OFSCDRS 1995

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

He later disputed a settlement agreement reached by his former counsel and filed a second application for arbitration claiming a deficiency balance, supplementary medical and rehabilitation benefits, and reinstatement of weekly income benefits.

The arbitrator found that the applicant had authorized the settlement and was bound by it.

The arbitrator also found that the claims for supplementary medical and rehabilitation benefits and reinstatement of weekly income benefits had not been mediated as required by the Insurance Act.

The applicant's claims were dismissed, and he was ordered to pay $1,000 in expenses to the insurer for bringing a frivolous and vexatious arbitration.

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

After 156 weeks, the insurer terminated the benefits, arguing the applicant did not meet the stricter test under section 12(5)(b) of the Statutory Accident Benefits Schedule, which requires that the injury continuously prevents the insured from engaging in any occupation or employment for which they are reasonably suited by education, training, or experience.

The applicant, a former nurse, argued she suffered from chronic pain syndrome and was retraining as a counsellor.

The arbitrator found the applicant's decision to retrain was reasonable and supported by her treating physicians.

The arbitrator concluded that the applicant's injuries continuously prevented her from engaging in suitable employment and ordered the insurer to pay ongoing weekly income benefits from the date of termination, along with arbitration expenses.

The applicant was injured in a minor motor vehicle accident and received statutory accident benefits until December 1993.

She sought ongoing weekly income benefits, claiming she was substantially unable to perform her pre-accident job as a Client Service Officer due to fibromyalgia and depression.

The arbitrator dismissed the claim for ongoing benefits, finding no objective signs of disability, noting the minor nature of the accident, and relying on surveillance evidence and the applicant's undisputed ability to work part-time.

The arbitrator awarded the applicant her arbitration expenses, finding the claim was not frivolous or vexatious.

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

The Applicant applied for arbitration, claiming ongoing entitlement to weekly income benefits.

The Insurer relied on video surveillance and medical reports indicating the Applicant had recovered and was capable of returning to work.

The Arbitrator found that the Applicant's injuries had sufficiently healed by the termination date, noting that his reluctance to return to work was due to job dissatisfaction rather than physical disability.

The claim for ongoing benefits was dismissed, but the Applicant was awarded the expenses of the arbitration.

The applicant's spouse died in a motor vehicle accident.

The insurer paid the applicant a $50,000 spousal death benefit under section 11(2)(a) of the Statutory Accident Benefits Schedule, but denied his claim for an additional $20,000 dependant death benefit under section 11(2)(c).

The arbitrator held that the spousal and dependant death benefits are not mutually exclusive, and a spouse may claim both if they meet the criteria for financial dependency.

However, after analyzing the family's income and expenses, the arbitrator found that the applicant was not principally dependent for financial support on his deceased spouse at the time of the accident.

The claim for the dependant death benefit was dismissed, but the applicant was awarded his arbitration expenses.

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

She applied for ongoing weekly benefits under section 13 of the Schedule, claiming a substantial inability to perform her essential tasks as a student, parent, and homemaker due to soft tissue injuries, headaches, and depression.

The arbitrator found that while the applicant experienced a reduced level of functioning, she was able to resume her full-time studies and manage her household with some assistance, and therefore did not meet the test for substantial inability.

The claim for ongoing weekly benefits was dismissed, but the insurer was ordered to reimburse the applicant for chiropractic and medication expenses, and to provide further rehabilitation assistance.

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

He owned a courier service that continued to operate for two months post-accident.

The insurer sought to deduct payments made to the applicant by his business during this period.

The arbitrator found that as the sole proprietor, any money flowing to the applicant from the business qualified as post-accident income under section 15 of the Schedule.

The arbitrator concluded that the applicant received $9,130 in post-accident compensation, of which 80% was deductible from his weekly income benefits.

The Applicant was injured in a motor vehicle accident while a passenger in a tractor driven by a co-worker.

The Insurer denied statutory accident benefits on the basis that the Applicant knew or ought to have known the vehicle was being driven without the owner's consent.

The arbitrator found that the employer had given the employees keys to the tractor without specific restrictions, implying authority to operate it.

Therefore, the driver had implied consent, and the Applicant was not precluded from receiving benefits under section 17(3)(b) of the Schedule.

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

The applicant sought reinstatement of benefits under section 12(1) of the Schedule for the period up to 156 weeks post-accident, and under section 12(5)(b) thereafter.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of her pre-accident employment as a sewing machine operator due to the demanding nature of the job and uncertainty about her capacity, granting benefits up to the 156-week mark.

However, the arbitrator dismissed the claim for ongoing benefits after 156 weeks, finding that the applicant was not continuously prevented from engaging in any occupation or employment for which she was reasonably suited, as she was capable of other light industrial work.

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

A dispute arose regarding the calculation of the applicant's gross weekly income under section 12 of the Statutory Accident Benefits Schedule.

The applicant, a 50% shareholder in a masonry business, had received a $6,000 bonus shortly before the accident.

The arbitrator found that the bonus was income but should be allocated over the 52 weeks preceding the accident rather than attributed solely to the four weeks prior.

Applying the formula in paragraph 12(7)1 of the Schedule, the arbitrator determined the applicant's gross weekly income to be $521.63 and awarded the applicant his arbitration expenses.

The applicant sought statutory accident benefits, including weekly benefits and housekeeping and care benefits, following a motor vehicle accident.

The arbitrator dismissed all claims, finding the applicant and her witnesses lacked credibility.

Surveillance evidence and testimony from an insurance broker contradicted the applicant's claims of severe disability.

The arbitrator concluded the claim was fraudulent and denied the applicant's request for a special award and expenses.

The Applicant was injured in a motor vehicle accident and initially issued a Statement of Claim against the tortfeasor and the Insurer for statutory accident benefits.

After mediation failed, the Applicant filed an Application for Arbitration and discontinued the court action against the Insurer.

The Insurer argued the Applicant was precluded from arbitration having already selected the court forum.

The Arbitrator held that the Applicant's prompt application for arbitration after mediation failed constituted a valid election to proceed by arbitration, and allowed the arbitration to proceed.

The Applicant was injured in a motor vehicle accident and claimed weekly income benefits based on a pre-accident offer of employment.

The Insurer denied the claim because the Applicant did not have a work permit at the time of the accident.

The arbitrator held that the words 'within one year' in section 12(2)1.(iii) of the Schedule refer to the date of the accident.

The arbitrator further found that the Applicant was not entitled to start work at the time of the accident because he had not fulfilled the condition of obtaining a work permit, and the offer had effectively been revoked by the prospective employer's conduct.

The claim for weekly income benefits under section 12 was dismissed, but the Applicant was awarded expenses.

The applicant was injured in two motor vehicle accidents and sought ongoing statutory accident benefits, including weekly benefits and medical/rehabilitation expenses, after the insurer terminated them in August 1992.

The applicant claimed ongoing disability due to physical injuries, aggravated multiple chemical sensitivities, and chronic fatigue.

The arbitrator found that the applicant suffered from longstanding pre-accident psychiatric and physical problems, including somatization disorder, and that she had substantially returned to her pre-accident level of activity by the time benefits were terminated.

The claim for ongoing weekly benefits was dismissed, though certain medical, rehabilitation, and transportation expenses incurred prior to the termination date were allowed.

The arbitrator declined to make a special award but granted the applicant her arbitration expenses.

The applicant was injured in a motor vehicle accident and received weekly income benefits until January 1992.

The insurer raised a preliminary issue that the applicant's 1994 application for arbitration was time-barred under the Insurance Act, arguing a February 1992 letter constituted a valid notice of refusal.

The arbitrator found that the letter did not clearly and unequivocally communicate the insurer's refusal to pay benefits and the reasons for the refusal.

Therefore, the letter did not meet the requirements of subsection 24(8) of the Schedule, the limitation period was not triggered, and the applicant was not precluded from proceeding to arbitration.

The applicant withdrew his application for statutory accident benefits but sought his legal expenses for the arbitration.

The insurer opposed and sought costs against the applicant and his representatives, arguing the proceeding was an abuse of process.

The arbitrator denied the applicant's request for expenses, finding his conduct unreasonably prolonged the proceedings.

The arbitrator awarded the insurer $1,000 against the applicant under section 282(11.2) of the Insurance Act due to his failure to comply with undertakings and production orders.

The insurer's request for costs against the applicant's representatives was denied for lack of statutory authority.

The applicant was injured in a motor vehicle accident when she was struck by a car as a pedestrian, sustaining knee injuries.

The insurer terminated her weekly income benefits after approximately 20 months.

The applicant sought ongoing benefits, arguing she was substantially unable to perform the essential tasks of her pre-accident employment as a fast-food restaurant assistant manager.

The arbitrator found that while the applicant had some limitations with heavy lifting and repetitive crouching, she could perform the great majority of her essential tasks without difficulty.

The application for ongoing weekly income benefits and a special award was dismissed, though the applicant was awarded her arbitration expenses.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits until the Insurer terminated weekly income benefits.

The Applicant applied for arbitration, claiming ongoing entitlement due to fibromyalgia and chronic pain syndrome.

The arbitrator found that the Applicant had returned to work and performed her essential tasks regularly for ten months prior to being laid off due to corporate downsizing.

The arbitrator concluded the Applicant did not suffer a substantial inability to perform the essential tasks of her employment and dismissed the claim for ongoing weekly income benefits, though the Applicant was awarded the expenses of the arbitration.

The appellants, family members of a deceased who was fatally injured in a motor vehicle accident, appealed an arbitrator's decision dismissing their motion for an interim award of expenses.

The appellants sought $29,358.00 from the respondent insurer to cover travel expenses from Ethiopia to Ontario to attend the arbitration hearing.

The Director of Arbitrations determined the appeal on the record.

The Director found that the arbitrator correctly exercised her discretion by applying the criteria from the Bernicky case, concluding that the application did not disclose a case of sufficient merit to warrant pursuit.

The Director noted the lack of evidence demonstrating why the personal attendance of the minor appellants was necessary or why alternative forms of evidence could not be used.

The appeal was dismissed with no order as to expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from her insurer.

The parties disputed the calculation of weekly income benefits for a self-employed farmer, specifically regarding the deduction of ceasing expenses, Canada Pension Plan disability benefits, and post-accident farm income.

The arbitrator determined the appropriate weekly income benefit amounts for 1991-1993.

The arbitrator also reviewed claims for supplementary medical and rehabilitation expenses, granting the cost of an exercise bike, bench, and cane, but denying claims for a hot tub, electric bed, replacement farm labour, and future housekeeping and transportation expenses.