John D. Johnson

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

The insurer terminated benefits, alleging the applicant wilfully misrepresented material facts by failing to disclose part-time employment.

On a preliminary issue motion, the arbitrator found that while section 48 of the Statutory Accident Benefits Schedule applied to the applicant, the insurer failed to prove that the applicant wilfully misrepresented material facts.

The arbitrator held that the applicant's silence did not amount to a wilful misrepresentation and that the undisclosed income was not material enough to justify terminating all future benefits under section 48.

The preliminary motion was dismissed.

The insurer appealed an arbitrator's decision ordering it to pay a $10,000 special award for unreasonably withholding statutory accident benefits.

The insured had suffered a back injury in a motor vehicle accident, and the insurer denied benefits based on a pre-existing condition.

The Director's Delegate dismissed the appeal, finding that the arbitrator's conclusion was supported by the evidence.

The insurer had maintained a stubborn and inflexible position, failing to re-evaluate the claim even after receiving MRI results and medical reports confirming an organic basis for the insured's ongoing symptoms.

The applicant was injured in a motor vehicle accident and claimed weekly benefits and yard maintenance expenses from his insurer.

The insurer denied the claims, arguing the applicant's disability was not caused by the accident and that he lacked motivation.

The arbitrator found that the accident aggravated the applicant's pre-existing spinal degeneration, causing a substantial inability to perform his essential daily tasks, including home renovations and strenuous recreational activities.

The arbitrator awarded three years of weekly benefits and partial yard maintenance expenses.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award under section 282(10) of the Insurance Act, finding that the insurer's continued denial of the claim after receiving objective MRI evidence was unreasonable.