Rebecca Nelson

The insurer brought a motion to require the insured to attend a medical assessment with a physiatrist under subsection 23(2) of the Statutory Accident Benefits Schedule.

The insured opposed the assessment, arguing it was scheduled to bolster the insurer's upcoming variation application and that there would be insufficient time to review the report before the hearing.

The arbitrator found the assessment reasonable, noting the insured had not been assessed in over two years and the insurer has a right to assess the claim.

The motion was granted and the insured was ordered to attend the examination.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, asserting he was a successful self-employed jewellery manufacturer.

The insurer paid the maximum weekly income benefit of $600 based on a purported purchase order.

The arbitrator found that the applicant had fraudulently misrepresented the status of his business and the existence of the purchase order, and that the insurer had erred in calculating benefits based on anticipated rather than earned income.

The applicant was found to be self-employed but only entitled to the minimum weekly benefit of $185.60 for 156 weeks.

The insurer was awarded a repayment of $21,446.40 for the overpayment.

Claims for benefits beyond 156 weeks and a special award were dismissed.

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

The insurer terminated weekly income benefits, and the applicant sought arbitration for ongoing income benefits, chiropractic expenses, and transportation expenses.

The arbitrator found that the applicant, who had a pre-existing back condition, was capable of returning to his modified duties as a mail service courier by October 1993.

The arbitrator also concluded that ongoing daily chiropractic treatments two and a half years post-accident were no longer reasonable or necessary.

The applicant's claims for ongoing benefits were dismissed, and he was ordered to repay 14 weeks of income benefits to the insurer, as he had received overlapping disability benefits from another source.

The applicant was awarded the expenses of the arbitration.

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

The insurer terminated benefits on the basis that the applicant was no longer substantially unable to perform his essential tasks.

The parties agreed prior to the hearing that the applicant had been overpaid due to an incorrect calculation of his pre-accident income.

The arbitrator found that the medical evidence did not support the applicant's claimed level of disability, concluding that he exaggerated his symptoms and failed to follow medical advice to exercise and return to work.

The arbitrator held that the applicant was not entitled to further benefits and ordered him to repay the $7,936 overpayment.

The applicant was awarded his arbitration expenses.

The applicant was injured in a motor vehicle accident and received no-fault benefits until they were terminated by the insurer.

The parties attended mediation, and the mediator issued a report stating the issues were settled.

The applicant disputed the settlement and applied for arbitration.

The insurer raised a preliminary objection, arguing the matter was settled.

The arbitrator held that an arbitrator has jurisdiction under the Insurance Act to determine whether a binding settlement was reached.

The arbitrator found that no binding agreement existed due to a misunderstanding between the parties, despite the applicant having cashed the settlement cheques.

The applicant was permitted to proceed to arbitration but was ordered to repay the settlement funds mistakenly paid by the insurer.

The Applicant sought weekly income benefits following a motor vehicle accident.

The Insurer terminated benefits, arguing the Applicant was no longer substantially unable to perform his employment tasks.

The Arbitrator found the Applicant to be highly unreliable, noting he had worked as a meat cutter for six weeks following the accident while claiming total disability, and had fabricated employment records.

Relying on the objective medical evidence and the Applicant's extensive pre-existing back issues, the Arbitrator concluded the Applicant was not significantly injured in the accident and was never entitled to the benefits received.

The Applicant was ordered to repay $25,660.07 to the Insurer.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits until the Insurer terminated them.

The parties attended mediation, and the mediator issued a report stating the issues were settled.

The Applicant disputed the settlement and applied for arbitration.

The Insurer raised a preliminary objection, arguing the matter could not proceed to arbitration because mediation had not failed.

The Applicant sought to introduce evidence of discussions held during mediation to prove no settlement was reached.

The arbitrator held that while the mediator's report is not conclusive, evidence of statements made during mediation is privileged and inadmissible without the consent of the Commissioner.