OFSCDRS 1992

The appellant, a taxi driver injured in a motor vehicle accident, appealed an arbitral decision that awarded him minimum weekly income benefits and ordered him to repay $1,695.60 to the insurer.

The appellant sought a stay of the repayment, admission of fresh evidence, and a recalculation of his benefits, alleging the arbitrator was biased against him and erred in assessing his income.

The Director of Arbitrations dismissed the appeal, finding no evidence of bias or procedural unfairness.

The Director held that the appellant failed to properly prove his gross income and expenses, and declined to admit fresh evidence that could have been presented at the original hearing.

The request for a stay and the claim for appeal expenses were also denied.

The applicant was injured in a motor vehicle accident and received weekly income benefits, which were terminated by the insurer on the basis that he failed to make progress in a rehabilitation program.

The applicant applied for arbitration, arguing that chronic back pain prevented him from returning to his heavy physical job.

The arbitrator found the applicant credible and accepted medical evidence that the accident aggravated a pre-existing back condition, resulting in chronic pain.

The arbitrator concluded that the applicant's inability to perform the essential tasks of his employment was genuine and not due to a deliberate failure to cooperate in rehabilitation.

The applicant was awarded ongoing weekly income benefits.

The applicant was seriously injured in a motor vehicle accident in which her husband was killed.

She claimed care benefits under the No-Fault Benefits Schedule for the gross income lost by her son, who took time off work to visit and care for her in the hospital.

The arbitrator found that the son's attendance to provide reassurance, support, and translation services constituted 'caring for the insured person' under s. 7(1)(a).

The arbitrator awarded $2,030.34 for the income reasonably lost by the son during the first month, but denied the claim for the subsequent period.

The applicant's claim for a special award for unreasonably withheld payments was dismissed.

The applicant, a full-time master's student and teaching assistant, was injured in a motor vehicle accident.

She applied for weekly income benefits under the No-Fault Benefits Schedule.

The insurer disputed whether she should claim under section 12 (employed) or section 13 (non-earner).

The arbitrator found that the applicant was employed as a teaching assistant at the time of the accident and suffered a substantial inability to perform the essential tasks of her occupation.

The arbitrator awarded weekly income benefits under section 12 from November 1990 to December 1991, deducting a portion of her teaching assistant salary and a summer bursary.

The applicant was injured in a motor vehicle accident and his weekly income benefits were suspended by the insurer.

In a previous decision, the arbitrator found the insurer unreasonably withheld benefits and ordered a special award under s. 282(10) of the Insurance Act.

In this decision on the quantum of the special award, the arbitrator rejected the insurer's attempt to introduce new evidence to reconsider the unreasonableness finding.

The arbitrator determined that a special award is not equivalent to punitive damages and does not require bad faith, but must be substantial enough to deter unreasonable conduct.

The arbitrator awarded a lump sum of 15% of the amount the applicant was entitled to, plus interest.

The appellant appealed an arbitrator's decision denying reimbursement for $200 in legal fees incurred to complete an application for no-fault accident benefits.

The Director's Delegate upheld the arbitrator's finding that legal fees do not qualify as 'other goods and services' under section 6(1)(f) of the No-Fault Benefits Schedule.

The Delegate agreed that the Schedule requires such expenses to be of a nature that a medical practitioner could validly opine on their necessity, which does not apply to legal fees.

The appeal was dismissed.

The applicants were injured in two motor vehicle accidents and claimed no-fault benefits from their insurer.

They sought reimbursement for $6,000 paid to their son for housekeeping, transportation, and care services, as well as $1,300 for two medical reports obtained after the insurer delayed paying weekly income benefits.

The arbitrator found that the son's services for housekeeping, meal preparation, and transportation to medical appointments were compensable under the No-Fault Benefits Schedule, awarding $2,880.

The arbitrator also ordered the insurer to pay for the medical reports, finding the applicants were justified in obtaining them due to the insurer's gross delay in paying benefits.

The insurer appealed an arbitrator's decision awarding the respondent the maximum weekly income benefit of $600.

The respondent had started a new job two days before the accident but had been unemployed for a portion of the preceding 52 weeks.

The insurer argued that the calculation of average gross weekly income under section 12(7) 1 of the No-Fault Benefits Schedule should include the weeks the respondent was unemployed, which would reduce the benefit amount.

The Director's Delegate dismissed the appeal, holding that the natural and ordinary meaning of the provision, in the context of the legislation's generous compensation scheme, requires averaging the income only over the weeks the insured was actually employed.

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

At the time of the accident, he was receiving Canada Pension Plan (CPP) disability benefits and Family Benefits.

The Insurer refused to pay accident benefits, arguing that the CPP and Family Benefits payments were deductible as 'payments for loss of income' under section 13 of the No-Fault Benefits Schedule.

The arbitrator held that Family Benefits are not employment-related and thus not deductible.

Furthermore, the arbitrator found that only payments for loss of income arising from the same accident are deductible, meaning the pre-existing CPP disability benefits were also not deductible from the Applicant's weekly accident benefits.

The applicant sought weekly income benefits following a motor vehicle accident, claiming physical and psychological injuries, including post-traumatic stress disorder.

The arbitrator found that the applicant's physical injuries had resolved to the point where he was no longer substantially unable to perform the essential tasks of his employment.

The arbitrator rejected the diagnosis of post-traumatic stress disorder, preferring the evidence of the insurer's physiatrist.

Although the insurer improperly interfered with the applicant's physiotherapy treatment, no penalty could be assessed because no benefits were found to be owing.

The applicant's claim for weekly income benefits was dismissed, but he was awarded the expenses of the arbitration.

The applicant, a self-employed duct cleaner, was injured in a motor vehicle accident and received weekly income benefits until they were terminated by the insurer.

The applicant sought reinstatement of benefits for the period from May 10, 1991, to September 30, 1991, arguing he was substantially unable to perform the physical tasks of his employment.

The insurer relied on surveillance evidence and an independent medical examination suggesting the applicant could return to work.

The arbitrator found the applicant credible, noting his essential tasks were physically demanding, and concluded the medical evidence supported his inability to work during the disputed period.

The applicant was awarded the claimed benefits, interest, and expenses.

The Applicant was injured in a motor vehicle accident and received weekly income benefits.

The Insurer terminated these benefits based on outdated medical predictions without providing notice or seeking updated medical information.

At the arbitration hearing, the Insurer conceded that the Applicant remained disabled and was entitled to ongoing benefits.

The arbitrator found that the Insurer acted unreasonably in withholding the benefits and ordered a special award under section 282(10) of the Insurance Act, with the quantum to be determined after further submissions.

The Appellant, an injured worker entitled to workers' compensation benefits, appealed an Arbitrator's decision denying him no-fault benefits under section 21 of the No-Fault Benefits Schedule.

The Appellant argued that the plain wording of section 21 entitled him to benefits either because he commenced a tort action or because he was not receiving workers' compensation payments.

The Director's Delegate upheld the Arbitrator's interpretation that section 21 requires a bona fide action for threshold-type injuries, and found the Arbitrator had jurisdiction to determine the action was not bona fide as it was commenced solely to qualify for no-fault benefits.

The appeal was dismissed, but the Appellant was awarded expenses due to the novelty and importance of the legal issues.

The applicant, a self-employed motorcycle mechanic, was injured in a motor vehicle accident and received weekly income benefits until they were terminated by the insurer.

He applied for arbitration claiming entitlement to maximum weekly benefits, supplementary medical and rehabilitation benefits, and care benefits.

The arbitrator found the applicant lacked credibility due to inconsistent testimony, failure to declare income for tax purposes, and surveillance evidence showing him performing physical tasks without restriction.

The arbitrator concluded the applicant failed to prove ongoing disability beyond March 21, 1991, and awarded minimum weekly benefits up to that date.

Claims for a rental vehicle and further therapy were denied, but full mileage for travel to his chiropractor was allowed.

The insurer appealed an arbitrator's order requiring it to pay the insured $600 per week in statutory accident benefits and sought a stay of the order pending the appeal under section 283(6) of the Insurance Act.

The Director's Delegate determined that the insurer bore the onus of establishing why a stay should be granted, based on factors including the bona fides of the appeal, the substance of the grounds, and hardship to the parties.

Balancing the insured's financial hardship against the insurer's risk of non-recovery, the Delegate granted a partial stay for arrears prior to February 4, 1992, but ordered the insurer to pay the ongoing $600 weekly benefits pending the appeal's disposition.

The insurer appealed an arbitrator's order requiring it to provide the catastrophically injured insured with a suitably modified mini-van under section 6(1)(f) of the No-Fault Benefits Schedule.

The insurer argued that transportation expenses were exhaustively covered by section 6(1)(d) and that a van was not 'necessary' for rehabilitation.

The insured cross-appealed, seeking a full-size custom van and a special award.

The Director's Delegate dismissed the insurer's appeal, finding that section 6(1)(f) authorized the provision of a motor vehicle and that a broad definition of rehabilitation included psychological adjustment and independence.

The cross-appeal for a full-size van was also dismissed, as the mini-van was deemed a reasonable expense.

The Director's Delegate refused to admit fresh evidence on the special award issue, finding it could have been adduced at the original hearing.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, arguing she was no longer disabled.

The applicant, a real estate agent, claimed she could not work the long and unpredictable hours required by her occupation due to ongoing neck and back pain.

The arbitrator preferred the medical evidence of the applicant's treating specialist over the insurer's expert, finding that the ability to perform essential tasks must incorporate the ability to perform them in a manner that renders the work remunerative.

The arbitrator concluded the applicant suffered a substantial inability to perform the essential tasks of her occupation and ordered the reinstatement of weekly income benefits.

The applicant was injured in a motor vehicle accident and claimed no-fault weekly benefits.

The insurer deducted the applicant's pre-existing workers' compensation pension and a private disability insurance benefit from the weekly benefit amount.

The arbitrator held that the workers' compensation pension for a permanent disability was not a payment for loss of income and therefore not deductible.

However, the private disability insurance benefit was found to be a payment for loss of income received under an income continuation benefit plan, and was therefore deductible from the no-fault weekly benefit.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them.

The applicant sought reinstatement of the benefits and compensation for his family's suffering due to the dispute.

The arbitrator found that surveillance evidence showed the applicant performing activities such as re-shingling a roof, contradicting his claim of substantial inability to perform essential tasks.

The application for weekly income benefits was dismissed, and the claims for family compensation were also denied as they did not fall within the statutory definitions.

The Applicant, a self-employed taxicab driver, was injured in a motor vehicle accident and applied for weekly income benefits.

The Insurer initially paid benefits based on the Applicant's verbal declaration but later reduced payments to the minimum statutory amount when the Applicant failed to provide satisfactory documentary proof of his gross weekly income.

The arbitrator found that the Applicant failed to establish a gross weekly income exceeding the statutory minimum of $232.00 per week.

The Applicant was awarded the minimum benefit of $185.60 per week, and the Insurer was ordered to be repaid $1,695.60 for the initial overpayment.