Jonathan A. Schwartzman

The applicant requested a reconsideration of a decision denying him income replacement benefits and a treatment plan.

He argued the adjudicator misapprehended expert evidence, breached procedural fairness, and made errors of fact and law regarding causation and expert qualifications.

The Vice Chair dismissed the request, finding no errors of law or fact and no breach of procedural fairness, noting the applicant was attempting to re-litigate the case.

The respondent's request for costs was also dismissed, as the applicant's conduct did not rise to the level of being unreasonable, frivolous, or vexatious.

The insurer brought a motion to stay the arbitration on the grounds that the insured refused to attend a proposed in-home occupational therapy assessment as part of its catastrophic impairment assessment process.

The arbitrator dismissed the motion, finding that the insurer failed to demonstrate that the further assessment was reasonably necessary under section 44 of the Statutory Accident Benefits Schedule.

The insurer's neuropsychologist had access to numerous existing occupational therapy reports and failed to provide a credible explanation for why a new assessment was required.

Furthermore, the arbitrator held that even if the assessment were necessary, a stay would not be the appropriate remedy, as the insurer failed to establish irreparable harm or that the balance of convenience favoured a stay.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated her weekly income replacement benefits.

The insurer relied on a Disability DAC assessment concluding she could perform alternative employment.

The arbitrator found that while the applicant was physically capable of performing the tested jobs, she suffered from a chronic pain condition and psychological impairments caused by the accident.

Relying on earlier DAC reports and psychological assessments, the arbitrator concluded that these psychological limitations rendered her completely unable to engage in any employment for which she was reasonably suited by education, training, or experience.

The deceased was killed in a motor vehicle accident.

The insurer paid a $10,000 death benefit to her mother, but refused to make an additional payment to her father, arguing the Statutory Accident Benefits Schedule provided for a single payment.

The arbitrator ordered the insurer to pay an additional $10,000 to the father.

On appeal, the Director's Delegate confirmed the arbitrator's decision, holding that each person in respect of whom the insured was a dependant is entitled to a separate $10,000 payment.

The applicant's daughter died in a motor vehicle accident.

The insurer paid a $10,000 death benefit to the deceased's mother, but denied a second $10,000 death benefit claimed by the applicant father.

The arbitrator interpreted subparagraph 25(2)(5)(i) of the Statutory Accident Benefits Schedule and found that it allows for multiple $10,000 payments to each person who qualifies as a person in respect of whom the insured was a dependant.

The arbitrator ordered the insurer to pay the applicant the $10,000 death benefit with interest.

The applicant's claim for a special award was dismissed because the law on the provision was unsettled, meaning the insurer did not unreasonably withhold payment.