Jeremy Solomon

An individual applied for intervenor status in an appeal concerning statutory accident benefits and allegations of institutional bias.

The Director of Arbitrations denied the application, finding that the applicant did not represent the interests of any recognized group and his participation would likely complicate the proceedings by raising substantially different issues and arguments.

The existing parties and intervenors were deemed sufficient to address the issues.

The insurer appealed an arbitration order that included a special award for unreasonably withholding benefits.

On appeal, the insurer brought a motion to admit new and extrinsic evidence.

The insurer sought to introduce evidence of institutional bias within the dispute resolution system, arguing that the use of full-time arbitrators created a reasonable apprehension of bias.

The Director of Arbitrations allowed this evidence to be admitted as extrinsic evidence, finding that the insurer had not waived its right to raise the issue.

However, the Director refused to admit new evidence regarding the insurer's belief about the insured's knowledge of available benefits, as this evidence could have been adduced at the original hearing.

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

The insurer sent a notice terminating her income replacement benefits.

The insurer argued the applicant's subsequent application for mediation was filed beyond the two-year limitation period.

The arbitrator held that the limitation period begins to run from the date the insurer stops paying benefits or the date specified in the stoppage notice, not the date the notice is mailed or received.

As the application was filed within two years of the specified stoppage date, it was not statute-barred.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, specifically income replacement benefits.

The applicant and her husband were self-employed, operating a retail electronics store.

The applicant claimed she was entitled to an income replacement benefit based on the cost of hiring replacement labour.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of her employment due to the accident.

However, because the business operated at a loss prior to the accident and there was no evidence that the business incurred additional losses as a result of the accident, the amount of the income replacement benefit was calculated to be zero.

The application for arbitration was dismissed, and the claim for a special award was denied.

The applicants were injured in a motor vehicle accident and applied for statutory accident benefits from State Farm.

State Farm denied the claims on the basis that the policy had been cancelled prior to the accident.

The applicants initially argued that State Farm was required to pay benefits pending a priority dispute with another insurer under Regulation 283/95.

At the hearing, the applicants conceded that the policy had been cancelled and consented to an order dismissing their claims against State Farm, intending to pursue the other insurer instead.

The arbitrator dismissed the claims on consent without expenses.

The applicant was struck by a motor vehicle as a pedestrian and claimed income replacement benefits, alleging he was self-employed in construction prior to the accident.

The insurer terminated benefits, and the applicant applied for arbitration.

The arbitrator found the applicant's evidence of self-employment unreliable, noting inconsistencies in documentary evidence and contradictory statements made to the Workers' Compensation Board claiming total disability during the same period.

The claim for income replacement benefits was dismissed as the applicant failed to prove he was self-employed in the 156 weeks prior to the accident.

The applicant was assaulted and his car was stolen in the underground parking garage of his apartment building.

He applied for statutory accident benefits, claiming the incident was an 'accident' under the Schedule.

The arbitrator found that the applicant was approaching his car when he was attacked, but had not yet reached it or begun to use it.

Applying the Amos test, the arbitrator concluded that the vehicle was not instrumental in causing the injuries and the incident did not arise out of the ordinary use or operation of an automobile.

The application for accident benefits was dismissed.

The appellant, Algoma Mutual Insurance Co., appealed a decision involving the respondent.

On consent of the parties, the Appeals Delegate ordered that the appeal be dismissed.

The parties agreed that the order is final and not subject to further appeal, variation, revocation, or judicial review.

The applicant was injured in a rear-end motor vehicle accident and sought ongoing income replacement benefits, which the insurer terminated.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of his employment due to accident-related low back pain, which was compounded by a pre-existing knee condition and psychological factors.

The arbitrator also held that the insurer failed to comply with the mandatory termination notice procedures under section 64 of the Statutory Accident Benefits Schedule, depriving the applicant of the opportunity to request a DAC assessment.

As a result of the insurer's non-compliance and unreasonable withholding of benefits, the applicant was awarded ongoing income replacement benefits and a $5,000 special award.

The applicant was injured in a motor vehicle accident when struck as a pedestrian.

She applied for statutory accident benefits, including caregiver benefits, housekeeping expenses, and various medical and rehabilitation expenses.

The insurer terminated weekly income replacement benefits and denied several medical expenses.

The arbitrator found that the applicant had significant pre-existing medical conditions and exaggerated her symptoms, concluding she was capable of performing her pre-accident activities by October 1996.

Claims for ongoing caregiver and housekeeping benefits beyond that date were dismissed.

However, the arbitrator allowed claims for indexation, limited housekeeping expenses prior to October 1996, and certain psychological, massage, and acupuncture treatments deemed reasonable and necessary.

The claim for a special award was dismissed.