Joseph Claude Alphonse Blouin

The insured was severely injured in a motor vehicle accident and subsequently convicted of dangerous driving.

The insurer denied Statutory Accident Benefits (SABS) after the conviction, arguing the conviction was a complete bar under s. 30(4) of O. Reg. 403/96.

The motion judge held that the insured was only excluded from receiving benefits for the period between being charged and being convicted, and that O. Reg. 403/96 governed the policy.

The Court of Appeal dismissed the insurer's appeal and the insured's cross-appeal, finding that while s. 30(4) likely contained a drafting error that failed to achieve the legislature's intent to completely bar benefits upon conviction, the language was clear and unambiguous, precluding the court from redrafting the regulation to fix the gap.

The insurer brought a preliminary motion seeking to compel the insured to attend psychiatric and neuropsychological assessments under section 42 of the Statutory Accident Benefits Schedule.

The insured opposed the motion, arguing the request was not reasonably necessary and was made too close to the scheduled arbitration hearing.

The arbitrator found that while earlier medical recommendations provided a reasonable basis for the assessments, the insurer's delay of over two years in arranging them was unreasonable and prejudicial to the insured.

The arbitrator also rejected the insurer's argument that a recent psychiatric report raised a new diagnosis warranting fresh assessments.

The motion was dismissed.

In a preliminary issue decision regarding statutory accident benefits, the arbitrator determined whether the applicant, a French-speaking person, was entitled to be assessed at a Designated Assessment Centre (DAC) by French-speaking assessors without interpreters.

The arbitrator found that the DAC was located in a designated area under the French Language Services Act and was obliged to provide services in French.

The Minister's Committee, which permitted DACs to use interpreters, bore the onus under section 7 of the Act to justify this limitation but failed to do so.

Consequently, the applicant's refusal to be assessed with an interpreter was reasonable, and he did not fail to make himself available for the DAC assessment.

However, as previously decided, he was not entitled to French-speaking assessors for the insurer's examinations and remained barred from arbitration until he attended those.

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.

The applicant, a French-speaking person, refused to attend Designated Assessment Centre (DAC) assessments because they were to be conducted in English with the assistance of a French interpreter.

On a preliminary issue, the arbitrator determined whether the French Language Services Act applies to DACs.

The arbitrator held that the Minister's Committee and the DACs are 'government agencies' and that DAC assessments are 'services' under the Act.

Applying a purposive interpretation of language rights based on R. v. Beaulac, the arbitrator concluded that French-speaking persons have the right to be assessed by French-speaking assessors without the assistance of interpreters.

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

The insurer denied the application on the basis that the applicant failed to attend insurer's examinations and a designated assessment centre (DAC) evaluation.

The applicant, a French-speaking person, refused to attend the examinations and evaluations because they were to be conducted with the assistance of interpreters rather than by French-speaking professionals.

On a preliminary issue, the arbitrator held that the applicant was not entitled to French-speaking examiners for the insurer's examinations, as the insurer is not a government agency bound by the French Language Services Act.

Consequently, the applicant was precluded from proceeding to arbitration until he made himself available for those examinations.

Regarding the DAC evaluations, the arbitrator deferred the decision to allow the Minister's Committee on the Designated Assessment Centre System and the Superintendent of Financial Services to make submissions on whether DACs are government agencies subject to the French Language Services Act.

The appellant appealed an arbitration decision dismissing her claim for income replacement benefits following a motor vehicle accident.

The arbitrator had rejected her claim on the basis that she was not employed at the time of the accident, relying in part on hearsay statements from an investigator's report.

On appeal, the Director's Delegate found that while the arbitrator erred in relying on the hearsay evidence without the witnesses being called, the error was not fatal.

The arbitrator's rejection of the appellant's evidence of employment was supportable based on other inconsistencies and gaps in her own testimony.

The appeal was dismissed, but the appellant was awarded her reasonable appeal expenses due to the arbitrator's evidentiary error.

The appellant sought leave to appeal an interim arbitration order that denied his claim for interim benefits to cover first-class airfare and hotel accommodations for a trip to Italy.

The arbitrator had found that the appellant failed to demonstrate the necessity or urgency of the expenses.

The Director's Delegate rejected the appeal, holding that appeals from interim orders are generally not permitted under Rule 46.2 of the Dispute Resolution Practice Code to avoid delay and minimize costs.

The Delegate concluded that the dispute would be best addressed at a full arbitration hearing rather than through an interim appeal.

The appellant was injured in a motor vehicle accident and received weekly income benefits for over 156 weeks.

The insurer terminated benefits, and an arbitrator upheld the termination, finding the appellant did not meet the post-156 week test of being continuously prevented from engaging in suitable employment.

On appeal, the appellant argued the arbitrator erred in law by focusing on whether she suffered a head injury, relying on hearsay evidence, and failing to properly analyze suitable employment options.

The Director's Delegate dismissed the appeal, finding the causation issue was properly before the arbitrator, the reliance on hearsay was permissible, and the arbitrator's conclusions were supported by the evidence.

The applicant, who sustained a traumatic brain injury in a motor vehicle accident, sought interim statutory accident benefits to cover the cost of upgrading his and his wife's airline tickets to first class and for hotel accommodations during a trip to Italy to visit family.

The applicant argued these expenses were necessary for his rehabilitation and to avoid overstimulation.

The arbitrator dismissed the motion for interim benefits, finding that the applicant failed to demonstrate the requisite need, necessity, or urgency, as the trip was voluntary and the 'emergent situation' was created by the applicant's own actions.

The appellant appealed an arbitration decision dismissing her claim for income replacement benefits following a motor vehicle accident.

The arbitrator had rejected her claim on the basis that she was not employed at the time of the accident, relying in part on hearsay statements made by her alleged employer and a co-worker to an investigator.

On appeal, the Director's Delegate found that the arbitrator erred in relying on the hearsay evidence without the witnesses being called to testify.

However, the appeal was dismissed because the arbitrator's rejection of the appellant's employment evidence was supportable based on other significant inconsistencies and gaps in her own testimony.

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

A dispute arose over the calculation of his Income Replacement Benefits (IRB), specifically whether he was an employee or self-employed at the time of the accident.

The arbitrator found that the applicant had structured his financial affairs to be an independent contractor for tax purposes, and therefore must be treated as self-employed under the Schedule, resulting in a lower IRB.

Although the insurer had overpaid the applicant based on his initial claim of employment, the arbitrator held the applicant was not required to repay the overpayment because there was no wilful misrepresentation.

Claims for dependent care expenses, medical/accounting reports, and a special award were dismissed.

The applicant was awarded the expenses of the arbitration.

The parties cross-appealed an arbitration decision regarding weekly income benefits and arbitration expenses following a motor vehicle accident.

The insured appealed the denial of weekly income benefits after September 5, 1994, and the refusal to adjourn the hearing to cross-examine the insurer's medical expert.

The insurer appealed the order requiring it to pay the insured's arbitration expenses, arguing that November 1996 amendments to the Insurance Act should have been applied.

The Director's Delegate dismissed both appeals, finding that the arbitrator's conclusions on benefits were supported by the evidence, the refusal to adjourn was a reasonable exercise of authority, and the new expense provisions did not apply retroactively to proceedings commenced before the amendments.

The insured was awarded $250 in appeal expenses for responding to the insurer's appeal.

The Applicant sought to withdraw his Application for Arbitration for statutory accident benefits after realizing he had missed the two-year limitation period, intending instead to pursue a court action against his former solicitor for negligence and an alternate claim for benefits.

The Arbitrator permitted the withdrawal but found that commencing and then withdrawing the arbitration to pursue a better forum constituted an abuse of process.

Consequently, the Applicant was ordered to pay the insurer's $2,000 assessment fee, and prohibited from commencing another arbitration for the same benefits until the fee is paid.

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

The insurer refused to pay, and the applicant applied for arbitration.

The insurer raised preliminary issues regarding whether the applicant was precluded from arbitration for failing to submit a completed application for benefits (s. 59) and failing to attend insurer's examinations (s. 65).

The arbitrator found that the applicant substantially complied with the application requirement but failed to make himself reasonably available for the scheduled medical examinations without a reasonable explanation.

As a result, the applicant was precluded from commencing an arbitration proceeding.

The Applicant was injured in a motor vehicle accident and received weekly income benefits until the Insurer terminated them.

The Applicant sought arbitration to reinstate benefits, claiming he was unable to return to his pre-accident employment as a construction carpenter due to soft tissue injuries.

The Arbitrator preferred the medical evidence of the Insurer's orthopaedic examiner, who opined the Applicant was fit to return to work, noting the Applicant's failure to undergo a recommended CT scan.

The claim for ongoing weekly income benefits was dismissed.

The Arbitrator also held that the new expense provisions under section 282(11) of the Insurance Act did not apply retroactively to arbitrations commenced before November 1, 1996, and awarded the Applicant his reasonable expenses under the former rules despite being unsuccessful.

The applicant was injured in a motor vehicle accident and received income replacement benefits, which were later terminated.

In a previous decision, the arbitrator found the applicant entitled to benefits for a specific period.

The issue in this hearing was the quantum of those benefits, specifically whether sick leave benefits received by the applicant should be deducted.

The arbitrator held that under section 75(2)(b) of the Statutory Accident Benefits Schedule, only 'available' but unreceived sick leave benefits are exempt from deduction.

Since the applicant had actually received the sick leave benefits, they were properly deducted, resulting in an award of $376.76 per week.

The applicant was injured when a storage tank in the back of a pick-up truck exploded while a neighbour was welding bolts to it.

The applicant applied for statutory accident benefits, but the insurer denied the claim, arguing the injury was not caused by the 'use or operation' of an automobile.

The arbitrator applied the two-part test from Amos, finding that repairing equipment permanently installed on a commercial vehicle is an ordinary and well-known activity to which such vehicles are put.

The arbitrator also found a direct causal relationship between the repair work and the explosion.

The arbitrator concluded the applicant was injured in an accident and awarded expenses.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on an orthopaedic assessment.

The applicant sought continued benefits under section 7 of the Statutory Accident Benefits Schedule, claiming a lower back injury prevented him from working.

The arbitrator found that the applicant's lower back problems were a recurrence of a pre-existing condition and not caused by the accident, dismissing the section 7 claim.

However, the arbitrator found that the insurer was required to pay benefits under section 64 of the Schedule from the date the applicant provided a signed medical release form until the date he was notified of the negative Designated Assessment Centre report.

The applicant was injured in a motor vehicle accident and received weekly income benefits until he returned to work.

After working for over a year, he left his employment due to chronic pain and substance abuse, and sought reinstatement of his benefits.

The arbitrator held that returning to work for more than 90 days under section 16(2) of the Schedule merely shifts the onus to the insured to re-establish disability, rather than acting as a complete bar.

The arbitrator also interpreted the 156-week period in section 12(5)(b) as 156 weeks of disability, not consecutive weeks from the accident.

Finding that the applicant's poor psychological health and substance abuse rendered him disabled, the arbitrator awarded weekly income benefits for the claimed period.