Nicholaus De Koning

The appellant appealed an arbitrator's decision denying her claims for income replacement and housekeeping benefits following a motor vehicle accident.

The arbitrator had found the appellant's evidence regarding her employment to be fabricated.

On appeal, the appellant argued that because the respondent insurer missed the statutory timeline to respond to her application by 15 days, she was automatically entitled to the benefits regardless of her actual eligibility.

The Director's Delegate rejected this argument, finding that the Statutory Accident Benefits Schedule provides specific remedies for delayed payments, such as mandatory interest and potential special awards, but does not mandate automatic entitlement to benefits for an insurer's procedural delay.

The appeal was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for caregiving, housekeeping, attendant care, and medical treatments.

The insurer denied most of the claims, citing discrepancies in the evidence and surveillance footage that contradicted the applicant's reported limitations.

The arbitrator found the applicant and her husband lacked credibility, noting significant inconsistencies between their testimony, the submitted invoices, and the surveillance evidence.

The claims for caregiver, housekeeping, and attendant care benefits were dismissed due to insufficient reliable evidence that the expenses were incurred or that the applicant met the test for substantial inability.

The arbitrator partially allowed the claim for medical benefits, awarding $2,384.59 for treatment plans that were deemed reasonable and necessary or were deemed approved due to the insurer's failure to respond.

The claim for a special award was dismissed as the insurer did not unreasonably withhold payments.

The applicant claimed statutory accident benefits following an alleged motor vehicle collision.

The insurer denied the claim, arguing that the collision did not occur as reported or was staged.

After hearing evidence from the parties, the investigating police officer, and accident reconstruction experts, the arbitrator found significant inconsistencies between the physical evidence and the applicant's testimony.

The arbitrator accepted the insurer's expert evidence that the vehicles' damage and final resting positions were inconsistent with the reported collision.

The application was dismissed as the applicant failed to prove on a balance of probabilities that an 'accident' occurred.

Following a decision denying the applicant's claims for statutory accident benefits, the arbitrator considered the issue of expenses.

The insurer was completely successful in the main proceeding.

The arbitrator found that the applicant's claim had no merit and was unnecessary, as she had fabricated the story of her employment, although her low intellect prevented her from recognizing that her story made no sense.

Applying the criteria under section 12(2) of Ontario Regulation 664, the arbitrator ordered the applicant to pay the insurer's expenses of the arbitration proceeding, with the amount to be agreed upon or assessed.

The applicant sought income replacement benefits and housekeeping expenses following a motor vehicle accident.

The insurer denied the claims, disputing that the applicant was employed at the time of the accident and questioning the need for housekeeping services.

The arbitrator found the applicant's evidence regarding her alleged employment at a restaurant to be implausible and fabricated, noting inconsistencies in her testimony and the lack of corroborating evidence.

The housekeeping claim was also dismissed due to inconsistent and unbelievable evidence.

Furthermore, the arbitrator held that the insurer's minor delays in responding to the application were procedural irregularities that did not prejudice the applicant, thereby dismissing the claim for a special award.

Following the dismissal of the applicant's claim for statutory accident benefits, the insurer sought its expenses of the arbitration against both the applicant and his solicitor personally.

The arbitrator ordered the applicant to pay $7,000 in expenses to the insurer, finding the insurer was completely successful and the applicant lacked credibility.

The arbitrator dismissed the insurer's claim for expenses against the solicitor personally and ordered the insurer to pay $1,000 in expenses to the solicitor for having to defend against the unreasonable claim.

The Insurer sought an order for expenses against the Applicant and his solicitor personally, alleging the solicitor advanced frivolous claims and caused unreasonable delay.

The solicitor brought a motion for summary judgment to dismiss the claim against him.

The Arbitrator granted the motion, finding no evidence that the solicitor knowingly participated in misrepresentations or advanced the claims in bad faith, and no evidence of substantial delay attributable solely to his default.

The applicant applied for statutory accident benefits following an alleged motor vehicle accident.

The insurer terminated benefits and sought repayment of over $27,000, alleging the applicant was not involved in the accident.

Prior to the preliminary issue hearing, the applicant sought to withdraw her application.

The parties reached a consent agreement whereby the application was withdrawn, the applicant agreed to pay the insurer $1,000 in monthly instalments towards its expenses, and the insurer agreed not to pursue its claim for repayment of the benefits.

The applicant sought various statutory accident benefits, including income replacement, medical, attendant care, and housekeeping benefits, following a motor vehicle accident.

The arbitrator dismissed the application in its entirety, finding the applicant lacked credibility due to numerous inconsistencies, deliberate misrepresentations about his living arrangements, and evidence of symptom exaggeration.

The arbitrator also found that the applicant made a material misrepresentation by failing to notify the insurer that he was residing and working in Illinois, which voided his entitlement to income replacement and housekeeping benefits under section 30(2) of the Schedule.

The applicant was injured in two separate motor vehicle accidents and filed two separate arbitration applications for statutory accident benefits against the same insurer.

At a pre-hearing discussion, the arbitrator considered whether the applications should be combined under Rule 30 of the Dispute Resolution Practice Code.

Finding that the parties and counsel were identical, and that there were common questions of fact and law regarding the duration and cause of the applicant's disability, the arbitrator ordered the applications combined to ensure the most just, quickest, and least expensive resolution and to avoid inconsistent findings.