OFSCDRS 1993

The applicant was injured in a motor vehicle accident and received no-fault benefits as a student for eight weeks.

He applied for arbitration, claiming he was a self-employed renovator entitled to higher weekly income benefits.

The applicant failed to attend the arbitration hearing.

In the absence of contradictory evidence, the arbitrator accepted the insurer's documentary evidence and dismissed the applicant's claims.

The arbitrator also denied the insurer's request for a refund of its filing fee.

The Applicant was injured in a motor vehicle accident and received accident benefits until the Insurer allegedly terminated them.

The Insurer argued the Applicant's request for arbitration was barred by the two-year limitation period under s. 281(5) of the Insurance Act.

The arbitrator found that the Insurer failed to prove actual delivery of the notice of denial as required by s. 148(15) of the Insurance Act, rejecting the application of the 'mailbox rule'.

The Applicant was permitted to proceed to arbitration.

The applicant, a homemaker, claimed she was totally disabled from performing her essential tasks after being injured as a passenger on a bus.

She applied for weekly benefits, childcare benefits, and a special award under the No-Fault Benefits Schedule.

The arbitrator dismissed the claims for benefits, finding the applicant's evidence of total disability implausible and inconsistent with medical reports, her own conduct, and observations by the insurer's representatives.

The arbitrator concluded the applicant was not substantially unable to perform her essential tasks.

However, the applicant was awarded her arbitration expenses as the proceeding was not brought for an improper purpose.

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

The insurer terminated weekly income benefits, and the parties attended mediation.

The insurer argued the dispute was resolved at mediation, relying on a signed Memorandum of Agreement and Report of Mediator.

The applicant contended she did not agree to the terms and signed under pressure.

The arbitrator found that the applicant understood the terms of the settlement and that signing the Memorandum would resolve the dispute.

The arbitrator concluded there was no undue influence or vitiating factor, and held that the mediation was successful in resolving the dispute, precluding the applicant from proceeding to arbitration.

The applicant was injured in a motor vehicle accident and received weekly income benefits from the insurer, as well as collateral loss of income benefits from National Life.

The insurer deducted the gross amount of the National Life benefits from 80 per cent of the applicant's gross weekly income to calculate her weekly income benefit under Section 12(4)(b) of the Statutory Accident Benefits Schedule.

The applicant disputed this calculation, arguing that only the net after-tax amount of the collateral benefits should be deducted.

The arbitrator agreed with the applicant, finding that deducting the gross amount of taxable collateral benefits would unfairly penalize the applicant and contravene the legislative goal of matching 80 per cent of pre-accident gross income.

The insurer was ordered to calculate the deduction based on the net after-tax amount of the collateral benefits and to pay interest and expenses.

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

After returning to part-time work, the insurer deducted 80 per cent of her post-accident earnings from her weekly benefit.

The applicant disputed this calculation, arguing the deduction should be from her pre-accident gross earnings.

The arbitrator held that under section 15 of the No-Fault Benefits Schedule, the insurer is entitled to deduct 80 per cent of post-accident earnings directly from the weekly benefit payable.

The applicant was injured in a motor vehicle accident while laid off and receiving unemployment insurance benefits.

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

The insurer denied the claim, arguing he was capable of working.

The arbitrator found the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment for a limited period.

The arbitrator determined that the applicant's gross weekly income should be averaged over the full 52 weeks preceding the accident, including periods of unemployment, resulting in a weekly benefit of $455.58.

The arbitrator also held that short-term disability benefits from another plan were not 'available' to the applicant and should not be deducted.

The applicant, a limousine driver, was kidnapped at gunpoint in his vehicle and forced to drive into the countryside before the vehicle was stolen.

He suffered psychological injuries and applied for accident benefits.

The insurer denied the claim, arguing the incident did not involve the use or operation of an automobile.

The arbitrator found that the forced operation of the vehicle at gunpoint directly or indirectly caused the psychological injury, satisfying the definition of an accident under the No-Fault Benefits Schedule.

The applicant was awarded $3,600 in weekly income benefits and his arbitration expenses.

The applicant, a self-employed restaurant owner, was injured in a motor vehicle accident and received weekly income benefits from the insurer until December 1992.

He applied for arbitration seeking ongoing benefits.

The arbitrator found that the applicant was no longer substantially disabled from performing the essential tasks of his occupation after December 1992, relying on extensive medical and rehabilitation evidence.

Furthermore, the arbitrator determined that the applicant had failed to prove his pre-accident income was higher than the deemed minimum, resulting in a finding that the insurer had significantly overpaid him.

The insurer was ordered to be repaid $28,593.60, and the applicant's claim for a special award was dismissed.

The appellant appealed an arbitrator's decision denying her weekly income and dependent care benefits following a motor vehicle accident.

She requested an oral rehearing, a referral to the Medical and Rehabilitation Advisory Panel, and a reinstatement of benefits, arguing the arbitrator misapplied the test for 'substantial inability' to perform essential tasks as a homemaker.

The Director of Arbitrations dismissed the appeal, finding no grounds to order a rehearing or a medical referral.

The Director upheld the arbitrator's conclusion that while the appellant experienced pain and her tasks took longer, she did not suffer a substantial inability to perform her essential tasks.

The appellant was awarded her expenses for the appeal.

The applicant sought reimbursement for arbitration expenses totaling $20,971.11 following a settlement with the insurer regarding accident benefits.

The arbitrator reviewed the claimed expenses, which included agent's fees, expert witness fees, medical reports, and miscellaneous disbursements.

The arbitrator reduced the agent's fees, noting that preparation time prior to the hearing was excessive and not fully compensable under the schedule.

Claims for transcripts, transportation, laser printer rental, and an accountant's report were denied or reduced for lack of connection to the arbitration or insufficient proof.

The insurer was ordered to pay $3,948.20 in outstanding expenses.

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

The parties reached a settlement at mediation, but the applicant subsequently sought to invalidate the agreement, arguing the insurer failed to disclose a rehabilitation consultant's report prior to the settlement.

The arbitrator held that the report contained no information that would render the settlement unconscionable and upheld the validity of the mediation agreement.

The applicant was awarded expenses for the preliminary issue hearing.

The applicant was injured in a motor vehicle accident and applied for no-fault benefits.

A dispute arose, and the applicant commenced a court action before seeking mediation.

After mediation failed, the applicant applied for the appointment of an arbitrator.

The insurer argued that the applicant had elected to proceed in court and was precluded from arbitration.

The arbitrator held that the applicant's application for arbitration constituted an election to proceed by way of arbitration, and allowed the arbitration to proceed provided the applicant withdrew his court action forthwith.

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

The applicant sought arbitration for ongoing weekly income benefits, care benefits for her mother and husband, and medical and rehabilitation expenses to be incurred in Korea.

The arbitrator found the applicant remained substantially unable to perform the essential tasks of her occupation due to a back injury and awarded ongoing weekly income benefits.

The claims for care benefits and foreign rehabilitation expenses were dismissed as the care was not required by the applicant herself and the foreign expenses were not reasonable.

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

The Insurer reduced these benefits by the amount of disability insurance payments made by Seaboard Life Insurance Company to Chrysler Credit to repay the Applicant's car loan.

The arbitrator held that the disability payments were not 'payments for loss of income' received by or available to the Applicant under an income continuation benefit plan, as their purpose was to protect the creditor, not to compensate the Applicant for lost earnings.

The payments were therefore not deductible.

The Applicant's claim for a special award was dismissed as the Insurer had a bona fide disagreement regarding the interpretation of the legislation.

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

The applicant sought arbitration to reinstate the benefits under section 13(1) of the No-Fault Benefits Schedule.

The arbitrator found that while the applicant continued to suffer pain and her ability to perform certain activities was impaired, she did not suffer a "substantial inability" to perform her "essential tasks" as she continued to perform nearly all her previous activities.

The claim for further weekly income benefits was dismissed, but the applicant was awarded her arbitration expenses and the insurer agreed to pay $513.00 in supplementary medical and rehabilitation expenses.

The applicant was injured in a motor vehicle accident and initially applied for accident benefits from her son's insurer, The Personal, who paid her expenses for a year before realizing she had her own policy with Zurich.

The applicant then applied to Zurich, who denied the claim due to the delay in notice.

On a preliminary issue hearing, the arbitrator found that under section 268 of the Insurance Act, Zurich was the priority insurer.

The arbitrator also found that the applicant had a reasonable excuse for the delay in notifying Zurich, as The Personal's error in sending the wrong claim form and subsequent payment of benefits caused the delay.

Zurich was ordered to pay the applicant's accident benefits.

The applicant was injured in a motor vehicle accident and sought accident benefits.

The arbitrator held that the applicant's pre-accident income included cash payments and food (beef and milk) received from his father in exchange for his work on the family farm, as these constituted 'income' under subsection 12(7) of the No-Fault Benefits Schedule.

However, the arbitrator dismissed the applicant's claim for reimbursement of the cost of hiring farm workers to replace his labour, finding that these were business expenses rather than rehabilitation expenses under clause 6(1)(f).

The applicant was awarded interest on overdue benefits and his expenses for the arbitration.

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

The insurer sought to exclude the applicant from receiving benefits under clauses 17(1)(c) and (d) of the No-Fault Benefits Schedule, arguing he was driving without insurance.

The arbitrator found that clause 17(1)(c) requires a conviction for driving without insurance, which the applicant did not have, as his charge was withdrawn and he pleaded guilty only to failing to have an insurance card.

The arbitrator also held that clause 17(1)(d) relates to licensing matters, not compulsory insurance legislation.

The applicant was found not to be excluded from receiving benefits and was awarded his expenses for the preliminary issue hearing.

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

The applicant sought ongoing benefits, claiming a substantial inability to perform the essential tasks of his employment as a vegetable produce trimmer due to low back pain.

The arbitrator reviewed medical evidence and surveillance footage showing the applicant performing strenuous physical activities, such as shovelling heavy snow and rolling a steel drum.

The arbitrator concluded that the applicant's injuries had resolved sufficiently by September 16, 1991, to allow him to return to his pre-accident employment.

Ongoing benefits were denied after that date, but the applicant was awarded arbitration expenses.