Neutral Citation: 1997 ONICDRG 1
OIC A-012159
ONTARIO INSURANCE COMMISSION
BETWEEN:
GEORGE SEMAAN
Applicant
and
ROYAL INSURANCE COMPANY OF CANADA
Insurer
DECISION
Issues:
The Applicant, George Semaan, was injured in a motor vehicle accident on May 30, 1993. He applied for and received statutory accident benefits from Royal Insurance Company of Canada ("Royal"), payable under Ontario Regulation 672.1 Weekly income benefits were terminated by Royal on June 15, 1994. As a result of mediation conducted through the offices of the Ontario Insurance Commission, weekly income benefits were reinstated and paid until July 25, 1994, at which point they were again terminated by the Insurer. Thereafter the parties were unable to resolve their disputes and Mr. Semaan applied for arbitration under the Insurance Act, R.S.O. 1990, c.I.8, as amended.
The issues in this hearing are:
Is the Applicant entitled to ongoing weekly income benefits, beyond July 25, 1994?
What is the proper amount of the weekly income benefit?
In the event that the quantum of the weekly income benefit is less than $600 per week, is the Insurer entitled to repayment of any of the weekly benefits paid to the Applicant?
Mr. Semaan also claims interest on any amounts owing, and his expenses incurred in the hearing.
A preliminary question concerning whether the disputes between the Applicant and the Insurer had been settled, was abandoned by the Insurer at the commencement of the hearing.
Result:
The Applicant is not entitled to further weekly benefits.
The proper amount of the benefit is $600 per week.
The Insurer's claim for a repayment is dismissed.
The Applicant is entitled to his expenses of the Arbitration.
Hearing:
The hearing was held in Ottawa, Ontario, on April 1, 2 and 3, 1996.
Present at the Hearing:
Applicant:
George Semaan
Royal's Representative:
Vance H. Cooper
Barrister and Solicitor
Royal's Officer:
Lorraine Leblond
Counsel for Susan Withey:
Mark Quinn Student-at-Law
Arbitrator:
Stewart M. McMahon
Witnesses:
Mr. George Semaan, Ms. Lorraine Leblond, and Ms. Susan Withey
Exhibits:
Thirty eight (38) exhibits were filed. They are listed in Schedule "A" to these reasons. In addition, a brief of documents was filed by the Insurer. Only those tabs within the brief specifically referred to by witnesses or counsel were considered by me in my reasons. Those tabs are as follows: 1, 2, 3, 4, 7, 10, 11, 12, 13, 14, 15, 17, 18, 19, 21, 22, and 23.
Evidence and Findings:
Background:
Mr. Semaan came to Canada from Lebanon in the mid-seventies. He remained for a couple of years and then returned to Lebanon. Late in 1989, Mr. Semaan returned to Canada. He applied for and received social assistance. He has remained on social assistance since that time. Towards the end of 1990, Mr. Semaan and his brother attempted to start up a business named Video 99. The business supplied videotaping services for weddings and parties, and converted other medium to videotape. The business soon folded when Mr. Semaan's brother declared bankruptcy. Sometime in or around the spring of 1992, Mr. Semaan entered into a business relationship with Francois Saikeley. Like the first business, this venture provided videotaping services. It is unclear whether Mr. Semaan and Mr. Saikeley were to be partners, or whether Mr. Semaan was to work for Mr. Saikeley. In any event, the relationship did not work out and Mr. Saikeley locked Mr. Semaan out of the shop.
Approximately six to eight weeks before the motor vehicle accident, Mr. Semaan began working for Al Moustakbal, a Lebanese community newspaper. Mr. Semaan was expected to attend local social events of interest to the Lebanese community, to report on them and provide still photos. He was also responsible for organizing parties to be hosted by the paper, soliciting advertising, and delivering the paper to various stores. Mr. Semaan was paid on a commission basis.
At about the same time Mr. Semaan began to advertise that he was available to videotape weddings and other social events. Mr. Semaan claims that he videotaped four events over the four weeks preceeding the accident.
On May 30, 1993, while travelling from a church to a reception hall, Mr. Semaan was involved in a motor vehicle accident. While Mr. Semaan was riding in the front passenger's seat, the vehicle was involved in a multi-vehicle accident at an intersection. Mr. Semaan testified that he received a blow to the side of his head, and both his legs were bruised, as were his left shoulder and ribs. He was taken to a local hospital, examined, X-rayed and discharged later that night, with instructions to his wife to wake him every couple of hours.
Mr. Semaan visited a walk-in clinic a couple of days later complaining of dizziness and nausea. A brain scan was conducted which revealed that there was no intercranial bleeding. Mr. Semaan has told various practitioners that he thinks he sustained a small skull fracture. A review of the medical reports filed at the hearing fails to support this belief. The reports do confirm that he suffered from a mild post concussive-disorder that included headaches, dizziness, nausea, photophobia, and some cognitive deficits.
Mr. Semaan visited Dr. Bhatia, his brother's family physician, about a week after the accident, and has been under his care since that time. Dr. Bhatia referred Mr. Semaan for a course of physiotherapy that lasted through the summer. Because of the persistence of the post-concussive symptoms, he referred Mr. Semaan to Dr. McIlraith, a neurologist. Dr. McIlraith confirmed the diagnosis of post- concussive syndrome,