3 total
Limitation period not triggered because insurer's notice of refusal failed to explain full dispute resolution process.
The Applicant was injured in a motor vehicle accident and received income replacement benefits until the Insurer terminated them based on a DAC assessment.
The Insurer argued the Applicant's arbitration was statute-barred because she failed to apply for mediation within two years of the refusal.
The Arbitrator found that the Insurer's notice of refusal only mentioned mediation and failed to explain the entire dispute resolution process, as required by the Supreme Court in Smith v. Co-operators.
Consequently, the notice was deficient, the limitation period was not triggered, and the Applicant was permitted to proceed with her arbitration.
GST on legal fees is a recoverable arbitration expense; interest on expenses is calculated as simple interest.
The applicant sought payment of GST on his lawyer's fees and disbursements, as well as compound interest on those expenses, following a successful arbitration for statutory accident benefits.
The arbitrator held that GST is a legitimate out-of-pocket expense incurred in furtherance of the arbitration and is therefore recoverable.
However, the arbitrator found that interest on the expenses should be calculated on a simple, rather than compound, basis, as the relevant provision of the Statutory Accident Benefits Schedule did not explicitly direct compounding.
Insured entitled to ongoing weekly income benefits during vocational retraining due to accident-related physical limitations.
The applicant was injured in a motor vehicle accident and received statutory accident benefits.
The insurer terminated his weekly income benefits three years post-accident.
The applicant sought further benefits under section 12(5)(b) of the Schedule, claiming he required extensive retraining due to his physical limitations.
The insurer argued the applicant was magnifying his disability and could return to his previous work as a brick mason.
The arbitrator found that the applicant's realistic work tolerances fell below the medium to heavy range required for his pre-accident job, but that his rehabilitation efforts and improved English skills opened new employment opportunities.
The arbitrator ordered the insurer to pay weekly income benefits from the date of termination until the conclusion of a pre-examination community college course the applicant had started.
