OFSCDRS 1993

The Applicant sought weekly income benefits following a motor vehicle accident.

The Insurer terminated benefits, arguing the Applicant was no longer substantially unable to perform his employment tasks.

The Arbitrator found the Applicant to be highly unreliable, noting he had worked as a meat cutter for six weeks following the accident while claiming total disability, and had fabricated employment records.

Relying on the objective medical evidence and the Applicant's extensive pre-existing back issues, the Arbitrator concluded the Applicant was not significantly injured in the accident and was never entitled to the benefits received.

The Applicant was ordered to repay $25,660.07 to the Insurer.

The applicant was injured in a motor vehicle accident and applied for arbitration after the insurer terminated his weekly income benefits.

At the opening of the arbitration hearing, the applicant withdrew his application, stating he wished to pursue the matter in court.

The insurer sought a refund of its $1,000 assessment fee, and the applicant sought his expenses for the arbitration.

The arbitrator held that there is no statutory provision allowing for the refund of the insurer's assessment fee when an application is withdrawn.

The arbitrator also declined to award the applicant his expenses, finding that his withdrawal at the hearing was capricious and unreasonably prolonged the proceedings.

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

After mediation failed, the applicant applied for arbitration.

The insurer subsequently offered $2,500 to settle the claim, which the applicant accepted and cashed.

The applicant later sought to proceed with the arbitration.

The arbitrator held that the $2,500 payment constituted a final settlement of the applicant's entitlement to weekly income benefits, and therefore the arbitration could not proceed.

The insurer's arbitration assessment was refunded, and the applicant was awarded his expenses.

The applicants' daughter was killed in a motor vehicle accident.

They applied for death benefits under the No-Fault Benefits Schedule, which the insurer denied on the basis that the daughter was not 'principally dependent for financial support' on her parents.

The arbitrator found that although the parents generously supplemented their daughter's income, she was employed full-time, lived in her own apartment, and was financially able to provide for herself.

The application for death benefits was dismissed, but the applicants were awarded their arbitration expenses.

The applicant, who was injured in a motor vehicle accident, sought a determination of the quantum of weekly income benefits payable by the insurer.

The arbitrator found that the applicant, as president of a closely-held corporation, had structured his financial affairs to minimize his income, receiving only director's fees and dividends rather than a salary.

Consequently, his gross weekly income from employment was insufficient to qualify for more than the minimum weekly benefit.

After deducting post-accident income received and available from the corporation, the arbitrator concluded the applicant was not entitled to any further benefits and ordered him to repay $6,496 that the insurer had overpaid.

The applicant was awarded his arbitration expenses.

The Applicant was injured in a snowmobile accident and sought ongoing weekly disability benefits, caregiver benefits, and rehabilitation expenses under the No-Fault Benefits Schedule.

The arbitrator found that the Applicant did not suffer a substantial inability to perform his essential tasks, relying on his own testimony that he continued to engage in activities such as gardening, fishing, and driving, albeit with pain.

Claims for caregiver benefits and child care benefits were dismissed as the statutory criteria were not met.

The arbitrator also rejected claims for expensive equipment, including a truck and tractor, as unreasonable and not medically required, but allowed transportation expenses for a horticultural therapy consultation.

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

The applicant applied for mediation.

The mediator issued a report stating the dispute was settled, but the applicant maintained no settlement was reached and applied for arbitration.

The insurer raised a preliminary objection, arguing the matter was settled and could not be arbitrated under section 281(2) of the Insurance Act.

The arbitrator found that the parties were never ad idem regarding the purported settlement, as evidenced by the applicant's immediate actions to clarify the misunderstanding and proceed with mediation.

The preliminary objection was dismissed, allowing the applicant to proceed to arbitration.

The Applicant was injured in a motor vehicle accident and sought weekly income benefits under the No-Fault Benefits Schedule, claiming he had an offer of employment made prior to the accident.

The Insurer disputed the existence of the pre-accident offer and paid benefits based on his pre-accident employment.

The arbitrator found the Applicant's evidence regarding the timing of the job offer implausible and uncorroborated.

The arbitrator concluded that the Applicant failed to prove on a balance of probabilities that the offer of employment was made before the accident.

The insured persons, a husband and wife, were both killed as a result of a motor vehicle accident.

They were survived by three dependent children.

The insurer paid death benefits to the children, including $10,000 to each child under section 11(1)(c) of the No-Fault Benefits Schedule.

The children claimed they were each entitled to $20,000 because they lost both parents.

The arbitrator held that under the plain meaning of section 3(2), the children were dependants of both their father and their mother.

Consequently, they were entitled to collect the $10,000 death benefit in respect of each deceased parent, totalling $20,000 per child.

The claim for a special award against the insurer was dismissed because the insurer's interpretation of the novel issue was arguable.

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

The applicant sought mediation and then arbitration, claiming entitlement to weekly benefits for an extended period due to neck pain, insomnia, and nightmares.

The arbitrator found that the applicant suffered a substantial inability to perform essential tasks for a limited period and awarded benefits for that time.

The insurer's claim for repayment of benefits was dismissed due to lack of evidence.

The applicant was also awarded prescription costs and arbitration expenses.

The applicant, a high school student who worked part-time and intended to work full-time over the summer, was injured in a motor vehicle accident.

She received weekly income benefits until January 1991 but claimed ongoing entitlement until August 1991, arguing that her injuries prevented her from working while attending school.

The arbitrator found that while the applicant continued to experience pain and headaches, her injuries did not cause a substantial inability to perform the essential tasks of her sedentary clerical employment, especially given her successful completion of high school and university courses during the same period.

The claim for ongoing weekly income benefits was dismissed.

However, the insurer was ordered to pay $250 for a medical report that was instrumental in resolving a dispute over the continuation of the applicant's physiotherapy treatments.

The applicant was injured in a motor vehicle accident while driving a van owned by his employer.

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

The insurer denied the claim on the basis that the applicant knew or ought reasonably to have known he was operating the vehicle without the owner's consent.

The arbitrator found that the applicant had abused his position of trust by appropriating the van for personal use during off-hours without permission.

The application for weekly income benefits was dismissed, though the applicant was awarded his arbitration expenses.

The appellant requested a further adjournment of a scheduled motion due to the continuing illness of his counsel.

The respondent agreed to a short adjournment but opposed further delays, noting the long history of the case and outstanding production issues.

The Director of Arbitrations granted the adjournment to March 23, 1993, making it peremptory to the appellant, and scheduled any potential new hearing to commence shortly thereafter.

The insurer appealed an arbitrator's decision that Canada Pension Plan (CPP) disability payments received by the respondent were not deductible from weekly income benefits payable under s. 13(3) of the No-Fault Benefits Schedule.

The respondent, who was unemployed at the time of the accident, had been receiving CPP disability payments for a prior condition.

The Director of Arbitrations allowed the appeal, finding that the phrase 'any payments for loss of income' in s. 13(3) is unambiguous and includes CPP disability payments, regardless of whether they relate to the accident or a prior condition.

The weekly income benefits must be reduced by the amount of the CPP payments.

The Applicant was injured in a motor vehicle accident and received weekly disability benefits until September 28, 1991.

He applied for ongoing weekly benefits, claiming a substantial inability to perform his essential tasks due to chronic pain in his neck, shoulder, and arm.

The arbitrator reviewed medical evidence and surveillance video showing the Applicant performing strenuous physical activities, such as lifting heavy wooden skids, without apparent difficulty.

The arbitrator concluded the Applicant failed to establish a substantial inability to perform his normal tasks and denied ongoing benefits.

The arbitrator also held that the Applicant's pre-existing permanent workers' compensation pension was not a payment for loss of income and therefore not deductible from no-fault benefits.

The Applicant was awarded his arbitration expenses.

The Applicant sought weekly income benefits following a motor vehicle accident.

The Insurer terminated benefits on November 24, 1991.

The Arbitrator found that the Applicant failed to prove a substantial inability to perform the essential tasks of his employment after that date.

Furthermore, the Arbitrator determined that the Applicant attempted to defraud the Insurer by claiming to be the beneficial owner of a business to inflate his pre-accident income.

The correct weekly income benefit was calculated based solely on his actual employment income.

As a result, the Applicant was ordered to repay an overpayment of $12,682.82 plus interest to the Insurer, and his claim for arbitration expenses was denied due to his fraudulent conduct.

The applicant was injured in a motor vehicle accident and received weekly income benefits until July 7, 1991.

He disputed the termination of his benefits, claiming entitlement until April 1, 1992, due to an inability to perform his essential tasks as a self-employed consultant.

The arbitrator found that the medical evidence, including testimony from the insurer's orthopaedic expert and the applicant's former family physician, did not support the claim of ongoing disability.

The application for ongoing weekly income benefits was dismissed.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and claimed weekly income benefits at the maximum rate of $600 per week, along with transportation expenses.

The insurer disputed the income amount, arguing the applicant failed to provide sufficient evidence of his earnings.

The arbitrator found the applicant's self-generated run-sheets unreliable and contradictory to his tax return, concluding he failed to prove his gross weekly income exceeded the statutory minimum.

The applicant was awarded the deemed statutory minimum of $185 per week for income benefits and $266 for transportation expenses.

The applicant was injured in a motor vehicle accident and received weekly income benefits until April 1991, when the insurer terminated them.

She applied for arbitration seeking ongoing weekly income benefits, childcare benefits, and supplementary medical expenses.

The arbitrator found that the accident aggravated a pre-existing fibromyalgia condition, but that by April 1991, the applicant had largely returned to her pre-accident state of health.

The claims for ongoing income benefits, childcare benefits, and supplementary medical expenses were dismissed due to the applicant's recovery and a lack of evidentiary foundation.

The applicant, a pedestrian struck by a motor vehicle, applied for statutory accident benefits, claiming ongoing substantial inability to perform his pre-accident work as a heavy manual labourer.

The insurer terminated weekly income benefits and disputed the quantum of the applicant's pre-accident income.

The arbitrator found that the applicant's financial records were fabricated after the accident and relied on forensic accounting evidence to limit his weekly income benefits to the statutory minimum.

The arbitrator also accepted medical evidence that the applicant's ongoing back issues were due to pre-existing degenerative disc disease, concluding he was no longer substantially disabled.

The applicant was ordered to repay an overpayment of benefits to the insurer, though the insurer was ordered to fund a four-week rehabilitation program.