James E. S. Allin

The applicant sought statutory accident benefits, including caregiver benefits and medical expenses, alleging that a 1994 motor vehicle accident caused a disc herniation in 1996.

The arbitrator found that the applicant's evidence regarding the onset of her disability was unsupported by contemporary medical documentation, which indicated the disability began at the time of the herniation, more than two years after the accident.

Furthermore, expert medical evidence failed to establish a causal link between the 1994 accident and the 1996 disc herniation.

All claims for benefits, expenses, and a special award were denied.

The insurer requested a correction to a previous arbitration order regarding the calculation of Loss of Earning Capacity (LEC) benefits.

The arbitrator found jurisdiction under the Statutory Powers and Procedure Act and the Dispute Resolution Practice Code to correct the technical calculation error, which had failed to deduct UI, CPP, and income tax from the pre-accident income.

The LEC benefits were recalculated and reduced accordingly.

The arbitrator also determined that the insured was entitled to her expenses of the arbitration process, as she was largely successful in establishing her entitlement to the LEC benefit and the insurer had not made an offer to settle.

Following a settlement of disputed claims for statutory accident benefits, the applicant sought an assessment of his legal expenses.

The insurer agreed the applicant was entitled to expenses but disputed the amount, specifically the hourly rate of the senior counsel, the rate and hours of the law clerk, and certain disbursements including accountant's reports.

The arbitrator allowed the senior counsel's rate of $150 per hour, the law clerk's rate of $45 per hour, and most of the disbursements, awarding a total of $19,449.35 in fees and disbursements.

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

The parties disputed the calculation of income replacement benefits (IRBs) and loss of earning capacity benefits (LECBs).

The arbitrator held that the employer's CPP contributions should not be included in the applicant's income for calculating IRBs.

The arbitrator also found that the insurer was entitled to assess the applicant's LECBs based on the Residual Earning Capacity Designated Assessment Centre (REC DAC) report, as it carries more weight than independent medical reports at this stage.

Finally, the arbitrator ruled that the insurer could not deduct prior disability payments made by another insurer, as the settlement agreement only permitted the deduction of the new settlement funds.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, including a loss of earning capacity (LEC) benefit, housekeeping expenses, and shop assistant expenses.

The arbitrator determined the applicant's pre-accident earning capacity based on her reported income and unreported tips, and found she had no residual earning capacity due to a mild to moderate brain injury.

The claim for a shop assistant was dismissed as an unreasonable rehabilitation expense, while the claim for housekeeping expenses was allowed.

The applicant's request for a special award was dismissed.

In a dispute over statutory accident benefits, the parties sought preliminary rulings on the production of documents.

The arbitrator ordered the insurer to produce draft reports and clinical notes of IME and DAC assessors, finding that such statutorily mandated assessments are not protected by litigation privilege.

The arbitrator also ordered the insurer to produce its complete accident benefits file, including adjusters' notes and reserve information, up to the date the applicant applied for mediation, applying the dominant purpose test.

The insurer was further ordered to produce all surveillance evidence if it intended to rely on any part of it.

The applicant's requests for the insurer's policy manuals and legal opinions were denied.

Finally, the applicant's Canada Pension Plan file was ordered produced as it was relevant to her medical condition.

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

The parties entered into a settlement agreement, but a dispute arose over the interpretation of a term regarding ongoing payment for a shop assistant and housekeeping expenses.

The arbitrator held that the settlement agreement implicitly required the applicant to demonstrate continuing entitlement to the benefits and to provide reasonable verification of her expenses, rather than providing a 'blank cheque' for life.

The insurer sought production of a transcript of the applicant's examination for discovery from a related civil action.

The applicant refused consent, relying on the implied undertaking rule.

The arbitrator held that under Rule 30.1.01 of the Rules of Civil Procedure, only a court has the authority to grant relief from the implied undertaking rule.

The arbitrator concluded that the tribunal lacked jurisdiction to order the production of the transcript, and the insurer's request was denied.

The applicant sought expenses following an arbitration decision that awarded her income replacement benefits.

The insurer disputed the amounts claimed for legal fees and accountants' services as excessive.

The arbitrator assessed the legal fees based on a reasonable ratio of preparation time to hearing time, allowing 24 hours at $125 per hour for the original bill.

The supplementary legal bill was reduced as excessive.

The arbitrator also reduced the claimed disbursements for two accounting firms, noting that one accountant did not testify and part of their report dealt with matters not in dispute.

The applicant was awarded a total of $6,427.07 in expenses.

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

A dispute arose regarding the calculation of her income replacement benefits.

The arbitrator held that draws taken from the family business, which were declared as dividends for tax purposes, formed part of the applicant's regular remuneration and should be included in her gross annual income.

The arbitrator also held that unemployment insurance premiums should not be deducted from her gross annual income because she was exempt from paying them as a joint owner of the business.

The Applicant was injured in a motor vehicle accident and applied for arbitration following a dispute over income replacement benefits.

Shortly before the hearing, the parties negotiated a settlement.

The Insurer subsequently refused to pay the Applicant's legal fees, arguing they were not part of the settlement and that the settlement was void for mistake, uncertainty, and failure to comply with the Settlement Regulation.

The Arbitrator found that the correspondence clearly established an objective agreement to pay expenses, including legal fees.

The Arbitrator held that the Insurer could not rely on its own failure to provide the required settlement disclosure notice to invalidate the agreement.

The settlement was declared binding, and the Insurer was ordered to pay a $7,500 special award for unreasonably delaying payment and attempting to evade the settlement.

The applicant was injured in a motor vehicle accident and claimed ongoing weekly and lump sum education disability benefits under the Statutory Accident Benefits Schedule.

She argued that her back injuries prevented her from pursuing her intended career as a nurse, constituting a substantial inability to continue her education.

The arbitrator held that the Schedule does not compensate for loss of future career opportunity and found she was able to continue her post-secondary education in other fields.

However, the arbitrator found she suffered a partial inability to carry on a normal life for a limited period due to restrictions on her mobility activities, awarding weekly benefits for that closed period.

The appellant was injured in a motor vehicle accident and developed severe fibromyalgia and chronic pain.

She appealed an arbitrator's decision denying her claims for various assistive devices, a hot tub, an electric bed, and replacement farm labour costs under the Statutory Accident Benefits Schedule.

The Director's Delegate upheld the arbitrator's denial of the hot tub, exercise equipment, and replacement farm labour, agreeing that the labour costs were a business expense rather than a rehabilitation need.

However, the Director's Delegate reversed the arbitrator's decision regarding the electric bed, finding it reasonably required for the appellant's rehabilitation to manage chronic pain.

The order was also varied to correct the calculation of CPP disability benefit deductions.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including weekly income and supplementary medical benefits, until April 1994.

She applied for arbitration to reinstate these benefits, claiming she suffered from chronic pain that prevented her from returning to her pre-accident job as a security guard.

The arbitrator reviewed medical evidence and video surveillance showing the applicant performing various physical activities, including shopping and shoveling snow.

The arbitrator preferred the evidence of the insurer's rehabilitation specialist and concluded the applicant no longer suffered a substantial inability to perform the essential tasks of her employment.

The claims for ongoing benefits were dismissed, though the applicant was awarded her arbitration expenses.

The applicant was injured in a motor vehicle accident and sought weekly income benefits.

Prior to the accident, he and his wife ran a business, with the applicant performing heavy labour and administrative duties.

Following the accident, the applicant's wife took over the administrative duties, though the applicant remained physically capable of performing them.

The arbitrator found that the reallocation of duties was a lifestyle decision rather than a result of the accident.

Consequently, the arbitrator declined to alter the pre-accident income allocation, finding that the applicant's post-accident income exceeded the benefits payable.

The claim for further benefits was dismissed, but the applicant was awarded his arbitration expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from her insurer.

The parties disputed the calculation of weekly income benefits for a self-employed farmer, specifically regarding the deduction of ceasing expenses, Canada Pension Plan disability benefits, and post-accident farm income.

The arbitrator determined the appropriate weekly income benefit amounts for 1991-1993.

The arbitrator also reviewed claims for supplementary medical and rehabilitation expenses, granting the cost of an exercise bike, bench, and cane, but denying claims for a hot tub, electric bed, replacement farm labour, and future housekeeping and transportation expenses.

The applicant sought an interim award of expenses for clinical notes and a medical-legal report under section 282(11.1) of the Insurance Act.

The insurer argued the section did not apply retrospectively to proceedings commenced before January 1, 1994.

The arbitrator held that the section applies immediately to all ongoing proceedings.

Applying a three-part test, the arbitrator found the application raised a bona fide issue, the expenses were necessary and reasonable, and the applicant was unable to carry the costs until the hearing.

The arbitrator awarded $800 in interim expenses.

The appellant insurer appealed an arbitrator's decision finding it responsible for paying the respondent's accident benefits.

The appellant argued the respondent failed to provide notice of her claim within the statutory time limits and lacked a reasonable excuse for the 16-month delay.

The Director of Arbitrations dismissed the appeal, upholding the arbitrator's finding that a combination of factors—including the respondent's initial claim to another insurer who paid expenses, incorrect documentation, and personal circumstances—constituted a reasonable excuse for the delay under section 22(2) of the No-Fault Benefits Schedule.

The applicant was injured in a motor vehicle accident and initially applied for accident benefits from her son's insurer, The Personal, who paid her expenses for a year before realizing she had her own policy with Zurich.

The applicant then applied to Zurich, who denied the claim due to the delay in notice.

On a preliminary issue hearing, the arbitrator found that under section 268 of the Insurance Act, Zurich was the priority insurer.

The arbitrator also found that the applicant had a reasonable excuse for the delay in notifying Zurich, as The Personal's error in sending the wrong claim form and subsequent payment of benefits caused the delay.

Zurich was ordered to pay the applicant's accident benefits.