OFSCDRS 1998

The applicants sought statutory accident benefits, alleging they were injured when their vehicle was rear-ended.

The insurer denied the claim on the basis that the accident was staged.

At the arbitration hearing on the preliminary issue of whether an accident occurred, the arbitrator accepted expert engineering evidence that the vehicle damage was inconsistent with a rear-end collision.

The arbitrator also found the applicant's testimony lacked credibility due to multiple contradictory statements in previous insurance claims.

The arbitrator concluded the applicants were not injured in the described accident and ordered the applicant to pay $2,000 in expenses for abuse of process.

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

The insurer terminated his income replacement benefits, arguing he was not substantially disabled from his employment as a wallpaper hanger.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of his employment due to chronic pain, severe headaches, and psychological difficulties resulting from the accident.

The arbitrator ordered the insurer to pay ongoing income replacement benefits, certain supplementary medical expenses, and a special award of $2,500 for unreasonably terminating benefits without a proper assessment.

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

The applicant sought reinstatement of benefits and payment for supplementary medical expenses related to dental services and nutritional counselling for swallowing difficulties.

The arbitrator found that the applicant remained substantially unable to perform the essential tasks of her pre-accident employment as a cook due to chronic pain and stress-induced swallowing difficulties.

The arbitrator also found a probable causal connection between the accident and the need for dental and nutritional treatments, ordering the insurer to pay the claimed expenses and reinstate the weekly benefits.

The applicant was struck by a tow-truck after a motor vehicle accident and claimed statutory accident benefits.

The insurer terminated his weekly income replacement benefits in September 1995.

The applicant applied for arbitration, arguing he remained substantially disabled from his pre-accident employment as a gas station attendant due to physical and psychological injuries.

The arbitrator found that while the applicant was not physically disabled from working, he required psychological treatment to facilitate his return to the workplace.

The arbitrator concluded the applicant remained substantially disabled until his psychotherapy sessions concluded in March 1996, after which any residual restrictions were self-imposed or could be accommodated.

The applicant was awarded income replacement benefits for the closed period from September 1995 to March 1996.

The applicant sought statutory accident benefits following a February 1992 motor vehicle accident.

The insurer argued the arbitration was barred because the applicant had previously settled the claims and missed the two-year limitation period after benefits were refused.

The arbitrator found that the prior settlement release did not explicitly include the February 1992 accident.

Furthermore, the insurer's notice of refusal was not clear and unequivocal, meaning the limitation period had not expired.

The applicant was permitted to proceed to arbitration.

The Applicant was injured in two motor vehicle accidents in May 1994 and received other disability benefits for 104 weeks.

She applied for ongoing benefits beyond the 104-week mark, which requires a complete inability to carry on a normal life.

The Arbitrator found that while the Applicant's life had changed, she retained a number of abilities and was not continuously prevented from engaging in substantially all of her pre-accident activities.

The claim for ongoing benefits and a special award was dismissed.

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

After his benefits were terminated, he applied for arbitration but failed to appear at the scheduled hearing.

The arbitrator dismissed the application due to the applicant's failure to prove his case.

The insurer requested reimbursement of the $2,000 assessment fee under subsection 282(11.2) of the Insurance Act, arguing the application was frivolous, vexatious, or an abuse of process.

The arbitrator denied the request, finding that the applicant's failure to appear did not automatically render the application entirely devoid of merit or an abuse of process.

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

The insurer terminated weekly income replacement benefits, and the applicant requested a Designated Assessment Centre (DAC) assessment.

The applicant later cancelled the assessment with insufficient notice, incurring a cancellation fee, and applied for mediation and arbitration.

The arbitrator held that the applicant failed to establish a bona fide change of mind regarding his election to proceed by way of a DAC assessment.

Consequently, the applicant is precluded from proceeding to mediation and arbitration until he completes the requested DAC assessment.

The applicant was struck by a motor vehicle as a pedestrian and claimed statutory accident benefits for an orthopaedic mattress, motorized wheelchair, attendant care, and housekeeping expenses.

The insurer terminated benefits, arguing the applicant's ongoing symptoms were due to a pre-existing dependent personality and inactivity rather than the accident.

The arbitrator found the applicant suffered from reflex sympathetic dystrophy (RSD) triggered by the accident.

The arbitrator awarded the wheelchair rental cost and ongoing attendant care and housekeeping benefits at a reduced rate (50%), reflecting the applicant's pre-existing reliance on his family, but denied the claim for an orthopaedic mattress.

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

The insurer terminated these benefits after 121 weeks, having offered a zero loss of earning capacity (LEC) benefit which the applicant was deemed to have rejected.

The applicant sought ongoing income replacement benefits pending the resolution of the LEC dispute.

The arbitrator held that under section 23 of the Statutory Accident Benefits Schedule, the insurer is required to continue paying income replacement benefits unless and until it elects to pay an LEC benefit based on its offer and the residual earning capacity assessment.

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

The parties disputed the calculation of income replacement benefits, loss of earning capacity benefits, and attendant care benefits.

The arbitrator found that the applicant, a seasonal truck driver, was entitled to extrapolate his income under section 9(7) of the Schedule because he was on a layoff from employment during the winter months.

The arbitrator also determined the applicant's pre-accident earning capacity based on a vocational evaluation, awarded additional attendant care benefits, and granted a 25% special award against the insurer for unreasonably reducing the attendant care benefits without a proper basis.

The applicant was injured in a motorcycle accident, sustaining a severe closed-head injury and spinal fractures.

He applied for statutory accident benefits, including education disability benefits (EDBs).

The insurer terminated his weekly EDBs and paid one lump sum EDB.

The arbitrator found that the applicant was entitled to a further lump sum EDB for the January 1996 semester because he was unable to successfully complete it as a result of the accident.

The arbitrator also found that the applicant was entitled to weekly EDBs from March 1996 to August 1997 because he suffered a substantial inability to continue his education and a partial inability to carry on a normal life, specifically regarding mobility and cognitive activities.

The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits and supplementary medical benefits for prescriptions after the insurer terminated them.

The arbitrator found that the applicant was not physically disabled from returning to her pre-accident employment as a hairstyling instructor.

However, the arbitrator concluded that the applicant suffered from accident-related panic attacks that substantially disabled her from working during an acute phase between December 1996 and August 1997.

Income replacement benefits were awarded for this limited period.

The arbitrator also awarded the cost of most claimed prescriptions, finding them reasonable and necessary for treating her accident-related psychological condition.

The applicant was injured while a passenger on a bus and received statutory accident benefits.

The insurer terminated weekly income benefits and supplementary medical benefits in 1995.

The applicant sought reinstatement of weekly income benefits, and the insurer sought repayment of medical benefits paid for psychological treatment.

The arbitrator found that the applicant was physically and psychologically capable of returning to work by April 1995, dismissing the claim for ongoing weekly income benefits.

The arbitrator also dismissed the insurer's claim for repayment, finding the psychological treatment received prior to termination was reasonable and beneficial.

The applicant was involved in a road rage incident where another driver aggressively tailgated him.

The applicant pulled over to calm the other driver, but an altercation ensued, resulting in the applicant fracturing his leg.

The insurer denied statutory accident benefits, arguing the injury did not arise from the use or operation of an automobile.

The arbitrator found that the use of the vehicles was the originating cause of the sequence of events and that the applicant was injured in an 'accident' within the meaning of the Schedule.

The applicant sought her expenses for an arbitration hearing regarding a claim for physiotherapy expenses, which had been dismissed.

The arbitrator denied the applicant's request for expenses, finding that her claim was unmeritorious, misguided, and that her conduct during the hearing, including a baseless bias application, unreasonably prolonged the proceedings.

However, the arbitrator ordered the insurer to pay $1,000 in expenses due to its failure to produce documents in a timely fashion.

The respondent was seriously injured when a bomb placed under the driver's seat of his parked vehicle exploded as he prepared to start it.

He applied for statutory accident benefits, and an arbitrator initially ruled the incident was an 'accident' under the Statutory Accident Benefits Schedule, applying the Supreme Court's reasoning in Amos.

On appeal, the Director's Delegate rescinded the arbitration order, finding that the Ontario legislation's 'caused by' wording is narrower than the 'arising from' wording in Amos.

The Delegate concluded that the respondent's injuries were caused by the independent act of the bomber using the vehicle as a location to hide the bomb, rather than by the ordinary use or operation of the automobile.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to weekly income benefits and rehabilitation expenses.

The insurer terminated benefits and sought repayment, alleging the applicant was not employed at the time of the accident and misrepresented his condition.

The arbitrator found the applicant lacked credibility, having concealed a pre-existing work-related knee injury and a prior severe head injury from both the insurer and medical assessors.

The arbitrator concluded the applicant was not employed at the time of the accident and did not suffer an ongoing disability caused by the accident.

The applicant's claims were dismissed, and the insurer was granted repayment of the weekly income benefits paid, as they were induced by the applicant's culpable error and failed to account for deductible workers' compensation benefits.

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

The insurer terminated his income replacement benefits (IRBs) based on a Designated Assessment Centre report.

The applicant sought IRBs for the period before he returned to work, for days missed after returning to work, and reimbursement for chiropractic expenses.

The arbitrator found the applicant was not entitled to IRBs for the period before returning to work, but was entitled to five days of IRBs for days missed after returning.

The arbitrator also ordered the insurer to recalculate the IRB amount and pay for chiropractic treatments incurred before a subsequent DAC assessment.

A special award of 30% was granted against the insurer for unreasonably withholding payment of the chiropractic expenses.

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

The applicant sought arbitration for ongoing income replacement benefits, supplementary medical benefits for physiotherapy, and a determination on the availability of collateral long-term disability benefits.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of her employment due to chronic pain and depression caused by the accident.

The arbitrator awarded ongoing income replacement benefits, partially granted the claim for physiotherapy expenses, and found that long-term disability benefits were not available to reduce the weekly benefits.