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Applicant permitted to arbitrate attendant care claim; insurer's objection based on mediation prerequisite dismissed as vexatious.
The applicant was injured in a motor vehicle accident and sought attendant care benefits from the insurer.
The insurer raised a preliminary issue, arguing that the applicant was precluded from proceeding to arbitration because the specific time period for the attendant care benefits claimed had not been the subject of a failed mediation.
The arbitrator found that the issue of attendant care benefits had indeed been mediated and failed, as evidenced by the mediator's report.
The arbitrator held that section 281(2) of the Insurance Act does not require a detailed analysis of every element of an issue raised in mediation.
The applicant was permitted to proceed to arbitration, and the arbitrator awarded expenses to the applicant, finding the insurer's position to be unnecessary and vexatious.
Insurer's appeal allowed; self-employed insured limited to minimum weekly income benefits due to inadequate records.
The insurer appealed an arbitration decision awarding the self-employed insured weekly income benefits above the minimum amount.
The insured cross-appealed the quantum, the duration of benefits, and the denial of arbitration expenses.
The Director's Delegate allowed the insurer's appeal, finding that the insured's inadequate and falsified business records provided no reliable basis for calculating his pre-accident income above the minimum.
The insured's cross-appeal was dismissed, upholding the arbitrator's findings on post-156 week entitlement and the denial of expenses due to the insured's fraudulent conduct.
