Statutory Accident Benefits Schedule matters (SABS) - OFSCDRS

The Applicant was injured in a motor vehicle accident while riding his motorcycle and sought statutory accident benefits.

The Insurer terminated his weekly disability benefits, prompting the Applicant to apply for arbitration.

The Applicant claimed he was employed "under the table" at the time of the accident and thus qualified for income benefits under section 12 of the Schedule.

The Arbitrator found the Applicant's evidence regarding his employment lacked credibility and concluded he was not employed at the time of the accident.

Furthermore, the Arbitrator determined the Applicant was not entitled to non-earner benefits under section 13, as he was able to perform the bulk of his pre-accident activities of daily living.

The application was dismissed, and the Applicant was denied his arbitration expenses due to the lack of merit in his case.

The applicant was injured in a motor vehicle accident while a passenger on a bus and received weekly income benefits.

She returned to work but later resigned, claiming an inability to perform her essential tasks due to accident-related injuries.

The arbitrator found that the applicant did not suffer a substantial inability to perform the essential tasks of her employment and denied ongoing benefits.

The arbitrator also ordered the applicant to repay benefits received while she was working, as she failed to disclose her return to work.

The insurer's request for a special award for a frivolous application was denied, and the applicant was awarded her arbitration expenses.

The appellant appealed an arbitrator's decision that her application for arbitration was barred by the two-year limitation period under s. 281(5) of the Insurance Act.

The appellant argued that the insurer's conduct estopped it from relying on the limitation period and that the notice of termination was insufficient.

The Director of Arbitrations dismissed the appeal, finding no error in the arbitrator's conclusion that the appellant and her counsel were aware of the termination date and that the insurer's conduct did not induce them to believe the limitation period would not be relied upon.

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

The insurer refused to pay for chiropractic treatments after July 30, 1993, arguing they were no longer reasonable or necessary.

The arbitrator found that the ongoing chiropractic care constituted therapeutically necessary supportive care rather than elective maintenance care, given the physical demands of the applicant's work.

The arbitrator also ruled that while the insurer had no statutory right to require a medical examination for a claim involving only medical and rehabilitation benefits, the resulting medical report was admissible because the applicant attended voluntarily.

The insurer was ordered to pay the outstanding chiropractic and transportation expenses, plus the costs of the arbitration.

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

She applied for ongoing benefits, claiming she was substantially unable to perform her essential tasks as a homemaker due to a knee injury.

The arbitrator dismissed the claim for ongoing benefits, finding that the medical evidence, surveillance video showing her performing tasks without apparent discomfort, and her history of non-compliance with treatment indicated she was no longer substantially disabled.

The claim for a special award was also dismissed, but the applicant was awarded her arbitration expenses.

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

The Insurer denied the claim, alleging the Applicant knowingly misrepresented his driving history on his insurance application by failing to disclose a prior licence suspension.

The arbitrator found that the Applicant had received notice of his licence suspension and knowingly misrepresented his driving history.

The misrepresentation was material, as the Insurer would have charged a higher premium had it known the truth.

The Applicant was precluded from receiving benefits and denied his arbitration expenses.

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

The Insurer terminated weekly income benefits, arguing she was no longer substantially unable to perform her essential tasks.

The Applicant sought ongoing benefits and a special award.

The arbitrator found the Applicant was entitled to weekly income benefits for a limited period following the termination, as her ongoing disabilities after that period were attributable to pre-existing medical conditions and subsequent slip and fall accidents, not the motor vehicle accident.

The claim for a special award was dismissed as the Insurer did not unreasonably withhold payments.

The Applicant was injured in a motor vehicle accident and claimed expenses for a Health Care Aide to assist her at home, arguing these were 'nursing services' under section 6(1)(a) of the Statutory Accident Benefits Schedule, which has no monthly limit.

The Insurer argued the services were 'care' benefits under section 7, subject to a $3,000 monthly limit.

The Arbitrator held that the services provided by the Health Care Aide were best described as 'care' rather than 'nursing services,' as they were primarily focused on assisting with daily tasks rather than active treatment or rehabilitation.

Therefore, the benefits were limited to $3,000 per month under section 7.

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

The parties attended mediation and the Insurer paid $750, which it claimed was a full and final settlement of all past and future weekly income benefits.

The Applicant argued the settlement only covered benefits up to the date of mediation.

On a preliminary issue hearing, the Arbitrator found that the mediator's report was ambiguous and there was no clear agreement or release extinguishing the Applicant's right to future benefits.

The Arbitrator concluded there was no meeting of the minds regarding the scope of the settlement, and allowed the Applicant to proceed to arbitration for ongoing benefits.

The applicant was injured in a motor vehicle accident and received statutory accident benefits, including weekly income benefits, which the insurer terminated on the basis that she was no longer substantially unable to perform the essential tasks of her pre-accident employment as a dental assistant.

The insurer relied on surveillance evidence and an independent medical examination suggesting she could return to work.

The arbitrator preferred the evidence of the applicant's treating professionals, finding that she remained unable to perform the specific, sustained physical tasks required of a dental assistant.

The applicant was awarded ongoing weekly income benefits, outstanding housekeeping expenses, and arbitration expenses.

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

The Insurer disputed his entitlement to weekly income benefits for a specific week, the amount claimed for lost income while attending physiotherapy, and his entitlement to chiropractic treatment.

The Arbitrator held that subsection 16(2) of the Schedule precluded the Applicant from receiving weekly income benefits for the week in question because he had returned to work for more than 90 days after the two-year anniversary of the accident.

The Arbitrator found the time claimed for physiotherapy attendance was reasonable, except for the week he was not working, but declined to order repayment.

The claim for chiropractic treatment was denied due to insufficient medical evidence.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and claimed statutory accident benefits.

A dispute arose regarding the calculation of her pre-accident gross weekly income, as she operated on a cash basis and did not file tax returns.

The arbitrator found that the applicant's uncorroborated testimony and self-created trip sheets for only one week were insufficient to prove an income higher than the deemed minimum.

Consequently, her weekly income benefits were set at the minimum of $185.60.

The insurer's claim for repayment of benefits previously paid at a higher rate was dismissed, as the insurer failed to prove the payments were made through error or fraud.

The Applicant was injured when struck by a car while riding her bicycle.

The Insurer paid weekly income benefits but terminated them, arguing the Applicant failed to mitigate her damages by finding alternative part-time employment.

The Arbitrator found the Applicant had not acted inappropriately, given her significant job barriers, physical limitations, and ongoing education and physiotherapy.

The Arbitrator ordered the Insurer to pay ongoing weekly income benefits and awarded a $2,500 special award because the Insurer unreasonably withheld benefits.

The Applicant's husband died in a motor vehicle accident.

At the time, the family was receiving general welfare assistance, with the husband designated as the head of the household and receiving the cheques.

The Insurer denied the Applicant's claim for a $10,000 death benefit under section 11(1)(c) of the Statutory Accident Benefits Schedule, arguing she was principally dependent on welfare, not her husband.

The Arbitrator found that because the welfare payments were structured such that the Applicant had no independent access to the funds and relied on her husband to administer them, she was principally dependent for financial support on her late husband.

The Applicant was awarded the $10,000 death benefit.

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

The insurer terminated benefits based on surveillance evidence showing the applicant working at a doughnut shop and a supermarket.

The applicant sought arbitration for ongoing benefits and a higher weekly rate based on alleged pre-accident income.

The arbitrator dismissed the applicant's claims, finding his evidence and financial documents lacked credibility.

The arbitrator ordered the applicant to repay an overpayment of $2,243.96 to the insurer and denied the applicant's request for expenses.

The applicant, a self-employed carpenter, was injured in a motor vehicle accident and applied for statutory accident benefits.

The parties disputed the calculation of his weekly income benefits.

The applicant argued his income should be based on the four weeks preceding the accident, utilizing a 'work-in-progress' accounting method for an unfinished renovation contract.

The arbitrator rejected this method because the partnership was not paid in full for the work and ultimately suffered a loss.

The applicant failed to establish his income exceeded the deemed statutory minimum.

The arbitrator ordered the insurer to pay the minimum weekly income benefit of $185.60, plus the applicant's arbitration expenses.

The applicant, a self-employed gas station owner, was injured in a motor vehicle accident and claimed statutory accident benefits.

The insurer terminated his weekly income benefits on January 3, 1991.

The applicant sought reimbursement for expenses incurred in hiring replacement workers to run his business while he was disabled, as well as ongoing weekly income benefits.

The arbitrator held that the cost of replacement labour is a business expense and cannot be claimed as a rehabilitation expense under section 6(1)(f) of the Schedule, nor under section 12.

However, the arbitrator found that the applicant was substantially disabled from performing his essential tasks until February 1, 1991, and ordered the insurer to pay weekly income benefits of $211.98 until that date, plus interest and arbitration expenses.

The applicant was injured in a rear-end motor vehicle accident and claimed weekly income benefits, alleging a substantial inability to perform her essential tasks in her family-run tile business.

The insurer denied the benefits.

At arbitration, surveillance evidence contradicted the applicant's testimony regarding her physical limitations and work attendance.

The arbitrator found the applicant's evidence unreliable and concluded she failed to prove a substantial inability to perform her essential job tasks.

The claim for weekly benefits was dismissed, but the applicant was awarded her expenses of the arbitration.

The applicants, two young children severely injured in a motor vehicle accident, applied for statutory accident benefits.

A priority dispute arose between the father's former insurer and the insurer of the vehicle involved in the accident.

The father's former insurer claimed it had cancelled his policy for non-payment of premiums prior to the accident by sending a notice via registered mail.

The vehicle's insurer argued the cancellation was invalid because the notice was never received.

The arbitrator found that the former insurer had validly terminated the policy in accordance with the statutory requirements, as the notice was received at the destination post office in time to provide the required 15 days' notice.

Consequently, the vehicle's insurer was held responsible for paying the statutory accident benefits.

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

The applicant sought arbitration to reinstate the benefits, claiming a substantial inability to perform essential tasks.

The arbitrator reviewed conflicting medical evidence and preferred the functional abilities evaluation of an occupational therapist, which demonstrated the applicant could perform his essential daily tasks.

The claim for ongoing weekly benefits was dismissed, though the applicant was awarded the expenses of the arbitration.