Neutral Citation: 1993 ONICDRG 46
File No. A-003659
ONTARIO INSURANCE COMMISSION
BETWEEN:
SELMA TAVES
Applicant
and
THE WAWANESA MUTUAL INSURANCE COMPANY
Insurer
DECISION
Issues:
The Applicant, Selma Taves, was injured by a motor vehicle on April 21, 1991. She applied for and received accident benefits from the Insurer payable under Ontario Regulation 672 (the "No-Fault Benefits Schedule"), enacted under the Insurance Act, R.S.O. 1990, c. I.8.
Mrs. Taves received weekly disability benefits until July 8, 1992. The Insurer stopped paying these benefits because it asserted Mrs. Taves no longer qualified for them according to the provisions of the No-Fault Benefits Schedule. Mediation was unsuccessful in resolving the dispute between the Applicant and the Insurer, and Mrs. Taves applied for this arbitration under the Insurance Act.
The issues in this hearing were:
- Is the Applicant entitled to weekly income benefits under section 13 of the No-Fault Benefits Schedule after July 8, 1992?
The Applicant also claimed interest on any outstanding amounts owing, and her expenses incurred in the hearing.
At the hearing, the Insurer agreed to pay $513.00 in supplementary medical and rehabilitation payments to the Applicant, within seven days of the hearing. It also withdrew its contention that the weekly income benefits issue had been settled at the mediation.
Result:
The Applicant is not entitled to further weekly income benefits after July 8, 1992.
The Applicant is entitled to her expenses of this hearing as prescribed under Ontario Regulation 664, Dispute Resolution Expenses.
The Insurer will pay $513.00 in supplementary medical and rehabilitation expenses to the Applicant, within seven days of the hearing.
Hearing:
The hearing was held in Windsor, on July 29, 1993, before me, K. Julaine Palmer, arbitrator.
Present at the Hearing:
Applicant: Selma Taves
Applicant's Representative: Albert Taves
Insurer's Representative: Guy Farrell, Barrister and Solicitor
Witnesses: Selma Taves, Albert Taves, Dr. Robert Haliburton
The parties filed 13 exhibits at the hearing.
Evidence and Findings:
Selma Taves was attending a golden wedding anniversary celebration on April 21, 1991, when a car suddenly crashed through a window of the building and landed on her. Another woman was killed in the accident. Mrs. Taves suffered multiple injuries, including four fractures of her pelvis, and was hospitalized for more than five weeks.
The Insurer paid weekly income benefits to Mrs. Taves until July 8, 1992, under the provisions of section 13(1) of the No-Fault Benefits Schedule, which states:
(1) The insurer will pay with respect to each insured person who sustains physical, psychological or mental injury as a result of an accident, a weekly benefit during the period in which the insured person suffers substantial inability to perform the essential tasks in which he or she would normally engage if he or she meets the qualifications set out in subsection (2).
Mrs. Taves has applied for weekly income benefits past July 8, 1992 on the basis that she meets the criteria of section 13(1). Thus, it was important in this arbitration to receive evidence as to the essential tasks in which she would normally engage. Also, I required evidence as to