Robert A. Besunder

Following an arbitration where the applicant was awarded income replacement benefits and a special award, both parties sought their expenses.

The arbitrator found that both parties engaged in conduct contributing to moderate delay, making that criterion moot.

Considering the applicant's partial success and an offer to settle, the arbitrator awarded the applicant a portion of her expenses.

The insurer was ordered to pay the applicant's expenses fixed at $15,000.00, inclusive of fees, disbursements, and taxes.

The applicant was injured in a minor rear-end motor vehicle accident and received statutory accident benefits.

The insurer terminated her income replacement benefits 11 months post-accident based on incomplete and deficient insurer examination reports.

The applicant sought ongoing income replacement benefits, interest, and a special award.

The arbitrator found that the insurer's termination of benefits was premature and unreasonable, entitling the applicant to benefits up to the 104-week mark and a special award of $7,500.

However, the arbitrator found the applicant was not entitled to benefits beyond 104 weeks, as she exaggerated her physical and psychological impairments, failed to make reasonable efforts to return to work, and her pre-accident employer was willing to accommodate her return.

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

A dispute arose regarding the calculation of his prior earning capacity (PEC).

The applicant argued that income from his family's business should be included, which would raise his PEC.

The arbitrator found that the applicant was not meaningfully employed by the family business at the time of the accident and that the funds he received were dividend income rather than employment income.

The applicant's PEC was quantified at $247.98 per week based solely on a pre-accident offer of employment from another business.

Following an arbitration hearing where the applicant was largely successful in her claims for statutory accident benefits, the parties disputed her entitlement to expenses.

The insurer argued that the applicant's pursuit of an indexation issue and an evidentiary objection prolonged the hearing.

The arbitrator found that these matters did not unduly prolong the hearing and, given the applicant's relative success, ordered the insurer to pay the applicant's expenses of the arbitration.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits that the insurer had terminated or denied.

The arbitrator found that the applicant's ongoing chiropractic and massage therapy treatments were reasonable for pain relief, and that her physical and cognitive limitations justified the cost of taxi transportation to treatment sessions and ongoing housekeeping expenses.

However, the claim for opioid prescription medication was denied, as the weight of medical opinion indicated it was not beneficial and potentially harmful.

The arbitrator rejected the applicant's argument that her income replacement benefits should include the indexation percentage for the first year following the onset of disability, finding the statutory language clear.

Finally, the arbitrator ordered the insurer to pay a $5,000 special award for unreasonably withholding payment for treatments and medication in blatant disregard of the pay-pending-dispute provisions of the Schedule.

The applicant sought statutory accident benefits following a minor motor vehicle accident.

The insurer terminated weekly income replacement and medical benefits, and sought repayment of an overpayment.

The arbitrator found that the applicant's severe headaches were not caused by the accident, but were related to a pre-existing chronic pain condition.

Furthermore, the applicant was not substantially disabled from performing the essential tasks of her employment as a travel agent.

The arbitrator dismissed the claims for benefits and a special award, and ordered the applicant to repay $20,166.25 in overpaid income replacement benefits because her tax returns showed higher employment income than she had reported to the insurer.

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

She subsequently fell down stairs, exacerbating her knee injury.

The insurer terminated benefits at the 104-week mark without making a loss of earning capacity benefit (LECB) offer, arguing the ongoing disability was caused by the fall, not the accident.

The arbitrator held that the insurer could not challenge the applicant's qualification for benefits after paying them without protest for 104 weeks.

Furthermore, applying the Amos test, the arbitrator found the subsequent fall was a direct consequence of the accident-induced knee weakness, unbroken by any negligence.

The applicant was awarded an LECB offer, specific medical and housekeeping benefits, and a special award for the insurer's delay in paying settlement funds.

The appellant appealed an order dismissing her personal injury action on a pre-trial motion under s. 266(3) of the Insurance Act.

The Court of Appeal held that the motions judge improperly disregarded uncontradicted affidavit and medical evidence concerning a significant deterioration in the appellant's condition in the 18 months preceding the motion.

Applying the appellate intervention principle for disregarded evidence, the onus framework under Chilman, and the three-step analysis from Meyer v. Bright, the court concluded that the record was capable of establishing a permanent serious impairment of an important bodily function caused by continuing physical injury.

Because the entire record was documentary and the respondents had not challenged the late medical evidence by cross-examination or responding evidence, the court set aside the order and dismissed the respondents' motion.

The appellant was awarded costs of the motion and the appeal.

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

The insurer terminated benefits under the post-156 week test, which requires the insured to be continuously prevented from engaging in any suitable occupation or employment.

The arbitrator upheld the termination, finding the appellant failed to prove he was unable to perform other less strenuous work suited to his background, and that there was insufficient evidence linking his depression to the accident.

On appeal, the Director's Delegate confirmed the arbitrator's decision, concluding that the appellant did not meet the burden of establishing disability within the meaning of the Schedule.

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

He applied for continued benefits under section 12(5)(b) of the Statutory Accident Benefits Schedule, claiming his physical and psychological injuries continuously prevented him from engaging in any suitable employment.

The arbitrator found that the applicant failed to prove his physical injuries prevented him from engaging in suitable employment other than his pre-accident work as a drywaller.

The arbitrator also found insufficient evidence linking the applicant's depression to the accident.

The claims for continued income benefits and a special award were dismissed, but the applicant was awarded expenses.

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

When the insurer terminated benefits, the applicant applied for arbitration and subsequently produced a psychiatric report diagnosing him with major depression.

The insurer scheduled a psychiatric independent medical examination (IME), but the applicant arrived 40 minutes late to the 90-minute appointment, leaving insufficient time for an assessment.

The arbitrator held that arriving unreasonably late frustrated the purpose of the IME and constituted a failure to make oneself reasonably available under section 25 of the Schedule.

The arbitration was stayed until the applicant attended a psychiatric IME.