Pamela M. Stevens

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

The insurer terminated the benefits in 2005.

The appellant argued that the benefits had automatically converted to loss of earning capacity benefits, which are lifetime benefits subject only to mandatory reviews.

The arbitrator found that the benefits remained income replacement benefits because the formal process for conversion, including a residual earning capacity assessment or a written agreement, had not occurred.

The Director's Delegate dismissed the appeal, finding no error of law in the arbitrator's interpretation of the evidence and the statutory scheme.

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

The insurer terminated benefits in November 2005.

The parties disputed whether the benefits paid from March 1997 to November 2005 were Income Replacement Benefits (IRBs) or Loss of Earning Capacity Benefits (LECBs).

The arbitrator found that the benefits were IRBs, as the insurer never properly converted the IRBs to LECBs under the Statutory Accident Benefits Schedule.

The insurer's continued payment of weekly benefits after an LECB offer was rejected did not constitute an agreement to convert the benefits.

Following a preliminary issue hearing where the applicant was entirely successful, the parties disputed the quantum of expenses.

The applicant claimed $16,914.37 based on preparation for a five-day hearing that was ultimately resolved in a half-day preliminary hearing.

The arbitrator found that while the issues were complex and required significant preparation, it was appropriate to reduce the claimed fees by 50% to reflect the shortened hearing time.

The insurer was ordered to pay expenses fixed at $6,887.08.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After failing to attend three scheduled pre-hearing conferences and losing contact with his own legal representative, the insurer requested that the application be dismissed as frivolous and vexatious.

The arbitrator found that the applicant was no longer interested in pursuing the matter and dismissed the application.

The insurer was awarded its expenses for the arbitration, fixed at $500.00.

The applicant, who suffered a severe brain injury as a pedestrian at age 7, sought education disability benefits (EDBs) and a Loss of Earning Capacity Benefits (LECBs) offer upon turning 16.

The insurer paid EDBs for over 104 weeks but later disputed entitlement to both EDBs and a LECBs offer.

The arbitrator held that by paying EDBs beyond the 104-week mark without invoking the stoppage provisions, the insurer conceded the applicant's qualification for EDBs and is precluded from disputing it.

The insurer was ordered to deliver a LECBs offer forthwith.

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

The applicant applied for arbitration, claiming a complete inability to engage in any employment due to intractable chronic pain resulting from the accident.

The arbitrator found the applicant and his expert witnesses credible, noting that the applicant had exhausted conventional medical treatments and required an intrathecal pain pump.

The arbitrator rejected the insurer's arguments that the applicant was merely 'de-conditioned' or drug-seeking, finding that the insurer had stereotyped the applicant.

The arbitrator concluded that the applicant suffered a complete inability to engage in any suitable employment and ordered the insurer to pay ongoing income replacement benefits and interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including loss of earning capacity benefits, attendant care, and housekeeping.

The insurer terminated benefits based on a DAC report that relied on surveillance video to conclude the applicant was not disabled.

The arbitrator rejected the insurer's argument that the applicant was malingering, accepting expert evidence that she suffered a traumatic brain injury resulting in severe major depression.

The arbitrator found the applicant was substantially unable to perform the essential tasks of her employment and awarded the claimed benefits, along with interest and arbitration expenses.

The Applicant sought statutory accident benefits following a motor vehicle accident.

The Insurer terminated benefits, initially alleging the Applicant was charged with a criminal offence, and later alleging he was not a passenger in the vehicle.

The Insurer also scheduled multiple insurer's examinations which the Applicant did not attend.

On preliminary issues, the Arbitrator found credible evidence that the Applicant was a passenger in the vehicle.

The Arbitrator also held that the Applicant was not precluded from proceeding to arbitration, as the insurer's examinations were not reasonably necessary given the lack of corresponding benefit claims and the Insurer's unjustified adversarial conduct.

The insurer requested a preliminary issue hearing to determine whether the insured was precluded from proceeding to arbitration due to her refusal to attend a psychiatric examination scheduled by the insurer.

The arbitrator found that the insurer had ample notice of the insured's psychological symptoms but waited until after the pre-hearing to schedule the examination.

The arbitrator concluded the request was a tactical maneuver to bolster the insurer's case rather than for adjusting purposes.

The insurer's request was deemed unreasonable, and the insured was permitted to proceed to the arbitration hearing.

The appellant insured was sued for defamation after posting messages on an internet message board.

He sought a declaration that his homeowner's liability insurer had a duty to defend him in the action.

The insurer denied coverage based on an exclusion for bodily injury or property damage caused by an intentional act.

The application judge dismissed the application, finding the exclusion applied.

The Court of Appeal dismissed the appeal, holding that the pleadings in the defamation action, which alleged intentional and malicious conduct, fell squarely within the intentional act exclusion, as the insured's intent to publish the statements necessarily involved an intent to injure the plaintiffs' reputation.

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

The arbitrator found that the applicant, a coffee truck operator who suffered a severe shoulder injury requiring multiple surgeries, remained substantially unable to perform the essential tasks of his employment.

The arbitrator rejected the insurer's surveillance evidence and the report of its medical examiner, finding them unpersuasive.

The applicant was awarded ongoing income replacement benefits at $214.19 per week plus interest, but his claim for a special award was denied.

The applicant, a real estate agent, was injured in a motor vehicle accident and claimed income replacement benefits.

The insurer argued she was self-employed and sought to deduct her employment expenses from her gross commission income, and also claimed an overpayment.

The arbitrator found that the applicant was an employee of the real estate brokerage, not an independent contractor.

The arbitrator further held that under the Statutory Accident Benefits Schedule, employment expenses cannot be deducted from gross employment income when calculating benefits.

Finally, the arbitrator determined that real estate commissions should be recognized on the firm deal date rather than the closing date.

The applicant was awarded outstanding benefits with interest, and the insurer's claim for repayment was dismissed.