Rita L. Urbonavicius

The appellant was injured in a motor vehicle accident and received income replacement benefits for 156 weeks before the insurer terminated them.

Three years later, the appellant applied for further benefits, arguing he now met the post-156-week test.

The insurer denied the claim as statute-barred and for failing to meet the continuous disability requirement.

The Director's Delegate affirmed the arbitrator's decision, holding that the claim was barred by the two-year limitation period under the Insurance Act and the SABS, as the post-156-week benefits do not constitute a separate claim.

Furthermore, the appellant failed to establish that he was continuously disabled from the 156-week mark.

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

The insurer made an offer of Loss of Earning Capacity Benefits (LECBs).

The applicant disputed the residual earning capacity (REC) component but did not expressly dispute the pre-accident earning capacity (PEC) component within 45 days.

The insurer brought a preliminary motion arguing the applicant was time-barred from arbitrating the PEC issue under s. 281(5) of the Insurance Act and s. 72(1) of the Schedule.

The arbitrator dismissed the motion, finding that under the Schedule, silence is deemed a rejection of both the REC and PEC components of the offer, and the limitation period had not expired.

The applicant was injured in a motor vehicle accident and received weekly income benefits for 156 weeks.

The insurer terminated benefits in October 1994, stating the applicant did not meet the post-156 week disability test.

The applicant did not dispute the termination at the time.

In 1998, the applicant claimed a relapse and sought benefits from September 1997 onwards.

The arbitrator held that the applicant was precluded from proceeding to arbitration because the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule had expired following the initial clear and unequivocal refusal in 1994.

The arbitrator rejected the argument that a relapse could trigger a new limitation period without continuity of disability.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for case management services.

After mediation failed, the applicant commenced a court action claiming medical and rehabilitation benefits, and subsequently applied for arbitration at the Financial Services Commission of Ontario for the same benefits.

The insurer argued the arbitration was an abuse of process due to the pre-existing court action.

The arbitrator dismissed the arbitration, finding the court action was commenced first and was more comprehensive in scope.

The arbitrator also found the arbitration was frivolous, vexatious, and an abuse of process from the outset, ordering the applicant to pay the insurer's $3,000 assessment and $510 in arbitration expenses.