Mauro D'Agostino

The appellant was injured in two motor vehicle accidents and sought income replacement benefits.

The insurer denied benefits for a period, arguing the appellant failed to comply with requests for information regarding collateral benefits under section 33 of the Statutory Accident Benefits Schedule.

The arbitrator found the appellant was precluded from receiving benefits for the period of non-compliance.

On appeal, the Director's Delegate held that the insurer failed to provide clear, straightforward, and consistent notice of the consequences of non-compliance and the saving provision for a reasonable explanation.

The appeal was allowed, and the appellant was not precluded from receiving benefits for the disputed period.

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

An arbitrator issued a preliminary order precluding the appellant from receiving income replacement benefits for a specific period due to non-compliance with section 33 of the Insurance Act.

The appellant sought to appeal this preliminary order.

The Director's Delegate accepted the appeal, finding that the issue of whether section 33(2) authorizes forfeiture or merely delay of benefits was of fundamental importance and that hearing the appeal expeditiously was the most just and efficient approach.

At a pre-hearing conference for a statutory accident benefits dispute, the insurer sought written particulars of the applicant's claim for a special award, and the applicant requested production of the insurer's adjuster's notes beyond the date of the application for mediation.

The arbitrator ordered the applicant to provide written particulars of the special award claim, finding that the insurer was entitled to know the case it had to meet under the Statutory Powers Procedure Act.

The arbitrator denied the applicant's request for the adjuster's notes beyond the mediation application date, as the applicant had not established their relevance or provided particulars for the special award claim.

The applicant applied for arbitration following the denial of statutory accident benefits by the insurer.

After failing to attend a scheduled pre-hearing and failing to communicate with the Commission or the insurer, the insurer requested that the application be dismissed as frivolous and vexatious.

The arbitrator found the applicant's conduct to be vexatious and dismissed the claims for income replacement benefits, interest, and a special award.

The insurer was awarded its reasonable expenses in the amount of $2,451.76.

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

After failing to appear at multiple pre-hearing discussions and the arbitration hearing, and failing to communicate with his representative or the Commission, the insurer requested that the claims be deemed withdrawn.

The arbitrator deemed the claims withdrawn due to the applicant's failure to pursue them.

The arbitrator awarded the insurer $1,000 in expenses but denied the request for reimbursement of the $3,000 assessment fee, as it is not a recoverable expense under the Expense Regulation.

The applicant was injured in a motor vehicle accident and elected to receive caregiver benefits.

She later sought to change her election to claim income replacement benefits.

In a prior preliminary decision, the arbitrator found her election invalid.

On appeal, the Director's Delegate directed the arbitrator to decide the alternative issue: assuming the election was valid, was the applicant entitled to change it as of right.

The arbitrator held that an insured person is not entitled to change a valid election as of right.

Any such change must be determined on the basis of relative prejudice, consumer protection, and legislative purposes.

The applicant was injured in a motor vehicle accident and elected to receive caregiver benefits after meeting with the insurer's adjuster.

She later sought to change her election to income replacement benefits, arguing the election was invalid because the adjuster failed to fully inform her of the consequences.

The arbitrator found that the insurer failed to comply with its obligation under section 32(2)(d) of the Statutory Accident Benefits Schedule to provide complete information, specifically that the benefit paying the most money might not pay for the longest period.

The election was deemed invalid, and the applicant was permitted to claim income replacement benefits.