3 total
Claims for income replacement, attendant care, and housekeeping benefits dismissed due to unreliable and insufficient evidence.
The applicant was injured in a motor vehicle accident and sought arbitration after the insurer denied his claims for income replacement, attendant care, and housekeeping benefits.
The arbitrator dismissed the claim for income replacement benefits, finding the applicant's evidence regarding his self-employment as an artist and a purported employment contract to be unreliable and contradicted by his tax returns.
The claims for attendant care and housekeeping benefits were also dismissed due to a lack of supporting evidence, including the absence of a recommendation from a qualified health practitioner and no proof that outside housekeeping services were actually engaged.
All claims were dismissed.
Injuries sustained from falling down stairs after a car hit the house constituted an accident.
The applicant sought statutory accident benefits after a tenant mistakenly drove her vehicle into the side of his house.
The impact caused a loud noise and shaking, prompting the applicant to panic and run to check on his children.
While running down the stairs, he tripped and fell, sustaining injuries.
The insurer denied benefits, arguing the injuries were not caused by an 'accident' as defined in the Schedule.
The arbitrator found that the car hitting the house directly caused the applicant's injuries, as the sequence of events was one continuous incident without an intervening act.
The arbitrator concluded the applicant was involved in an accident within the meaning of the Schedule.
Application for arbitration withdrawn; applicant ordered to pay $3,000 assessment fee for abuse of process.
The applicant sought to withdraw his application for arbitration regarding statutory accident benefits shortly before the second scheduled hearing date.
The insurer argued that the applicant had abused the process by failing to provide requested productions, forcing an adjournment, and withdrawing without explanation.
The arbitrator allowed the withdrawal but found the applicant's conduct amounted to an abuse of process.
Pursuant to section 282(11.2) of the Insurance Act and Rule 67.3(c) of the Dispute Resolution Practice Code, the applicant was ordered to pay the insurer's $3,000 assessment fee.
