Neutral Citation: 1994 ONICDRG 49
File No. A-005706
ONTARIO INSURANCE COMMISSION
BETWEEN:
JODI E. WISEMAN
Applicant
and
COACHMAN INSURANCE COMPANY
Insurer
DECISION
Issues:
The Applicant, Jodi E. Wiseman, was injured in a motor vehicle accident on September 6, 1992. She applied for and received accident benefits from the Coachman Insurance Company ("Coachman"), payable under Ontario Regulation 6721.
Ms. Wiseman received a total of $3,842.85 in weekly income benefits for the period from September 13, 1992 to March 7, 1993. Coachman terminated her weekly income benefits, effective March 8, 1993, on the basis that she was no longer substantially unable to perform the essential tasks of her pre-accident employment. Ms. Wiseman claims that she continues to be eligible for weekly income benefits. The parties also disagree about the proper amount of her weekly income benefits.
The dispute was not resolved through mediation, and Ms. Wiseman applied for arbitration. The issues are:
Is Ms. Wiseman entitled to weekly income benefits under section 12 of the Schedule from March 8, 1993, the date they were terminated?
What is the proper amount of Ms. Wiseman's weekly income benefits, calculated according to section 12 of the Schedule?
Should Coachman be ordered to pay a special award under section 282(10) of the Insurance Act, R.S.O. 1990, c. I.8, on the basis that it unreasonably withheld or delayed the payment of accident benefits?
Ms. Wiseman also claims interest on any outstanding amounts owing, and her expenses related to the arbitration.
Result:
Ms. Wiseman is entitled to weekly income benefits from March 8, 1993.
During the entire period of her eligibility, Ms. Wiseman is entitled to weekly income benefits of $445.59. Coachman is entitled to reduce her weekly income benefits by 80 per cent of her post-accident income, according to section 15 of the Schedule. The reduction for the period from the date of the accident through April 7, 1994 is $4,962.53.
Ms. Wiseman is entitled to interest on the amounts owing, according to section 24 of the Schedule.
Coachman unreasonably failed to pay weekly income benefits and, therefore, is required to pay a special award of $1,500.00, inclusive of interest to the date of this decision.
Ms. Wiseman is