OFSCDRS 1996

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

The insurer terminated the benefits based on a medical report, providing notice to the applicant.

The applicant sought an interim order reinstating the benefits, arguing the insurer failed to comply with the technical requirements of section 64 of the Statutory Accident Benefits Schedule and failed to provide adequate reasons.

The arbitrator found that the insurer substantially complied with the notice requirements and provided adequate reasons for the termination.

The request for an interim order was dismissed.

The applicant was struck by a car and claimed ongoing income replacement benefits (IRBs) due to a left knee injury.

The insurer terminated benefits after the applicant failed to attend a scheduled medical examination and refused to participate in rehabilitation.

The arbitrator found that the applicant was not disabled from her pre-accident employment beyond April 6, 1995, relying on medical evidence and surveillance footage showing her performing physical tasks.

However, the arbitrator awarded full IRBs for a brief one-week period because the insurer had prematurely terminated benefits prior to the scheduled examination date.

The applicant was awarded 50% of her arbitration expenses.

The applicant was injured in a motor vehicle accident and received weekly income benefits until May 8, 1994.

He sought reinstatement of benefits until November 1, 1994, claiming he was substantially unable to perform his essential tasks as a ditch digger due to a knee injury.

The arbitrator found that the applicant had largely recovered by January 1994 and failed to prove he was substantially unable to perform his essential tasks during the disputed period.

The claims for weekly income benefits and a special award were dismissed.

The insurer's claim for repayment of post-accident income was also dismissed.

The applicant, a 62-year-old labourer with a grade three education, was struck by a motor vehicle and suffered multiple injuries, including fractured ribs and a head injury.

He applied for ongoing weekly income benefits under section 12(5)(b) of the Statutory Accident Benefits Schedule after the insurer terminated them.

The arbitrator found that the applicant suffered from post-concussion syndrome and chronic disabling pain resulting from the accident.

Given his age, limited education, poor English skills, and physical limitations, the arbitrator concluded that the applicant was continuously prevented from engaging in any suitable occupation or employment.

The insurer was ordered to pay weekly income benefits of $536.75 from May 5, 1994 onwards, plus interest and expenses.

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

The applicant sought ongoing weekly income benefits under the post-156 week test, arguing that chronic low back pain and depression prevented her from working as a registered nursing assistant or in any other suitable occupation.

The arbitrator found that the applicant's accident-related pain and disability remained the main reason for her depression and inability to work.

The arbitrator also found that the insurer's exclusive reliance on labour market surveys to terminate benefits was unreasonable, given the consensus that her recovery was prolonged by psychological factors.

The applicant was awarded ongoing weekly income benefits and a special award of $3,000.

The claimant was injured while preparing to unload his transport truck when a forklift dropped a steel plate on his feet.

He claimed statutory accident benefits.

The arbitrator found that the injuries were caused by the use or operation of the truck, and that the claimant's personal auto insurer (Royal), rather than the truck's fleet insurer (Markel), was liable to pay the benefits because the claimant was a 'named insured' under his personal policy but not under the fleet policy.

Royal appealed.

The Director's Delegate dismissed the appeal, confirming that the injuries arose from the use or operation of the vehicle and that Royal was the priority insurer under section 268(2) of the Insurance Act.

Royal was ordered to repay Markel the benefits it had already paid.

The appellant was injured in a motor vehicle accident and received weekly income benefits for three years until the insurer terminated them.

An arbitrator upheld the termination, finding the appellant could work in a clerical setting.

On appeal, the Director's Delegate found the arbitrator failed to address key medical evidence from the insurer's own orthopaedic specialist, who considered the appellant completely unfit to work.

The arbitrator also failed to explicitly rule on the period between the termination date and the hearing, and did not sufficiently analyze the appellant's pre-accident employment.

The appeal was allowed, the arbitration order rescinded, and the matter remitted for a new hearing.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including weekly income benefits and the cost of physiotherapy and transportation.

The insurer denied benefits, arguing that the applicant's disabilities arose from a previous work-related injury for which she was receiving WCB benefits.

The arbitrator found that the applicant's pre-existing back injury was the principal cause of her inability to work, and dismissed the claim for weekly income benefits.

However, the arbitrator found it was reasonable for the applicant to undergo an initial 12-week physiotherapy program to alleviate neck symptoms, and ordered the insurer to pay for those treatments and associated transportation costs.

The applicant was awarded 50 percent of her arbitration expenses.

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

At the hearing, the applicant's mother and statutory guardian requested permission to withdraw the application for arbitration.

The insurer did not oppose the withdrawal but sought an order requiring the applicant to pay its $2,000 assessment fee.

The arbitrator permitted the withdrawal and declined to order the payment, finding no evidence that the withdrawal constituted an abuse of process.

The applicant was injured in a motorcycle accident and received weekly income benefits for over four years.

The insurer terminated benefits under the post-156 week test.

The applicant, a young unskilled labourer who underwent a hip replacement, argued he was continuously prevented from engaging in suitable employment.

The arbitrator found that while the applicant could no longer perform heavy physical labour, he was capable of performing sedentary work such as light assembly or delivery driving.

The arbitrator concluded the applicant was reasonably suited for these jobs by education, training, and experience, and dismissed the claim for ongoing weekly income benefits.

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

The applicant brought a motion for interim benefits, arguing the insurer failed to comply with the benefit stoppage provisions under section 64 of the Statutory Accident Benefits Schedule.

The arbitrator held that to obtain interim benefits, an applicant must establish a prima facie case for entitlement and a sense of urgency.

The arbitrator found that the medical evidence raised the possibility that the applicant's cognitive problems resulted from non-accident related causes, such as age-related dementia.

As the applicant failed to present sufficient evidence or legal arguments to establish a prima facie case for entitlement, the motion for interim benefits was dismissed.

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

The applicant sought arbitration to reinstate the benefits, claiming a substantial inability to perform his pre-accident job as a machinist due to soft tissue injuries.

The arbitrator found that the applicant had successfully worked full-time at another manufacturing job post-accident without seeking medical attention.

Relying on this work history and the opinion of the insurer's orthopaedic examiner, the arbitrator concluded the applicant failed to prove a substantial inability to perform the essential tasks of his employment and dismissed the claim for further benefits.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and received weekly income benefits for four years.

The insurer terminated benefits on the basis that the applicant could engage in suitable employment.

The arbitrator found that the applicant did not have the education, training, or experience for the sedentary jobs proposed by the insurer and had made bona fide efforts to retrain.

The arbitrator ordered the reinstatement of weekly income benefits, calculated the quantum at $385 per week based on pre-accident self-employment income and ceasing expenses, and dismissed the insurer's claim for repayment of an overpayment since the benefits were ongoing.

The applicant was injured when a storage tank in the back of a pick-up truck exploded while a neighbour was welding bolts to it.

The applicant applied for statutory accident benefits, but the insurer denied the claim, arguing the injury was not caused by the 'use or operation' of an automobile.

The arbitrator applied the two-part test from Amos, finding that repairing equipment permanently installed on a commercial vehicle is an ordinary and well-known activity to which such vehicles are put.

The arbitrator also found a direct causal relationship between the repair work and the explosion.

The arbitrator concluded the applicant was injured in an accident and awarded expenses.

The appellant appealed an arbitration decision denying his claim for weekly income benefits following a motor vehicle accident.

The appellant argued the arbitrator failed to give proper weight to evidence of a flare-up of back problems and a bulging disc.

The Director's Delegate dismissed the appeal, finding that the arbitrator properly weighed the evidence, preferring the uniform opinions of several orthopaedic specialists over the appellant's general practitioner.

The arbitrator's conclusion that the appellant was not substantially unable to perform the essential tasks of his pre-accident work was supported by the evidence.

No appeal expenses were awarded.

The insured was injured in a motor vehicle accident and claimed the cost of a home whirlpool spa as a medical expense.

The insurer denied the claim, relying on a Designated Assessment Centre report.

The arbitrator denied the cost of the specific spa purchased but ordered the insurer to pay the reasonable cost of a Jacuzzi-type bathtub.

The insurer appealed, arguing the arbitrator exceeded her jurisdiction and erred in her treatment of the medical certificate and DAC report.

The Director's Delegate dismissed the appeal, finding the arbitrator's order reasonably arose from the evidence and submissions, and that there was sufficient evidence to support her findings.

The appellant was injured in a motor vehicle accident and received weekly income benefits for approximately two years before the insurer terminated them.

The arbitrator found that the appellant was not eligible for further benefits, concluding that his failure to resume employment was due to an unreasonable refusal to work rather than a genuine psychological disability.

On appeal, the appellant argued the arbitrator failed to give due weight to his psychiatrist's report and was biased.

The Director's Delegate dismissed the appeal, finding that the arbitrator's assessment of the evidence was reasonable and supported by the record.

The Delegate also refused to admit new medical evidence on appeal and upheld the arbitrator's decision to award the appellant only one-third of his arbitration expenses.

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

The responding party applied for arbitration.

Shortly before the hearing, the moving party brought a motion to stay the proceeding because the responding party refused to attend psychiatric and neuropsychological examinations requested by the moving party.

The Arbitrator found that the moving party's requests for the examinations were reasonable under section 23(2) of the Statutory Accident Benefits Schedule, given the conflicting medical evidence regarding the responding party's cognitive and emotional impairments.

However, the Arbitrator dismissed the moving party's motion for a stay, concluding that there was no statutory authority under the Insurance Act or the Schedule to stay the proceedings or compel attendance at the examinations.

The applicant was injured in a motor vehicle accident and received weekly income benefits until he returned to work.

He later stopped working due to shoulder pain and underwent surgery.

He applied for weekly income benefits for the period he was off work.

The arbitrator found that the accident significantly contributed to the aggravation of his pre-existing shoulder instability.

However, the applicant only proved he was disabled from performing the essential tasks of his employment from July 21, 1994, when his orthopaedic surgeon first examined him, to June 19, 1995, when he returned to work.

The applicant was awarded benefits for that period, along with interest and expenses, subject to a minor reduction for late production of documents.

The applicant was involved in a motor vehicle accident and applied for income replacement benefits, which the insurer denied.

The applicant applied for arbitration more than two years after the insurer's clear and unequivocal written denial.

The arbitrator held that under section 281(5) of the Insurance Act, the two-year limitation period begins to run from the date of the insurer's refusal to pay, not on a rolling basis as under previous legislation.

Consequently, the applicant was precluded from proceeding to arbitration.