OFSCDRS 1992

The Applicants were injured in a motor vehicle accident and applied for no-fault weekly income benefits.

They argued that the value of their unpaid services in renovating a cottage for their business should be included in calculating their pre-accident gross weekly income, and alternatively, that their partnership agreement constituted an offer of employment.

The arbitrator held that the statutory definition of income does not include the imputed value of unpaid services.

The arbitrator further held that the partnership agreement did not constitute a legitimate offer of employment under the No-Fault Benefits Schedule.

The Applicants were entitled only to the minimum statutory benefit.

The applicant was injured in a motor vehicle accident two days after starting a new job.

The insurer calculated his weekly income benefits by averaging his income over the full 52 weeks prior to the accident, resulting in a benefit of $304.53 per week.

The applicant argued his benefits should be based on his regular weekly rate at the time of the accident.

The arbitrator held that under Section 12(7) of the No-Fault Benefits Schedule, the applicant's gross weekly income should be calculated by averaging his income over the weeks he was actually employed in the 52 weeks before the accident, disregarding periods of unemployment.

This resulted in the applicant being entitled to the maximum weekly benefit of $600.00.

The applicant, a construction contractor, was injured in a rear-end motor vehicle accident and claimed weekly income benefits.

The insurer terminated benefits, arguing the applicant was no longer substantially unable to perform the essential tasks of his occupation, relying in part on surveillance evidence.

Following an arbitration hearing, the arbitrator found that the applicant was substantially unable to perform his essential tasks during the disputed period.

The arbitrator relied on the applicant's testimony, corroborating evidence from tradesmen, and medical reports, noting that the applicant's brief visits to a job site did not demonstrate an ability to work.

The applicant was awarded entitlement to benefits and arbitration expenses.

The applicant was injured when her car door fell off its hinges.

She received weekly income benefits until the insurer terminated them based on medical reports indicating she could return to work.

The applicant sought arbitration, claiming ongoing chronic pain prevented her from performing her job as an accounts receivable clerk.

The arbitrator dismissed the claim, finding the medical evidence did not support a causal link between the minor trauma and her ongoing complaints.

Furthermore, video surveillance evidence contradicted her claims of physical limitation, leading the arbitrator to conclude she had not established a substantial inability to perform the essential tasks of her employment.

The insurer appealed an interim order of an arbitrator that limited the scope of the arbitration to the specific issues raised by the insured person.

The insurer argued that once an insured person refers a matter to arbitration, the arbitrator has jurisdiction to hear all disputes between the parties, including the insurer's claims for overpayment or other benefits.

The Director of Arbitrations dismissed the appeal, holding that the Insurance Act restricts the arbitrator's jurisdiction to the specific matter referred by the insured person and any issues that naturally or consequentially flow from it, unless the parties agree otherwise.

The applicant, a university student, was injured in a motor vehicle accident and missed the first week of her third year.

She returned to school but claimed she was substantially unable to perform her essential tasks due to pain, lack of concentration, and lower grades.

The insurer paid no-fault weekly benefits until April 1991, then terminated them and sought repayment, arguing she was not disabled and had failed to cooperate with medical assessments.

The arbitrator found the applicant was only disabled for the first six weeks after returning to school, as her academic performance did not demonstrate a substantial inability to perform her essential tasks as a student.

The arbitrator ordered the applicant to repay the benefits received after October 16, 1990, finding they were paid through error materially caused by the applicant's failure to provide medical releases or attend an independent medical examination.

The appellant appealed an arbitrator's decision that entitled him to weekly income benefits of $185.00 and required him to repay the insurer $67.00 weekly for overpayments.

The appellant sought an oral rehearing, arguing the arbitrator erred in preferring documentary evidence over oral testimony.

The Director of Arbitrations denied the request for an oral rehearing, finding no error of law or fact in the arbitrator's assessment of credibility and evidence.

The appeal was dismissed on the record, and the appellant was ordered to repay the overpaid benefits.

The appellant's request for expenses was also denied due to his conduct unreasonably prolonging the proceedings.

The applicants, injured in motor vehicle accidents, claimed legal fees charged by their lawyers for completing their applications for no-fault benefits under Section 6(1)(f) of the No-Fault Benefits Schedule.

The insurers refused to pay these fees.

The arbitrator held that legal fees for completing claim forms are not recoverable as they are not a reasonable expense resulting from the accident, nor are they required because of the accident.

The arbitrator noted that while some individuals may have difficulty completing the forms, the services of a lawyer are not essential, and such expenses fall outside the realm of medical or rehabilitative necessity contemplated by the legislation.

The applicant was injured in a motor vehicle accident and received no-fault weekly income benefits from the insurer, as well as disability income benefits from a third-party group policy.

The third-party insurer deducted income tax at source and remitted the net amount to the applicant.

The insurer deducted the gross amount of the disability benefits when calculating the applicant's no-fault benefits.

The applicant disputed this, arguing only the net amount should be deducted.

The arbitrator held that the gross amount of the disability benefits is a payment 'available to the insured person' under Section 12(4)(b)(i) of the No-Fault Benefits Schedule and is therefore deductible in full.

The Applicant suffered catastrophic injuries in a motorcycle accident, resulting in paraplegia.

He applied for no-fault benefits, including home renovations and a suitably modified motor vehicle.

The Insurer refused to provide a vehicle, arguing it was only liable for transportation costs to and from treatment.

The arbitrator held that a modified mini van was a reasonable expense resulting from the accident under section 6(1)(f) of the No-Fault Benefits Schedule, as it was necessary for the Applicant's rehabilitation and independence.

The arbitrator dismissed the Applicant's claim for a special award under section 282(10) of the Insurance Act, finding that the Insurer had not unreasonably withheld or delayed payments.