006, claiming disability due to the accident.

He sought to resume his income replacement benefits, which the insurer refused, arguing the claim was time-barred.

The arbitrator held that the two-year limitation period under section 281(5) of the Insurance Act was triggered by the clear and unequivocal refusal in September 2003.

Relying on the Court of Appeal's decision in Haldenby, the arbitrator found that the return to work provisions in the Schedule do not create a second limitation period.

The applicant's claim for further benefits was therefore precluded.

The applicant, an 18-year-old, was severely injured in a motor vehicle accident while driving a stolen vehicle.

He applied for statutory accident benefits from his parents' insurer, Simcoe & Erie, and the insurer of the stolen vehicle, Pilot.

The issue was which insurer was liable to pay the benefits, which depended on whether the applicant was "principally dependent for financial support" on his parents at the time of the accident.

The arbitrator reviewed the applicant's living arrangements and financial support in the years leading up to the accident.

The arbitrator found that the applicant had returned to live with his parents in the months prior to the accident because he had no independent means of support.

Consequently, the applicant was principally dependent on his parents, making Simcoe & Erie liable to pay the statutory accident benefits.

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

The appellant argued the respondent failed to provide notice of her claim within the statutory time limits and lacked a reasonable excuse for the 16-month delay.

The Director of Arbitrations dismissed the appeal, upholding the arbitrator's finding that a combination of factors—including the respondent's initial claim to another insurer who paid expenses, incorrect documentation, and personal circumstances—constituted a reasonable excuse for the delay under section 22(2) of the No-Fault Benefits Schedule.

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.