Sean Miller

The applicant, a pedestrian who sustained catastrophic injuries when struck by a vehicle, sought retroactive attendant care benefits from the date of the accident in 2007 until she formally applied in 2015.

The respondent insurer had denied coverage in a related tort action for years before finally admitting it insured the vehicle.

The Tribunal found that it was initially impossible, and later impractical, for the applicant to submit her application earlier due to the insurer's non-coverage position and failure to notify her of her rights.

The Tribunal awarded retroactive attendant care benefits of $6,000 per month with interest accruing from the date of her hospital discharge in 2007.

The applicant was injured in an ATV accident 27 days after purchasing the vehicle, but only one day after taking physical possession of it.

He applied for an income replacement benefit, which the insurer denied on the basis that he was operating an uninsured vehicle.

The Tribunal held that 'delivery' under the standard automobile policy means constructive possession, which occurred on the date of purchase when the applicant had authority to determine where the ATV would go.

Because the applicant failed to notify the insurer within 14 days of constructive possession, the ATV was uninsured.

The Tribunal further found the applicant did not reasonably believe the ATV was insured, precluding him from receiving benefits under s. 31(1)(a)(i) of the Schedule.

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

The parties were unable to resolve their disputes through mediation, and the applicant applied for arbitration.

Prior to the hearing, the parties consented to the dismissal of the application for arbitration without costs.

The arbitrator dismissed the application and ordered no costs.

The applicant was injured in a motor vehicle accident as a pedestrian and applied for income replacement benefits.

The insurer denied the benefits and later brought a motion arguing the applicant was statute-barred from proceeding to arbitration because more than two years had passed since the denial.

The arbitrator found that the insurer's denial letter was clear and unambiguous, as evidenced by the applicant's subsequent participation in mediation.

Because the applicant failed to commence arbitration within two years of the denial or 90 days after mediation failed, the application for income replacement benefits was statute-barred.

The applicant sought accident benefits following a motor vehicle accident but failed to attend a pre-hearing discussion and the subsequent arbitration hearing.

The applicant's counsel sought to be removed from the record but was denied for failing to comply with Rule 9.7 of the Dispute Resolution Practice Code.

As the applicant failed to appear and presented no evidence to support her claims, the application for arbitration was dismissed without costs.

The appellant was injured in an accident and applied for statutory accident benefits to Unifund, and later to Intact.

Both insurers denied payment.

The arbitrator refused to combine the two arbitrations and set a preliminary issue regarding a coverage exclusion under the Unifund policy.

On appeal, the Director's Delegate found the arbitrator erred in law.

The arbitrations were combined on consent, and the preliminary issue was redefined to apply the 'nexus test' to determine if Unifund, as the first insurer to receive the application, was obliged to commence payment of benefits pending any priority dispute.

Unifund was ordered to pay the appeal costs of both the appellant and Intact.