OFSCDRS 1997

The appellants appealed an arbitration decision that denied their claims for additional accident benefits, ordered them to repay specified amounts to the insurer, and denied their arbitration expenses.

The arbitrator had found the appellants to be unreliable witnesses and concluded they failed to establish their entitlement to benefits.

On appeal, the Director's Delegate dismissed the appeal, finding ample evidence to support the arbitrator's findings and noting that the appeal improperly sought to second-guess the arbitrator's assessment of the evidence.

Requests for appeal expenses and the insurer's assessment fee were also denied.

The applicant was injured in a motor vehicle accident in December 1991 and received weekly income benefits until May 1992, when he returned to work and the insurer terminated benefits.

In February 1995, after injuring his back at work, the applicant sought reinstatement of benefits, which the insurer refused on the basis of the two-year limitation period.

The arbitrator held that the applicant was precluded from proceeding to arbitration under section 281(5) of the Insurance Act and section 26(1) of the Statutory Accident Benefits Schedule, as the application was commenced more than two years after the insurer's clear refusal to pay benefits in June 1992.

The arbitrator found that the applicant's return to work after the termination of benefits did not suspend the limitation period.

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

The insurer terminated the weekly income benefits, arguing the applicant was no longer substantially unable to perform the essential tasks of his pre-accident employment as a videographer and newspaper worker.

The applicant applied for arbitration to reinstate the benefits and determine the proper quantum.

The arbitrator found that the applicant failed to prove a substantial inability to perform his essential tasks beyond the termination date, dismissing the claim for ongoing benefits.

However, the arbitrator determined the proper quantum of the weekly benefit was the maximum $600 per week, and therefore dismissed the insurer's claim for repayment of alleged overpayments.