Karen McGuire

The appellant was injured in a fight with another passenger on a TTC bus and subsequently required a leg amputation.

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

The Arbitrator found that the bus was merely the location of the fight and its use or operation did not directly cause the impairment.

On appeal, the Director's Delegate upheld the Arbitrator's decision, applying the Amos and Chisholm tests, and concluding that an assault on a bus is not a normal incident of risk created by the use or operation of a vehicle.

The appeal was dismissed.

The plaintiff was injured during an altercation with another passenger on a TTC bus and subsequently required a leg amputation.

He sued the TTC and the bus driver for negligence, alleging they failed to provide a safe environment, intervene, or call for help promptly.

The defendants brought a motion for summary judgment.

Relying heavily on video surveillance from the bus, the court found no evidence that the driver or TTC breached their duty of care as common carriers.

The motion for summary judgment was granted and the action was dismissed.

The applicant sought statutory accident benefits after an incident on a TTC bus where he engaged in a physical altercation with another passenger, fell, and allegedly injured his toe, which later led to a leg amputation.

The insurer denied the claim on the basis that the incident was not an 'accident' under section 2(1) of the Statutory Accident Benefits Schedule.

The arbitrator found that the incident was an assault, not an accident, as the bus merely provided the location for the fight and was not moving at the time.

Furthermore, the assault was an intervening act that broke the chain of causation, and the applicant failed to establish a causal link between the bus incident and his subsequent amputation.

The preliminary issue was resolved in favour of the insurer.

The applicant, who had pre-existing mobility and health issues and used a motorized scooter, was involved in two motor vehicle accidents.

She applied for non-earner benefits from the insurers, claiming a complete inability to carry on a normal life.

The arbitrator found that while the applicant experienced pain and some functional limitation for a few months, she continued to live basically the same life as she had prior to the accidents, including driving her scooter, relying on meals on wheels, and eventually returning to social activities.

The application for non-earner benefits was dismissed, as the applicant failed to meet the stringent statutory test of being continuously unable to engage in substantially all of her pre-accident activities.

The applicant sought a determination that he was catastrophically impaired as a result of a 2001 motor vehicle accident.

In a previous arbitration, it was determined that the accident caused his impairments for the purpose of various statutory accident benefits.

The applicant argued that the issue of causation was res judicata and could not be relitigated in the current catastrophic impairment arbitration.

The arbitrator held that the specific issue of causation as it relates to assigning a percentage of whole person impairment for catastrophic impairment had not yet been adjudicated.

Therefore, the insurer was permitted to argue causation at the upcoming hearing.

In a pre-hearing decision regarding a claim for statutory accident benefits, the insurer sought to add the issue of the quantum of income replacement benefits and requested production of various pre-accident employment and medical records.

The arbitrator denied the request to add the issue of quantum, noting the insurer had previously agreed to the quantum and raising it now would prejudice the applicant and complicate the proceeding.

The arbitrator also denied the production requests, finding they were not properly raised or justified at this stage of the proceeding.

The applicant was injured while attempting to board a bus and claimed statutory accident benefits for medical and housekeeping expenses.

The insurer paid benefits for a few months but denied further claims.

At arbitration, the arbitrator found the applicant and his witnesses lacked credibility due to significant inconsistencies regarding his employment status and the extent of his impairment.

Relying on the insurer's medical experts, who found symptom magnification and no objective evidence of ongoing impairment or chronic pain syndrome, the arbitrator dismissed the claims for ongoing medical and housekeeping benefits, as well as the claim for a special award.

The applicant, who was injured in a motor vehicle accident, brought a motion to exclude the insurer's evidence regarding whether his impairments resulted from a pre-existing condition, arguing res judicata based on a prior arbitration decision.

The insurer had appealed the prior decision, and the appeal decision was pending.

The arbitrator adjourned the motion until after the appeal decision was released, finding it inefficient to proceed when the appeal could render the motion moot.

The insurer's request for expenses thrown away due to late delivery of the motion was reserved until the completion of the arbitration.

The insurer brought a motion for the production of the applicant's welfare records, employment records, and income tax returns in an arbitration for statutory accident benefits.

The arbitrator ordered the production of the medical and drug benefit portions of the welfare file, as well as employment records detailing job duties and hours, finding them relevant to the applicant's claim for medical and housekeeping benefits.

The request for income tax returns was dismissed as they were not relevant to the applicant's physical capabilities.

The applicant, a 69-year-old man, was struck by a streetcar while riding his bicycle.

He applied for statutory accident benefits, which the insurer denied on the basis that his impairments were caused by the natural progression of his pre-existing polyneuropathy rather than the accident.

The arbitrator found that the accident materially contributed to the applicant's physical and psychological impairments, including chronic pain, which rendered him completely unable to carry on a normal life.

The applicant was awarded non-earner benefits, medical benefits, attendant care, housekeeping, and the costs of various assessments.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award under s. 282(10) of the Insurance Act for unreasonably withholding benefits in the face of overwhelming medical evidence supporting the applicant's claim.

The applicant was a passenger on a public transit bus.

She alleged that as she was exiting the bus, the doors closed on her jacket and purse, and the bus moved, causing her injury.

She applied for statutory accident benefits.

The insurer denied the benefits and raised two preliminary issues: whether an "accident" occurred within the meaning of the Statutory Accident Benefits Schedule, and whether the applicant was precluded from proceeding to arbitration for failing to attend insurer's examinations.

The arbitrator found that the applicant's jacket and purse were caught in the doors, constituting an "accident".

Furthermore, the arbitrator held that the insurer's notice of examinations was defective because it failed to state the specific benefits to which the examinations related, as required by section 42(2) of the Schedule.

Therefore, the insurer could not rely on the notice to preclude the arbitration.

The Director's Delegate issued a correction to an appeal decision dated September 20, 1999.

Three references to s.28(4) on pages 7 and 9 of the original decision were corrected to s.24(8).

The appellant appealed an arbitration decision dismissing her application for statutory accident benefits as statute-barred.

The appellant argued that the insurer's termination letter was not clear and unequivocal, and that sending the notice to her lawyer rather than directly to her was insufficient to trigger the two-year limitation period.

The Director's Delegate dismissed the appeal, finding that the termination letter, read with its enclosures, provided clear and unequivocal notice.

Furthermore, where an insured person retains a lawyer to conduct dealings with the insurer, notice to the lawyer is sufficient to start the limitation period.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them.

The applicant applied for arbitration more than two years after the termination.

The insurer raised a preliminary issue that the application was statute-barred.

The applicant argued the limitation period did not begin because the notice of termination was sent to her lawyer, not to her personally, and was not clear and unequivocal.

The arbitrator found the notice was clear and that the insurer was entitled to rely on the lawyer's actual or ostensible authority to receive the notice.

The application was dismissed as untimely, but the applicant was awarded her arbitration expenses.

The applicant was injured while standing on a bus that stopped suddenly.

She received weekly income benefits until September 13, 1992, and sought further benefits up to February 28, 1993, along with a special award and expenses.

The arbitrator dismissed the claims, finding the applicant lacked credibility due to significant inconsistencies in her accounts of the accident and her failure to disclose prior injuries to assessing doctors.

The medical reports supporting her claim were deemed unhelpful as they relied on her inaccurate history.

The insurer's termination of benefits was found to be reasonable, and expenses were denied due to the applicant's lack of candour.

The applicant, a bus passenger, claimed statutory accident benefits following a minor motor vehicle accident.

She sought weekly income benefits, care benefits for her mentally incapacitated son, housekeeping expenses, and a special award.

The arbitrator found the applicant was not a credible witness and that her ongoing complaints were related to pre-existing conditions rather than the accident.

The claims for weekly income benefits, housekeeping expenses, and a special award were dismissed.

The applicant was awarded care benefits for a limited period and her arbitration expenses.

At a pre-hearing discussion, the parties disagreed on the issues to be included in the arbitration hearing.

The applicant sought to exclude her eligibility for supplementary medical and rehabilitation benefits, which she had not raised in her current application, while the insurer argued all outstanding disputes should be heard together.

The arbitrator held that, following the Director's decision in DeCicco, an insurer cannot raise a new matter (benefit category) not included in the applicant's application without consent.

Therefore, the supplementary medical and rehabilitation benefits were excluded from the arbitration.