Joseph Sullivan

The applicant sought statutory accident benefits for two dental treatment plans related to temporomandibular joint pain following a motor vehicle accident.

The respondent denied the plans based on an insurer's examination which concluded further treatment was unlikely to be beneficial.

The adjudicator dismissed the application, finding the treatment plans were not reasonable and necessary because the applicant failed to provide any supporting medical evidence to contradict the respondent's expert.

The appellant mistakenly filed a notice of appeal in the Divisional Court instead of the Court of Appeal.

Upon discovering the jurisdictional error, the appellant brought a motion under section 110 of the Courts of Justice Act to transfer the appeal to the Court of Appeal.

Applying the Dunnington criteria, the court found that while the appellant moved expeditiously and there was no undue prejudice to the respondent, the appeal lacked merit.

Although the appellant raised an arguable point of statutory interpretation regarding underinsured motorist coverage, the claim was statute-barred by the Limitations Act, 2002.

The motion to transfer was dismissed.

The applicant was receiving weekly income benefits following a motor vehicle accident.

The insurer reduced her benefits by the amount of her CPP disability benefits.

The insurer argued the applicant was barred from contesting the deduction due to the two-year limitation period.

The arbitrator held that a reduction in benefits is not a denial, so the limitation period was not triggered.

Relying on recent jurisprudence, the arbitrator found that CPP disability benefits are not an indemnity for loss of income and therefore cannot be deducted from weekly income benefits.

The insurer was ordered to pay the applicant's expenses.

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

The appellant disputed the termination and the benefit amount, but an arbitrator found he was not entitled to benefits beyond the termination date and was only entitled to the minimum benefit amount, resulting in an overpayment.

The appellant appealed the arbitration order.

The Director of Arbitrations dismissed the appeal, finding that the arbitrator's conclusions regarding the appellant's ability to return to work and his employment status were fully supported by the evidence.

The Director also upheld the denial of arbitration expenses and declined to award appeal expenses, noting the appeal was an ill-considered attempt to relitigate credibility findings.

The applicant's husband was killed in a motor vehicle accident while in the course of his employment.

The family received workers' compensation benefits and also claimed death benefits under the deceased's automobile insurance policy.

The insurer denied the claim, arguing that section 20 of the Statutory Accident Benefits Schedule precludes payment of no-fault benefits when workers' compensation benefits are payable.

The arbitrator agreed, finding that section 20 reflects a legislative intent to prevent double recovery and makes the auto insurer the payer of last resort.

The applicants were ordered to repay the $45,000 in death benefits previously advanced by the insurer, along with interest.

The applicant was injured in a motor vehicle accident and received weekly income benefits until they were terminated by the insurer.

The applicant sought reinstatement of benefits under section 12(1) of the Schedule for the period up to 156 weeks post-accident, and under section 12(5)(b) thereafter.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of her pre-accident employment as a sewing machine operator due to the demanding nature of the job and uncertainty about her capacity, granting benefits up to the 156-week mark.

However, the arbitrator dismissed the claim for ongoing benefits after 156 weeks, finding that the applicant was not continuously prevented from engaging in any occupation or employment for which she was reasonably suited, as she was capable of other light industrial work.

The applicant, a high school student, was severely injured in a motor vehicle accident and suffered significant psychological trauma.

His therapist recommended a transfer to a private boarding school to assist his recovery by providing a structured social environment.

The insurer refused to pay the tuition, arguing it was not a reasonable or necessary expense resulting from the accident.

The arbitrator found that the applicant's pre-existing psychological vulnerability made him particularly susceptible to trauma, and that the boarding school placement was a successful and reasonable rehabilitation measure.

The insurer was ordered to reimburse the tuition and boarding expenses for two years.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits to purchase a new, 'safe' vehicle to treat her severe car phobia, which had been exacerbated by the accident.

The insurer refused to fund the vehicle purchase.

The arbitrator found that while the applicant suffered a serious psychological injury that aggravated a pre-existing condition, the insurer's rehabilitation obligations did not extend to purchasing a new vehicle.

The insurer was only required to return the applicant to her pre-accident state, at which time she was already suffering from car phobia and had not been provided a new vehicle.

The claim for a vehicle was dismissed, but the applicant was awarded her arbitration expenses.

The applicant was involved in a motor vehicle accident and received weekly income benefits from the insurer.

The insurer terminated the benefits on the basis that the applicant was capable of performing the essential tasks of his pre-accident occupation.

The applicant sought arbitration to reinstate benefits and increase the weekly quantum, claiming he was an employee earning a higher wage.

The arbitrator found the applicant's evidence regarding his employment and income lacked credibility, determining he was a partner in a business that lost money, entitling him only to the minimum weekly benefit.

The arbitrator also found the applicant failed to prove he suffered a substantial inability to perform his essential tasks during the disputed period.

The application was dismissed, the applicant was ordered to repay the overpayment, and his claim for expenses was denied.