L. Craig Brown

Following a preliminary issue hearing where the applicant was precluded from proceeding to arbitration on attendant care benefits, the insurer sought its expenses.

On consent of the parties, the arbitrator ordered the applicant to pay the insurer's expenses in the amount of $5,000, payable in equal monthly instalments over six months.

If the applicant defaults, the insurer may request an order for the balance of the expenses originally sought.

The applicant, who was rendered a paraplegic in a 1994 motor vehicle accident, sought to arbitrate his entitlement to attendant care benefits.

The insurer argued that a 1996 settlement agreement precluded arbitration until the applicant moved into permanent housing accommodation and underwent a further Designated Assessment Centre (DAC) assessment.

The arbitrator found that the applicant's fluctuating living arrangements, which included living in a van and a recreational vehicle while pursuing a competitive sailing career, did not constitute permanent housing accommodation.

The arbitrator held that the applicant was bound by the procedural terms of the settlement and was precluded from proceeding to arbitration until he complied with the agreed-upon assessment process.

The applicant was injured as a pedestrian in a motor vehicle accident and applied for statutory accident benefits from multiple insurers, including the Motor Vehicle Accident Claims Fund.

A dispute arose regarding which insurer was responsible for paying the benefits and whether Ontario Regulation 283/95 applied.

The arbitrator determined that because the applications for benefits and the dispute arose after March 27, 1995, Ontario Regulation 283/95 applied.

Consequently, the Commission lacked jurisdiction to decide the priority dispute, and the issue of which insurer is required to pay benefits must be resolved through private arbitration under the Arbitration Act, 1991.

The applicant was injured in a rear-end motor vehicle accident and received weekly income benefits for 156 weeks.

The insurer terminated benefits, arguing the applicant's ongoing severe anxiety disorder was not caused by the accident and that he was not continuously prevented from working.

The arbitrator found that the applicant's psychological disability was materially caused by the accident and rendered him unable to maintain employment.

The arbitrator ordered the insurer to pay ongoing weekly income benefits and awarded a $5,000 special award under section 282(10) of the Insurance Act, finding the insurer had unreasonably withheld payments without a reasonable basis.

The appellant was injured in a motorcycle accident after losing control on a public highway and crashing on private property.

He did not have a motorcycle licence.

The insurer denied his claim for income replacement benefits under the 'not authorized by law to drive' exclusion in section 58(1)(d) of the Statutory Accident Benefits Schedule.

The appellant argued the exclusion did not apply because the injury occurred on private property where no licence is required.

The Director's Delegate dismissed the appeal, upholding the arbitrator's finding that the accident was an unbroken chain of events that began on the highway where a licence was required.