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Insurer ordered to pay attendant care expenses concurrently for both an aide and a long-term care facility.
The applicant, who sustained severe quadriplegia in a motor vehicle accident, resided in a chronic care facility.
His family provided additional necessary attendant care services because the facility's care was insufficient.
The insurer argued that under section 16(2) of the Statutory Accident Benefits Schedule, it was only required to pay for either an aide or a long-term care facility, but not both, interpreting the word 'or' exclusively.
The arbitrator held that 'or' should be read inclusively in the context of the legislative scheme and the remedial nature of the statute.
The insurer was ordered to pay attendant care expenses incurred concurrently under both subsections.
Applicants ordered to pay insurer's expenses of $5,111.71 each following dismissal of fraudulent accident benefits claims.
Following an arbitration decision where the applicants' claims for statutory accident benefits were dismissed due to misrepresentation, the insurer requested an expenses hearing.
Neither applicant appeared at the hearing.
The arbitrator found the insurer's claimed expenses of $10,223.42 to be reasonable, given the multiple proceedings, late withdrawal of claims, and the applicants' misrepresentation.
Each applicant was ordered to pay 50% of the insurer's expenses, amounting to $5,111.71 each.
Accident benefits denied as applicants wilfully misrepresented material facts regarding a staged motor vehicle collision.
The applicants claimed to have been injured in a motor vehicle accident and applied for statutory accident benefits.
The insurer denied the benefits, alleging that the applicants wilfully misrepresented material facts by claiming they were involved in an accident that did not occur as described.
Relying on expert evidence in accident reconstruction, the arbitrator found that the physical damage to the vehicles was inconsistent with the applicants' accounts.
The arbitrator concluded that the applicants deliberately misrepresented material facts and were therefore precluded from receiving accident benefits under section 48 of the Schedule.
The applicants' claims for income replacement and medical benefits were dismissed, and they were ordered to pay the insurer's arbitration expenses.
Applicant awarded ongoing weekly income benefits due to accident-related psychological and physical limitations preventing suitable employment.
The applicant was injured in a motor vehicle accident and received weekly income benefits for three years.
The insurer terminated benefits, arguing she was no longer substantially unable to perform the essential tasks of her employment and lacked motivation to return to work.
The arbitrator found that the applicant suffered from post-traumatic stress disorder, depression, anxiety, and chronic pain as a result of the accident.
Based on medical and psychological evidence, the arbitrator concluded that the applicant's physical and psychological limitations continuously prevented her from engaging in any suitable occupation or employment.
The applicant was awarded ongoing weekly income benefits and interest.
