Manoucher Baradaran

The Applicants were injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied several claims.

The insurer brought a preliminary issue motion arguing that the FSCO Arbitration Unit lacked jurisdiction because the Applicants applied for mediation before the insurer had denied the claims, in breach of Rule 12.1 of the Dispute Resolution Practice Code.

The Arbitrator dismissed the motion, finding that while the Applicants breached the procedural rule, the statutory preconditions under section 50 of the Schedule and section 281(2) of the Insurance Act were met by the time the mediation actually occurred.

The Applicants were permitted to proceed to arbitration.

The applicant was involved in a motor vehicle accident and delayed applying for statutory accident benefits for several months, hoping to recover without going through the claims process.

The insurer raised a preliminary issue that the applicant was disentitled to benefits for failing to apply within the 30-day time limit under section 32(1) of the Statutory Accident Benefits Schedule.

The Arbitrator found that the insurer, having been notified of the accident, failed to promptly inform the applicant of the time limit and the potential consequences of non-compliance, which is required to assist the person in applying for benefits under section 32(2)(c).

Therefore, the insurer could not rely on the time limit to defeat the claim, and the applicant was not disentitled to benefits.

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

The insurer denied benefits on the basis that the applicant was operating an uninsured vehicle and had made a material misrepresentation.

The arbitrator found that the applicant deliberately misled his insurance broker by producing ownership documentation for a 1983 vehicle while claiming to insure a 1988 vehicle that he did not own.

The arbitrator concluded that the applicant knew or ought reasonably to have known that he was operating an uninsured vehicle at the time of the accident.

As a result, the applicant was barred from recovering benefits under section 30(1) of the Statutory Accident Benefits Schedule.

The applicant was injured in a motor vehicle accident while driving a tractor-trailer and applied for statutory accident benefits.

The insurer argued the applicant was entitled to workers' compensation benefits and thus precluded from receiving accident benefits under section 59 of the Schedule.

In a preliminary issue hearing, the arbitrator found that the applicant had not elected to bring a tort action, meaning the exception under subsection 59(2) was unavailable.

The arbitrator declined to determine whether the applicant was entitled to workers' compensation benefits under subsection 59(1), finding that the Workplace Safety and Insurance Appeals Tribunal had exclusive jurisdiction over that issue, and adjourned the entitlement hearing to allow an application to the Tribunal.