OFSCDRS 1996

The applicant sought to withdraw his second application for arbitration regarding statutory accident benefits after an unsuccessful appeal on his first application.

The insurer opposed the withdrawal unless awarded $2,000 for expenses, arguing the second application was frivolous, vexatious, or an abuse of process under section 282(11.2) of the Insurance Act.

The arbitrator found the application was not frivolous, vexatious, or an abuse of process, as there was some chance of success when it was commenced and the applicant was attempting to correct an oversight from the first proceeding.

The applicant was permitted to withdraw the application without terms.

The applicant was injured in a motorcycle accident and received statutory accident benefits until the insurer terminated them, claiming he could return to his pre-accident employment.

The parties disputed the physical demands of his pre-accident job as a folding wall installer and service coordinator.

The arbitrator found the job involved medium to occasionally heavy physical demands.

Relying on medical and functional capacity evidence, the arbitrator concluded the applicant remained disabled until he completed a functional restoration program on April 8, 1994.

The insurer was ordered to pay arrears of weekly income benefits totaling $12,167.94, plus interest, and supplementary medical and rehabilitation expenses.

The Applicant was injured while operating a stock car during a race and applied for statutory accident benefits.

The Insurer denied the claim, arguing that a stock car is not an 'automobile' under the Schedule.

The Arbitrator found that the stock car qualifies as an automobile under the broad definition in section 1 of the Insurance Act, as it is a self-propelled vehicle not specifically excluded.

The Applicant was therefore injured in an 'accident' and is entitled to proceed with his claim for benefits.

The appellant, a self-employed house painter, appealed an arbitration decision terminating his weekly income benefits and ordering repayment of interim benefits.

He sought to introduce a new medical report on appeal to address the arbitrator's concerns about his chronic pain syndrome diagnosis.

The Director's Delegate refused to admit the new evidence, finding it would not have affected the result.

The Delegate upheld the arbitrator's conclusion that the appellant was substantially able to perform the essential tasks of his occupation, noting that job flexibility is an appropriate consideration for self-employed individuals.

The Delegate also affirmed the arbitrator's reliance on the mediator's report over the appellant's testimony regarding an alleged agreement to pay benefits during rehabilitation.

The appeal was dismissed, but the appellant was awarded his reasonable appeal expenses due to the merit of the issues raised.

The applicant's stepfather, a police officer, took time off work using his accumulated sick bank time to visit the applicant, who was severely injured in a motor vehicle accident.

He applied for visitor's expenses under section 53(1) of the Statutory Accident Benefits Schedule for the value of the lost sick bank time.

The arbitrator held that the stepfather was not entitled to visitor's expenses because the use of sick bank time did not constitute an expense 'actually incurred' under the Schedule, but rather a potential future loss.

Furthermore, recovery was barred by section 75(13) as the sick bank was part of a plan available to the officer.

The applicant, a tailor, was involved in multiple motor vehicle accidents and sought statutory accident benefits from two insurers.

The insurers terminated or refused weekly income benefits, arguing the applicant was not substantially unable to perform the essential tasks of his employment.

The arbitrator found that the applicant exaggerated his symptoms and that surveillance evidence contradicted his claims of severe disability.

The arbitrator concluded the applicant failed to prove a substantial inability to perform his essential tasks and dismissed the claims for weekly income benefits, though expenses were awarded to the applicant.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them, arguing her continuing kidney problems were due to pre-existing conditions.

The applicant claimed the accident caused severe trauma to her kidney, embedding a stone that led to chronic infections.

The arbitrator preferred the insurer's expert medical evidence, finding that the applicant's ongoing kidney issues and infections were a spontaneous recurrence of her extensive pre-existing kidney stone condition, not caused by the accident.

The applications for weekly income benefits and supplementary medical and rehabilitation expenses were dismissed, though the applicant was awarded her hearing expenses.

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

The appellant argued he was self-employed at the time of the accident or, alternatively, that his occupational tasks should be considered under the 'benefits if no income' test.

The Director's Delegate upheld the arbitrator's findings that the appellant had not resumed his self-employment at the time of the accident and that his previous occupational tasks were properly excluded from his normal tasks given the length of time since he last worked.

The appeal was dismissed.

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

He sought a declaration at arbitration regarding his entitlement to payment for expenses incurred by his rehabilitation case manager for communicating with his solicitors, despite all accounts having been paid in full by the insurer.

The insurer objected on the basis that there was no substantive dispute.

The arbitrator dismissed the application, finding that an arbitrator has no jurisdiction under the Insurance Act to make pronouncements or issue guidelines in the absence of a specific dispute over entitlement or quantum of benefits.

The Arbitrator issued a decision correction to adjust the fees and disbursements payable to the applicant from a previous decision.

An omission of hearing attendance fees for senior counsel was corrected, adjusting the total fees and disbursements payable to $7,377.16.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The parties disputed the quantum of weekly income benefits for her self-employment and her entitlement to payment for housekeeping services provided by a relative and her children.

The arbitrator awarded partial payment for the relative's housekeeping services but denied the claim for the children's services.

The arbitrator also determined the appropriate calculation for the Applicant's weekly income benefits, awarding $15,029.19, plus interest on overdue payments, but denied a special award.

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

The applicant sought arbitration for ongoing weekly income benefits and supplementary medical benefits.

The arbitrator found the applicant's evidence regarding his pre-accident employment and income to be unreliable and contradictory, concluding he was only entitled to the minimum weekly benefit of $185.60, which had already been paid.

The arbitrator dismissed the claim for ongoing weekly benefits, finding insufficient medical evidence of a continuing disability that would prevent the applicant from working as a handyman.

The applicant was awarded $537.64 for certain supplementary medical and rehabilitation expenses, along with arbitration filing fees.

The applicant was injured in a motor vehicle accident and claimed accident benefits from the insurer.

The parties attended mediation and signed a settlement agreement.

The applicant later applied for arbitration, arguing the settlement was invalid due to a language barrier, lack of education, and emotional problems (non est factum).

The arbitrator found the applicant understood the mediation process, as the mediator translated discussions and documents, and the applicant had prior business experience.

The arbitrator concluded the claims were validly settled and dismissed the application for arbitration.

The arbitrator declined to award expenses to the applicant and declined to order an award against the applicant for a frivolous proceeding.

In an assessment of expenses following an arbitration where the applicant was unsuccessful, the arbitrator determined the appropriate quantum of costs payable by the insurer.

The arbitrator ruled that the applicant's former counsel had standing to represent her at the assessment, as any expenses awarded were subject to a court order requiring payment into court.

The arbitrator held that while the Legal Aid Tariff sets maximum hourly rates, arbitrators may also consider Tariff A under the Rules of Civil Procedure when assessing the reasonableness of hours claimed.

The applicant was awarded $6,288.40 in fees and disbursements, including reduced allowances for expert medical reports.

The appellant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, claiming he had returned to work.

An arbitrator found the appellant was able to perform his essential tasks and ordered him to repay $26,125.36 in overpaid benefits.

On appeal, the Director's Delegate upheld the arbitrator's decision, finding no error in the credibility assessment or the conclusion that the appellant's post-accident business income demonstrated a return to work.

The appeal was dismissed with no expenses payable.

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

The applicant sought arbitration, arguing that the benefits were terminated prematurely and that she met the post-156 week eligibility test.

The arbitrator held that the 156-week period in section 12(5)(b) of the Statutory Accident Benefits Schedule refers to 156 weeks of disability, meaning the benefits were not terminated prematurely.

Furthermore, the arbitrator found that the applicant was capable of returning to full-time employment with restrictions and had not made a bona fide effort to find suitable employment.

The application for ongoing weekly income benefits was dismissed.

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

The insurer terminated his weekly income benefits after 156 weeks.

The applicant applied for arbitration, arguing he remained continuously prevented from engaging in any occupation for which he was reasonably suited by education, training, or experience.

The arbitrator found that the applicant's physical restrictions prevented him from returning to his pre-accident work as an automotive mechanic or his previous work as a long-distance truck driver.

The arbitrator concluded the applicant was entitled to ongoing weekly income benefits and arbitration expenses.

The appellant was injured in a motor vehicle accident and received weekly income benefits until the respondent terminated them.

An arbitrator found that while the appellant suffered from accident-related pain, he was not substantially unable to perform the essential tasks of his employment as a machinist.

The appellant appealed, arguing the arbitrator misapprehended the medical and surveillance evidence, misapplied the test under section 12 of the Statutory Accident Benefits Schedule, and that the hearing was unfair because he was unrepresented.

The Director of Arbitrations dismissed the appeal, finding the arbitrator's factual conclusions were supported by the evidence, the correct legal test was applied, and the arbitration process was fair.

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

The insurer terminated benefits, and the applicant sought arbitration to reinstate them under section 12(5)(b) of the Statutory Accident Benefits Schedule, claiming he was continuously prevented from engaging in any suitable occupation.

The arbitrator dismissed the application, finding the applicant's evidence regarding his post-accident employment and level of disability to be unreliable and not credible.

This finding was supported by surveillance video showing the applicant at his former workplace and medical evidence suggesting symptom magnification and voluntary simulation.

The applicant's claim for arbitration expenses was also denied due to his lack of credibility.

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

The applicant applied for arbitration, claiming ongoing weekly income benefits, a special award, interest, and expenses.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of her employment as a seamstress due to a herniated disc caused by the accident.

The arbitrator preferred the evidence of the applicant's treating orthopaedic surgeon over the insurer's medical experts.

The applicant was awarded ongoing weekly income benefits, interest, and expenses, but the claim for a special award was dismissed as the insurer's termination of benefits was not unreasonable.