Kevin Wolf

The insurer appealed an arbitration order finding that the insured's claim for weekly benefits was not time-barred.

The insurer argued it had provided clear notice of termination of income replacement benefits (IRBs) effective August 2, 1997.

However, the insurer later agreed to pay IRBs up to the 104-week mark and made a loss of earning capacity benefits (LECBs) offer, which required the insured to continue qualifying for IRBs.

The Director of Arbitrations held that by engaging in the LECB process, the insurer acknowledged the insured's ongoing qualification for IRBs, preventing it from relying on the earlier termination date.

The appeal was dismissed.

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

The insurer terminated benefits on multiple occasions but subsequently reinstated them after mediation and assessments.

The insurer argued the applicant's arbitration was time-barred under the two-year limitation period.

The arbitrator held that the insurer's reinstatements of benefits nullified its prior refusals, and its final termination failed to comply with the notice requirements under section 71 of the Statutory Accident Benefits Schedule.

Therefore, the limitation period had not begun to run, and the arbitration was permitted to proceed.

The applicant's spouse died from carbon monoxide poisoning while operating a Gravely tractor in an underground parking garage.

The applicant sought death benefits under a standard automobile policy.

The insurer denied the claim on the basis that the tractor was not an automobile.

The arbitrator applied the three-stage test from Regele v. Slusarczyk and found that the tractor was not an automobile in ordinary parlance, was not covered by the policy, and was not required to be insured under the Compulsory Automobile Insurance Act or the Off-Road Vehicles Act because it was not operated on a highway or off the owner's property.

The preliminary issue was resolved in favour of the insurer.

The applicant, a taxi driver, was injured when pinned between two vehicles.

He claimed ongoing weekly income benefits, alleging chronic pain and depression prevented him from working.

The insurer terminated benefits after medical assessments indicated he could return to work.

The arbitrator dismissed the claim for ongoing benefits, finding the applicant lacked credibility, exaggerated his symptoms, and had been working covertly at his brother's store, as revealed by surveillance evidence.

The medical opinions supporting disability were rejected as they relied on the applicant's unreliable subjective reporting.

The applicant was awarded one-third of his expenses.

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

The insurer terminated her weekly income benefits, and the applicant applied for arbitration.

The arbitrator found the applicant's testimony regarding her pre-accident health and essential tasks to be unreliable.

Relying on objective medical evidence and reports from rehabilitation facilities, the arbitrator concluded that the applicant was no longer substantially disabled from performing her essential tasks as a homemaker when her benefits were terminated.

The claim for ongoing weekly benefits was dismissed, while a claim for gas expenses was settled during the hearing.