A. Sandy Williams

The applicant sought $10,200.00 for a multidisciplinary report to rebut the respondent's termination of his income replacement benefit.

The applicant argued that procedural fairness and section 25 of the Statutory Accident Benefits Schedule entitled him to an insurer-funded rebuttal report.

The Tribunal held that the Schedule does not provide for the funding of rebuttal reports for income replacement benefit determinations, noting that section 25(1)5 specifically applies to catastrophic impairment applications.

The Tribunal dismissed the application, finding the respondent was not liable for the cost of the assessment.

The applicant sought $10,200 for a multidisciplinary report to rebut the respondent's termination of his income replacement benefit.

The applicant argued that procedural fairness and section 25 of the Schedule entitled him to funding for the report.

The Tribunal held that the Schedule does not provide for funding of rebuttal reports for income replacement benefit determinations, noting that section 25(1)5 applies specifically to catastrophic impairment applications.

The application was dismissed.

The applicant sought payment for the cost of an accounting report obtained to calculate his Income Replacement Benefit (IRB) following a motor vehicle accident.

The insurer denied the expense.

The Tribunal found that the accounting report was not reasonable and necessary because it was commissioned prematurely before any dispute over the IRB quantum existed, and the applicant's IRB calculation was straightforward, based on only two income sources.

The claim for the cost of the report and interest was dismissed.

The respondent requested a reconsideration of an adjudicator's order directing that the issue of payment for an economic loss report proceed by way of a written hearing rather than a hybrid hearing.

The respondent argued that an oral hearing was necessary to cross-examine the applicant's employer, who was also the applicant's lawyer, regarding the decision to submit an accounting report instead of an OCF-2.

The Associate Chair dismissed the reconsideration request, finding that the adjudicator appropriately applied the Tribunal's rules promoting efficient and proportional resolution and did not violate the rules of procedural fairness.

The applicant sought statutory accident benefits for injuries sustained in a motor vehicle accident, arguing that a pre-existing low back condition exempted him from the Minor Injury Guideline.

The Tribunal found insufficient medical evidence to establish a pre-existing condition that would prevent maximal recovery within the Guideline, noting that most of the applicant's medical evidence post-dated a second motor vehicle accident.

Consequently, the Tribunal held that the applicant's injuries were predominantly minor, and his claims for prescription medications were denied as he had exhausted the Guideline's monetary limits.

Aviva appealed an arbitrator's decision in a priority dispute which found that Aviva was the priority insurer for accident benefits because it failed to prove the claimant was the 'spouse' of a driver insured by Security National.

Aviva argued the claimant and the driver were married in a foreign religious ceremony.

The Superior Court dismissed the appeal, holding that the arbitrator's decision was reasonable.

The court found that Aviva bore the burden of proof and failed to provide sufficient evidence of the date, place, or legal validity of the foreign marriage under the lex loci celebrationis.

The applicant was injured in a motor vehicle accident and applied for arbitration after mediation failed.

The insurer made a Rule 76 offer to settle, which the applicant did not accept.

The applicant subsequently requested to withdraw his application prior to the hearing.

The insurer consented to the withdrawal on the condition that an expense hearing be held, seeking its costs of preparation.

The arbitrator found that the proceeding had not formally ended and retained jurisdiction to determine expenses.

Considering the consumer protection objectives of the legislation and the applicant's legitimate reasons for not accepting a full and final settlement, the arbitrator ordered that each party bear its own expenses and formally withdrew the application.

The insurer sought an order for its expenses and disbursements totalling $166,613.39 against the applicant and her lawyer personally, following the dismissal of the applicant's claim for statutory accident benefits.

The arbitrator found that the applicant and her counsel failed to adequately prepare for the hearing, maintained unmeritorious claims until the last minute, and engaged in conduct that prolonged the proceeding.

The arbitrator ordered the applicant to pay $49,190.13 in expenses and her counsel to personally pay $6,051.36.

The applicant sought statutory accident benefits, including non-earner, attendant care, and housekeeping benefits, following a motor vehicle accident.

The insurer denied the claims, arguing the applicant's impairments pre-dated the accident and that she misrepresented her medical history.

The arbitrator dismissed the application, finding the applicant and her husband lacked credibility.

The evidence demonstrated the applicant had a significant pre-existing history of chronic pain and degenerative arthritis for which she was already receiving a disability pension, and she failed to disclose this history to post-accident assessors.