OFSCDRS 1993

The applicant sought ongoing weekly income benefits following a motor vehicle accident, claiming he was substantially unable to perform the essential tasks of his employment.

The insurer terminated benefits on the basis that the applicant was no longer disabled.

At arbitration, the evidence revealed that the applicant had been involved in two prior motor vehicle accidents which he had concealed from several assessing and treating physicians.

Furthermore, surveillance video demonstrated the applicant performing physical movements that contradicted the severe restrictions he reported during medical examinations.

The arbitrator found the applicant's testimony and subjective reports to medical professionals to be unreliable.

Consequently, the claim for ongoing weekly income benefits and a special award was dismissed.

However, the arbitrator exercised discretion to award the applicant his arbitration expenses.

The applicant sought weekly accident benefits following a motor vehicle accident.

The applicant failed to attend the arbitration hearing, and his agent requested an adjournment.

The arbitrator denied the adjournment request because the agent had made inadequate efforts to contact the applicant and had not notified the insurer or the Commission in advance.

As no evidence was presented to support the claim, the application for benefits and expenses was dismissed.

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

The applicant brought a preliminary motion seeking interim reinstatement of benefits and challenging the insurer's right to require medical examinations by multiple practitioners after terminating benefits.

The arbitrator held that the insurer may require examinations under section 23(2) of the No-Fault Benefits Schedule even after terminating benefits, and that the Schedule permits examinations by more than one qualified medical practitioner.

The arbitrator also found no statutory authority to grant an interim order reinstating weekly income benefits pending the final disposition.

The applicant was struck by a motor vehicle and applied for no-fault benefits from the insurer.

After a dispute arose, the applicant commenced a court action against the insurer and the at-fault driver.

The applicant subsequently applied for arbitration at the Ontario Insurance Commission regarding unpaid medical invoices.

The insurer brought a preliminary motion to prevent the arbitration from proceeding, arguing the applicant had elected to proceed in court.

The arbitrator held that the applicant is not entitled to proceed in both forums for issues that significantly overlap, and granted the insurer's motion to dismiss the arbitration to avoid duplicative proceedings.

The Applicant was injured in a motor vehicle accident and received weekly income benefits until they were terminated by the Insurer.

More than two years after the termination, the Applicant applied for arbitration.

The Insurer raised a preliminary issue that the application was time-barred under section 281(5) of the Insurance Act.

The arbitrator found no discretion to extend the limitation period and held that the relief from forfeiture provision in section 129 did not apply to non-compliance with a time-limit to commence an action.

The application was dismissed as time-barred, and no expenses were awarded to the Applicant.

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

He returned to work for over 90 days after the two-year anniversary of the accident.

When he subsequently missed work due to the injury, the insurer denied benefits under s. 16(2) of the No-Fault Benefits Schedule.

The arbitrator held that the applicant lost his eligibility for weekly income benefits because he worked for more than 90 days after the two-year anniversary.

The application for benefits was dismissed, but the applicant was awarded his $50 filing fee for raising a novel issue of interpretation.

The applicant was injured in a motor vehicle accident and received no-fault benefits until they were terminated by the insurer.

The applicant applied for arbitration to claim ongoing weekly benefits, childcare benefits, and supplementary medical and rehabilitation benefits.

The applicant failed to attend the scheduled arbitration hearing and did not produce the required medical and financial documentation.

Consequently, the arbitrator proceeded in the applicant's absence and dismissed all claims for lack of evidence.

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

He was the president and controlling shareholder of an electrical contracting business.

The Insurer argued the Applicant should be treated as self-employed, attributing the company's income and expenses directly to him, which would reduce his benefits.

The arbitrator rejected the Insurer's approach, finding that the Applicant's pre-accident salary of $600 per week was a real and reasonable salary within the context of the company's history.

The arbitrator ordered the Insurer to pay the maximum weekly income benefit of $600, without deducting business expenses or post-accident corporate income, plus interest and arbitration expenses.

The applicant, a taxi driver, was injured in a motor vehicle accident while driving a cab owned by another individual and insured by Canadian General.

She also owned a personal vehicle insured by Pilot.

Canadian General argued that she was not a named insured under its policy and must claim benefits from Pilot.

The arbitrator found that the cab was made available for the applicant's regular use and rented to her, bringing her within subsection 3(1) of the No-Fault Benefits Schedule.

This provision gave her the same rights as a named insured, allowing her to elect to claim benefits from Canadian General under subsection 268(5) of the Insurance Act.

Canadian General was held liable to pay the benefits.

The applicant was injured in a motor vehicle accident and applied for weekly and childcare benefits under the No-Fault Benefits Schedule.

The insurer denied the benefits, arguing that the applicant's disability resulted from a previous workplace injury.

The arbitrator found the applicant lacked credibility due to inconsistencies between his testimony and prior statements regarding his pre-accident activities.

Relying on medical reports indicating that the applicant's post-accident condition was substantially the same as his pre-accident condition and that his disability was largely psychogenic, the arbitrator concluded the applicant failed to prove he was substantially unable to perform his essential tasks as a result of the accident.

The claims for weekly and childcare benefits were dismissed, but the applicant was awarded his arbitration expenses.

The applicant, a Manitoba resident, was injured in a motor vehicle accident in Ontario while driving a vehicle insured by the Saskatchewan Government Insurance Office (SGIO).

The applicant applied for no-fault benefits under the Ontario Insurance Act, but SGIO refused to pay, arguing it was not liable under Saskatchewan law.

The arbitrator held that SGIO was bound by a Power of Attorney and Undertaking it had signed, which precluded it from setting up a defence that would not be available to an Ontario insurer.

Consequently, SGIO was found liable to pay no-fault benefits to the applicant.

The Applicant was injured in a rear-end motor vehicle accident and received weekly income benefits until they were terminated by the Insurer.

He applied for arbitration, claiming ongoing inability to perform the essential tasks of his job as a band-saw operator due to neck and back pain.

The arbitrator preferred the medical evidence of the Insurer's orthopaedic surgeon over the Applicant's functional assessment, finding that the Applicant's pain did not cause a substantial inability to perform his job duties beyond May 29, 1992.

The Applicant was awarded weekly income benefits up to that date, along with interest and arbitration expenses.

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

She applied for arbitration, claiming ongoing entitlement based on an alleged pre-accident offer of full-time employment.

The arbitrator found insufficient evidence of the full-time job offer and assessed her disability based on her part-time role.

Relying on medical evidence that she was fit to return to part-time work, the arbitrator dismissed the claim for ongoing benefits but awarded the applicant her arbitration expenses.

The applicant was injured in two motor vehicle accidents.

He received accident benefits from Allstate for the first accident and applied for benefits from Zurich for the second accident.

Zurich failed to respond to the arbitration application or pay the assessment fee, and the hearing proceeded without them.

Zurich later moved to re-open the hearing, citing inadvertence.

The arbitrator dismissed the motion to re-open, finding Zurich's conduct amounted to negligence and re-opening would prejudice the applicant.

The arbitrator awarded the applicant weekly income benefits of $185.60 and medical/rehabilitation benefits of $1,649.80 based on his uncontested evidence.

The claim for a special award was dismissed as there was insufficient evidence to find Zurich acted unreasonably beyond its failure to participate.

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

The applicant sought ongoing benefits, while the insurer claimed he had returned to work as a self-employed leathercutter.

Relying on surveillance evidence and medical observations of calluses on the applicant's hands, the arbitrator found the applicant was working and able to perform his essential tasks by January 22, 1992.

The arbitrator also found the applicant had post-accident earnings that were deductible from his benefits.

The applicant was ordered to repay $26,125.36 in overpaid benefits, and his claims for expenses and a special award were dismissed due to his lack of credibility and pursuit of a claim despite clear evidence he was working.

The applicant, a taxi driver, was injured in a motor vehicle accident and sought statutory accident benefits, including weekly income benefits, medical/rehabilitation benefits, and care benefits.

The insurer terminated weekly income benefits on the basis that the applicant no longer suffered a substantial inability to perform his essential tasks.

The arbitrator found the applicant to be an unreliable witness, noting significant discrepancies between his testimony and independent records regarding his income and receipt of social assistance.

The arbitrator concluded the applicant failed to establish disability beyond the termination date and set his weekly income benefit at the minimum rate of $185.60.

Claims for a special award and arbitration expenses were dismissed, with the arbitrator noting the applicant's conduct unreasonably prolonged the proceedings.

The applicant was injured in a motor vehicle accident and received weekly income benefits until August 1991, when he returned to work part-time at a bakery.

He sought ongoing weekly income benefits, arguing he remained substantially unable to perform his pre-accident job as a furniture delivery driver.

The arbitrator found that the applicant failed to prove substantial inability after August 1991, noting his return to work, medical evidence of improvement, and failure to report his return to work to the insurer.

The arbitrator also determined the correct quantum of pre-accident earnings, ordered repayment of overpaid benefits, and dismissed the claim for a special award.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them based on surveillance video showing him moving furniture.

The applicant applied for arbitration.

The arbitrator found that the applicant, a heavy equipment operator, remained substantially unable to perform his essential tasks and reinstated the $600 weekly benefits.

The arbitrator also found the insurer acted unreasonably in terminating benefits without further medical investigation or discussing the video with the applicant, awarding a $2,000 special award to the applicant.

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

The insurer terminated benefits on the basis that the applicant was able to perform the essential tasks of his employment as a machinist.

The applicant sought reinstatement of benefits and a special award for unreasonable delay.

The arbitrator found that medical and surveillance evidence demonstrated the applicant was not substantially unable to perform his pre-accident employment duties.

The claims for weekly income benefits and a special award were dismissed, but the applicant was awarded his arbitration expenses.

The applicant was injured in a motorcycle accident and claimed statutory accident benefits, including care benefits for his wife who took time off work to care for him, and weekly income benefits.

The arbitrator found that the applicant required full-time care only during his two-month recuperation from spinal surgery, awarding care benefits for that period but denying them thereafter, as his ongoing vertigo and orthopaedic injuries did not necessitate 24-hour supervision.

On the issue of income benefits, the arbitrator held that the applicant's prior workers' compensation and no-fault benefits did not constitute 'income from employment', meaning his weekly benefits had to be calculated based on the statutory deemed minimum earnings.

The arbitrator remained seized of the insurer's claim for repayment of an alleged overpayment pending a pending Divisional Court ruling.