OFSCDRS 1991

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them based on an orthopaedic surgeon's report.

The applicant sought arbitration for benefits from January to March 1991.

The arbitrator preferred the evidence of the applicant's family physician, who examined him on an ongoing basis, over the insurer's specialist who saw him only once.

The arbitrator found the applicant suffered a substantial inability to perform the essential tasks of his employment and awarded weekly income benefits until March 17, 1991, with interest.

The Applicant sought weekly income benefits following a motor vehicle accident while driving an uninsured vehicle.

The arbitrator determined that the Toronto Transit Commission, as the owner of the other vehicle involved, was the proper insurer.

However, the arbitrator dismissed the claim for benefits, finding that the Applicant had never been employed as claimed and that the claim was entirely fraudulent.

The arbitrator noted the inability to award costs against a fraudulent applicant under the existing legislation.

The self-employed applicant was injured in a motor vehicle accident and claimed maximum weekly income benefits of $1050 under the No-Fault Benefits Schedule.

The insurer paid $755.23 based on incomplete financial records and later sought to reduce the amount to $523 based on a forensic accounting report.

The arbitrator accepted the insurer's accounting evidence, finding the applicant failed to produce adequate records and deliberately delayed the hearing.

The arbitrator set the weekly benefit at $523, ordered the applicant to repay the overpayment, and denied the applicant's claims for interest, a special award, and costs.

The applicant was injured in a motor vehicle accident while driving a bus in the course of his employment.

He elected to sue the at-fault third party rather than claim workers' compensation benefits, and subsequently applied for interim no-fault benefits under Section 21 of the No-Fault Benefits Schedule.

The insurer denied the claim under Section 20, arguing that the applicant was entitled to workers' compensation benefits.

The arbitrator held that Section 21 only applies to bona fide threshold claims where damages are recoverable, not to cases where a lawsuit is initiated solely to qualify for no-fault benefits.

The application for no-fault benefits was dismissed.

The applicant was injured in a motor vehicle accident and applied for arbitration regarding her continuing entitlement to weekly income and care benefits after they were terminated.

The insurer sought to raise additional issues, including repayment of care benefits already paid, repayment of transportation expenses, and a ruling that it was not required to pay rehabilitation expenses.

The arbitrator held that she had jurisdiction to determine issues related to the specific benefits raised by the applicant, including the insurer's claim for repayment of those benefits.

However, the arbitrator lacked jurisdiction to determine disputes over entirely different benefits (transportation and rehabilitation expenses) that the applicant had not referred to arbitration.

The applicant, a self-employed vendor of cosmetic products, was injured in a motor vehicle accident and claimed weekly income benefits at the maximum rate of $600.00 per week.

The insurer disputed the applicant's documentation of his earnings and paid $252.00 per week.

At arbitration, the arbitrator found the applicant's evidence regarding his sales and profits to be contradictory, unreliable, and largely unsubstantiated.

Relying only on objectively verifiable documentation, the arbitrator calculated the applicant's gross weekly income to be $232.00, entitling him to the statutory minimum benefit of $185.00 per week.

The applicant was ordered to repay the insurer the $67.00 weekly overpayment.

The applicant was injured in a motor vehicle accident shortly after being terminated from his employment.

He received a severance package, including a $22,700 lump sum transferred to an RRSP.

The insurer deducted this amount from his no-fault weekly income benefits, arguing it was a payment for loss of income.

The arbitrator held that the severance payment was not a payment for loss of income under s. 12(4)(b) of the No-Fault Benefits Schedule because it was payable regardless of whether the applicant obtained re-employment.

The arbitrator also dismissed the insurer's preliminary motion for disqualification based on apprehension of bias, and denied the applicant's request for a special award, finding the insurer's position was based on a legitimate legal dispute.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and claimed weekly income benefits at the maximum rate of $600 per week.

The insurer disputed the calculation of his income, preferring to rely on his 1990 tax return rather than his daily run sheets.

The arbitrator accepted the run sheets as prima facie evidence of earnings but adjusted the expenses based on the 1990 tax return, concluding the applicant was entitled to a weekly benefit of $252.10.

The applicant was injured in a motor vehicle accident and could no longer lift her handicapped child into her vehicle.

She traded in her van for a comparable vehicle that could accommodate a wheelchair lift.

The insurer disputed the trade-in value she received and the total replacement cost.

The arbitrator found that the applicant acted reasonably by shopping at three dealerships and accepting the best trade-in offer, and ordered the insurer to pay the full difference in cost between the trade-in and the replacement vehicle.

The applicant, a pedestrian whose foot was run over by a car, sought weekly no-fault benefits after the insurer terminated them.

During the arbitration, the insurer attempted to introduce undisclosed surveillance video to impeach the applicant's credibility.

The arbitrator excluded the video, applying the rule in Browne v. Dunn, because the insurer failed to put the evidence to the applicant during cross-examination, which would cause undue prejudice and delay in an arbitration context.

On the merits, the arbitrator found that while the applicant suffered discomfort from his injuries, he failed to establish a substantial inability to perform his essential tasks.

The application for weekly benefits and interest was dismissed.