Philippa G. Samworth

The insured was injured in a motor vehicle accident and claimed the cost of a home whirlpool spa as a medical expense.

The insurer denied the claim, relying on a Designated Assessment Centre report.

The arbitrator denied the cost of the specific spa purchased but ordered the insurer to pay the reasonable cost of a Jacuzzi-type bathtub.

The insurer appealed, arguing the arbitrator exceeded her jurisdiction and erred in her treatment of the medical certificate and DAC report.

The Director's Delegate dismissed the appeal, finding the arbitrator's order reasonably arose from the evidence and submissions, and that there was sufficient evidence to support her findings.

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

The insurer terminated benefits on the basis that the applicant did not meet the stricter test of being continuously prevented from engaging in any suitable occupation after 156 weeks.

The arbitrator found the applicant lacked credibility, as extensive video surveillance contradicted his claims of severe physical and cognitive disability, showing him engaging in vigorous activities and working as a waiter.

The arbitrator dismissed the claim for ongoing benefits, ordered repayment of an overpayment due to CPP benefits, and awarded the applicant only 50% of his arbitration expenses.

The applicant was injured in a rear-end motor vehicle accident while she was a full-time law student and pregnant.

She applied for statutory accident benefits, claiming weekly income benefits and housekeeping expenses.

The arbitrator found that while the applicant sustained soft tissue injuries, she did not suffer a substantial inability to perform her essential tasks as a student and homemaker, as she successfully completed her studies and her husband performed the household chores.

The claim for housekeeping expenses was also denied because the husband's services were provided out of love and duty, and did not constitute a compensable expense under the Schedule.

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

A dispute arose regarding the correct method of calculating his gross weekly income under section 12(7) of the Statutory Accident Benefits Schedule, as he had only worked for part of the four weeks preceding the accident.

The arbitrator found that the legislation is ambiguous and should be interpreted to best reflect the applicant's actual employment income.

The arbitrator concluded that the applicant's income should be averaged only over the weeks he actually worked, resulting in a weekly benefit of $429.31.

The applicant was injured in a motor vehicle accident and sought reinstatement of weekly income benefits, arguing she was on a 'temporary lay-off' from her work as a real estate salesperson and thus entitled to benefits under section 12 of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant had resigned from her position 15 months prior to the accident, actively sought other employment, and was therefore unemployed rather than on a temporary lay-off.

The claim for interim benefits was also denied due to a lack of medical evidence.

The applicant's entitlement to benefits will be considered under section 13 of the Schedule at a continuation of the hearing.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until they were terminated by the insurer.

The applicant applied for arbitration to determine her ongoing entitlement to weekly benefits and whether they should be calculated under section 12 or 13 of the Schedule.

The insurer brought a motion to include the issues of repayment of overpaid benefits and the deductibility of CPP and Old Age Pension benefits.

The arbitrator dismissed the insurer's motion, finding that the insurer's proposed issues did not naturally or consequentially flow from the matters referred to arbitration by the applicant.

The insurer sought to raise issues regarding the repayment and ongoing entitlement to weekly income benefits in an arbitration initiated by the insured.

The insured had only referred the calculation of the quantum of benefits and transportation expenses to arbitration.

The arbitrator held that the insurer could not expand the scope of the arbitration to include issues that did not naturally or consequentially flow from the specific matters referred by the insured.

The insurer's request to add these issues was dismissed.

The applicant was injured in a motor vehicle accident and received weekly, childcare, and housekeeping benefits until the insurer terminated them, claiming an overpayment.

The insurer relied on a medical report and a nurse's assessment to conclude the applicant was no longer disabled.

The arbitrator found the nurse was not qualified as an expert and her assessment lacked an objective basis, while the treating orthopaedic surgeon's testimony was contradictory and unreliable.

Relying on the applicant's credible testimony regarding her ongoing physical limitations, the arbitrator ordered the reinstatement of all benefits and dismissed the insurer's claim for repayment.