Neutral Citation: 1995 ONICDRG 32
File No. A-008639
ONTARIO INSURANCE COMMISSION
BETWEEN:
SAMANTHA DORIS MICHAEL
Applicant
and
GENERAL ACCIDENT ASSURANCE COMPANY OF CANADA (formerly GENERAL ACCIDENT INDEMNITY COMPANY)
Insurer
DECISION
Issues:
The Applicant sustained severe head injuries in a motor vehicle accident on August 20, 1991. She applied for and received statutory accident benefits from the Insurer, under Ontario Regulation 6721. She is claiming certain supplementary, medical and rehabilitation benefits.
The issues in this hearing are:
1.(a) Is the Applicant entitled to payment of tuition fees under section 6 of the Schedule?
(b) Is the Applicant entitled to payment of accommodation costs as Supplementary Medical and Rehabilitation Benefits under section 6 of the Schedule?
The Applicant also claims interest on any outstanding amounts owing and her expenses incurred in the hearing.
Result:
1.(a) The Applicant is entitled to reimbursement for tuition expenses paid for: two courses at Trent University; two courses at University of Toronto; and three courses at Ryerson, taken between 1992 and the date of the hearing, as well as to tuition for the continuation of her studies at Ryerson, subject to further review in December 1996.
(b) The Applicant is entitled to reimbursement for monies paid to live in residence at the University of Toronto from September 1992 to April 1993.
Some of the above amounts have already been paid. Interest is payable for unpaid amounts, pursuant to section 24 of the Schedule. The parties will settle the interest and expenses issues between themselves.
Hearing:
An arbitration hearing was held in North York, Ontario, on March 2, 1995, before me, R. E. Hartman, arbitrator.
Present at the Hearing:
Applicant:
Samantha Doris Michael
Applicant's
P. Auerbach
Representative:
Barrister and Solicitor
Insurer's
G. Heckel
Representative:
Barrister and Solicitor
The evidence was recorded by a court reporter provided by the Insurer and I heard evidence under oath from Dr. P.G. Rumney and Ms. Michael. Five exhibits were filed and a case brief provided by the Insurer.
Cases cited:
Jeffrey Boyes and State Farm Mutual Automobile Insurance Company, September 8, 1994, OIC File No. A-003369
Gail Burley and State Farm Mutual Automobile Insurance Company, April 29, 1994, OIC File No. A-005048
Debra H. MacPherson and Pilot Insurance Company, January 31, 1994, OIC File No. A-003688
Balwmder Singh and Simcoe Erie Group, February 2, 1994, OIC File No. P-000532
Evidence:
The Applicant, now 21, was riding as a passenger in the rear seat of a motor vehicle, without belt restraint, when the vehicle went out of control at a curve in the highway and hit a tree, on August 20, 1991. The accident occurred near Bracebridge, after midnight. Both the driver and passenger had consumed alcohol. The Applicant suffered severe injury to the head and chest, including skull and facial fractures. She was airlifted to Sunnybrook Hospital Trauma Centre in Toronto and was admitted to The Hugh MacMillan Rehabilitation Centre ("the Centre") on October 15, 1991, for assessment by a team of medical professionals under the supervision of Dr. P. G. Rumney, a pediatrician and full-time director of head injuries at the Centre.
By way of background, the Applicant had completed an accelerated high school program in Courtice, Ontario (near Oshawa) in June 1991, graduating as an Ontario Scholar. She described her high school years as busy, taking OAC credits in four rather than five years, and working at a number of part-time jobs. In the summer of 1991, she was working full-time at a department store, and "had been engaged in fairly heavy drinking", as reported to her post-accident psychotherapist, M. Macartney-Filgate, Ph.D.. She had been accepted into the sciences program at McMaster University in Hamilton for September 1991, and was aiming for a career in medicine. She was to move to the university