Jeffrey Raphael

The insurer brought a pre-hearing motion seeking a stay of the arbitration until the insured attended three requested medical assessments under section 42 of the Statutory Accident Benefits Schedule.

The insured had refused to attend the assessments, which were requested approximately two months prior to the scheduled arbitration hearing.

The arbitrator found that the assessments were not authorized by section 42, as they were requested long after the issue of post-104-week income replacement benefits had crystallized.

The arbitrator concluded that the assessments were sought to buttress the insurer's case rather than to determine entitlement, and that the late request would cause prejudice to the insured.

The motion for a stay was dismissed.

The applicant was injured in a 1996 motor vehicle accident and sought various statutory accident benefits, including supplementary medical benefits for an adjustable bed and physiotherapy, rehabilitation benefits for moving expenses and taxi fares, and housekeeping and home maintenance expenses.

The arbitrator found that the applicant had a significant pre-existing medical and psychological history.

The claims for the bed, physiotherapy, moving expenses, and housekeeping were dismissed, as the arbitrator concluded they were either not reasonably necessary or not causally related to the 1996 accident.

However, the claim for taxi expenses to attend occasional social activities was allowed as a reasonable rehabilitation measure to facilitate social reintegration.

Claims for a special award and arbitration assessment fees were dismissed.

The appellant appealed a decision refusing to certify her action as a class proceeding.

She alleged that she and other women were coerced into posing nude or topless for the respondents' newspaper and subjected to inappropriate conduct.

The Divisional Court upheld the motions judge's finding that the claims lacked common issues, as determining liability would require individual assessments of each proposed class member's circumstances.

The appeal was dismissed.

The applicant fractured his hand when a trailer he was manually pulling to hook up to his van rolled and crushed his hand against a wall.

The insurer denied statutory accident benefits, arguing the incident was not an 'automobile accident' because the trailer was not an 'automobile' and the slip-and-fall was an intervening cause.

The arbitrator found that the trailer was being 'used in connection with' the van, bringing it within the policy's definition of an automobile.

The arbitrator concluded that the applicant was involved in an automobile accident and his impairments arose directly from the use or operation of an automobile.

The applicants, husband and wife, were injured in a motor vehicle accident and filed separate applications for arbitration regarding statutory accident benefits.

A Commission case administrator purported to combine the applications without following the notice and consent requirements of the Dispute Resolution Practice Code and the Statutory Powers Procedure Act.

At a pre-hearing discussion, the arbitrator found the administrative combination invalid but, exercising adjudicative discretion and with the consent of both parties, formally ordered the proceedings combined to avoid inconsistent results, save costs, and promote efficiency given the overlapping facts and witnesses.

The applicant was injured in two motor vehicle accidents and claimed various statutory accident benefits from her insurer.

The insurer argued she had signed a full and final release for her income replacement benefits, which also barred her claim for loss of earning capacity benefits (LECBs).

The arbitrator found the release only applied to income replacement benefits and that the applicant was entitled to an offer for LECBs because she was substantially unable to perform the essential tasks of her pre-accident employment at the 104-week mark.

The arbitrator also awarded supplementary medical expenses, housekeeping and attendant care benefits, and a special award against the insurer for unreasonably withholding certain benefits.

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

The insurer terminated these benefits and made a loss of earning capacity (LEC) offer of zero.

The applicant claimed a higher LEC benefit, transportation expenses, housekeeping expenses, and a special award.

The arbitrator found that the applicant was not entitled to a LEC offer because she did not have the functional capacity to earn income at the time of the accident due to severe pre-existing psychiatric problems.

The arbitrator awarded the claimed transportation and housekeeping expenses, but denied the special award.