10 total
Application for accident benefits arbitration dismissed after applicant failed to participate; insurer awarded $750 expenses.
The applicant was injured in a motor vehicle accident and sought accident benefits from the insurer.
After the applicant failed to attend a pre-hearing discussion and his counsel lost contact with him, counsel successfully moved to withdraw.
The insurer subsequently moved to dismiss the application for arbitration.
The arbitrator granted the motion to dismiss under Rule 68 of the Dispute Resolution Practice Code, finding the application frivolous, vexatious, or commenced in bad faith due to the applicant's failure to participate.
The insurer was awarded $750 in expenses.
Arbitration for statutory accident benefits dismissed on consent of the parties without costs.
The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer terminated.
The applicant sought arbitration.
During the proceedings, the applicant's representative was found to have a conflict of interest and withdrew.
After being given time to find new representation, the applicant and the insurer ultimately signed a consent to dismiss the arbitration without costs.
The arbitrator dismissed the issues in the arbitration hearing based on the consent of the parties.
Claims for caregiver and housekeeping benefits dismissed due to credibility issues and surveillance evidence.
The applicant claimed caregiver and housekeeping benefits following two motor vehicle accidents.
The insurer disputed the claims, relying on surveillance evidence and inconsistencies in the applicant's statements regarding the identity of the service providers and the services rendered.
The arbitrator found significant unresolved conflicts in the evidence and noted the applicant's failure to call the alleged caregiver to testify.
The arbitrator concluded the applicant failed to establish on a balance of probabilities that she incurred the claimed expenses.
The claims for benefits and interest were dismissed.
The insurer's claim for an assessment award was also dismissed as the statutory authority for such awards had been repealed.
Insurer awarded fixed arbitration expenses after applicants' claims were dismissed due to unreliable evidence.
Following a decision that the applicants were not injured in a motor vehicle accident and were precluded from proceeding to arbitration, the insurer sought its arbitration expenses under subsection 282(11) of the Insurance Act.
The arbitrator found that the applicants were unsuccessful and that their oral evidence was implausible and unreliable, leading to needless time and resources being expended.
The arbitrator awarded the insurer a fixed portion of its expenses, ordering the applicants to pay a total of $800.
Claims for accident benefits dismissed as the arbitrator found the alleged motor vehicle accidents did not occur as described.
The applicants claimed statutory accident benefits following two alleged motor vehicle accidents on July 15 and July 30, 2002.
The insurer denied the claims, arguing that the incidents did not meet the definition of an "accident" under section 2(1) of the Statutory Accident Benefits Schedule.
At a preliminary issue hearing, the arbitrator heard evidence from the applicants and three accident reconstruction experts retained by the insurer.
The arbitrator found the applicants' accounts of both incidents to be unreliable and implausible.
Relying on the expert evidence, which demonstrated that the vehicle damage was inconsistent with the applicants' descriptions, the arbitrator concluded that the applicants were not involved in accidents within the meaning of the Schedule and were therefore precluded from proceeding to arbitration.
Application for accident benefits dismissed due to unexcused failure to notify insurer within 30 days.
The applicant was involved in a motor vehicle accident and applied for statutory accident benefits.
The insurer refused to pay, arguing the applicant failed to notify them of his intention to apply within 30 days as required by subsection 59(1) of the Statutory Accident Benefits Schedule.
The arbitrator found that the applicant did not notify the insurer until 87 days after the accident and lacked a reasonable excuse for the delay.
The application for arbitration was dismissed.
Application for accident benefits dismissed as arbitrator found no collision occurred between bicycle and van.
The Applicant claimed she sustained neck and back injuries when her bicycle collided with a cube van insured by the Respondent.
The Insurer denied that an accident occurred.
Following a hearing on the preliminary issue of whether an 'accident' occurred within the meaning of the Statutory Accident Benefits Schedule, the Arbitrator found the Applicant's testimony implausible and preferred the evidence of the van driver and two independent witnesses who testified there was no contact between the van and the bicycle.
The Arbitrator concluded that the Applicant was not involved in an accident and did not sustain an impairment caused by the use or operation of an automobile.
The application for statutory accident benefits was dismissed.
Claim for ongoing statutory accident benefits dismissed as disability resulted from pre-existing degenerative disc disease.
The applicant was injured in a motor vehicle accident in December 1990 and received weekly income benefits until June 1991.
He applied for arbitration, seeking ongoing weekly income benefits and supplementary medical and rehabilitation expenses, claiming he was substantially unable to perform his essential tasks as a home day care provider due to continuing back and leg pain.
The arbitrator found that the applicant's ongoing pain and disability after June 1991 were the result of a pre-existing degenerative disc disease process rather than the motor vehicle accident.
The claims for ongoing weekly income benefits and rehabilitation expenses were dismissed, though the applicant was awarded his arbitration expenses.
Claim for weekly accident benefits dismissed as applicant failed to prove accident caused ongoing disability.
The applicant was injured in a motor vehicle accident and received statutory accident benefits from the insurer.
The insurer terminated her weekly benefits, and the applicant sought arbitration to claim benefits for the period between December 1991 and May 1993.
The arbitrator found that the applicant had a pre-existing disability and failed to prove that the accident caused or significantly contributed to her inability to perform her homemaking tasks during the disputed period.
The arbitrator accepted the insurer's medical evidence that the applicant was substantially able to perform her essential tasks.
The claim for weekly benefits was dismissed, but the applicant was awarded her arbitration expenses.
Applicant failed to prove self-employment income exceeded minimum threshold; insurer awarded repayment of overpaid benefits.
The applicant was injured in a motor vehicle accident and received weekly income benefits from the insurer.
A dispute arose regarding the correct calculation of his pre-accident income from self-employment.
The arbitrator found that the applicant failed to provide sufficient documentation to prove his net income exceeded the minimum threshold, entitling him only to the minimum benefit of $185.60 per week.
Consequently, the insurer was entitled to repayment of $15,951.51 in overpaid benefits, while the applicant was awarded his arbitration expenses.