Rudolph Lobl

The applicant was injured in a motor vehicle accident and received caregiver benefits, which the insurer terminated after 104 weeks.

The applicant attended a scheduled DAC assessment but insisted on videotaping it.

The DAC refused to proceed and charged a cancellation fee.

The insurer argued the applicant failed to make himself reasonably available for the assessment under section 50 of the Schedule and sought reimbursement of the fee.

The arbitrator found that the applicant made himself reasonably available by attending the assessment, and it was the DAC that refused to proceed without providing reasons.

The applicant was permitted to proceed to arbitration and was not required to pay the cancellation fee.

The appellant was injured in a motor vehicle accident and initially awarded ongoing income replacement benefits.

Years later, the respondent insurer applied to revoke the benefits, arguing a material change in circumstances.

The arbitrator found that the appellant's medical condition had improved and that her extensive involvement in a highly successful gospel choir demonstrated a capacity for suitable employment, terminating her benefits.

On appeal, the Director's Delegate upheld the arbitrator's decision, finding no error of law in the determination that a material change had occurred and that the appellant was no longer continuously prevented from engaging in suitable employment.

The applicant sought income replacement benefits following a motor vehicle accident but failed to produce required financial documents.

She subsequently failed to attend pre-hearing discussions and the arbitration hearing itself, and her counsel withdrew due to lack of instructions.

The arbitrator dismissed the application due to a lack of evidence.

The arbitrator denied the applicant's expenses, awarded the insurer a portion of its expenses to be assessed, and ordered the applicant to pay $1,000 to the insurer for abuse of process under subsection 282(11.2) of the Insurance Act.

The insurer applied to vary or revoke a 1996 arbitration order that required it to pay ongoing weekly income benefits to the respondent under the post-156 week disability test.

The respondent had suffered severe hip injuries in a 1990 motor vehicle accident.

The insurer presented evidence that since the original order, the respondent had achieved significant professional success as the lead vocalist and musical director of a gospel choir, including recording contracts, Juno awards, and film appearances.

The arbitrator found that the respondent's activities demonstrated she was fully capable of engaging in the occupation of a professional musician or choir director, and that her lack of remuneration was a lifestyle choice rather than a result of her disability.

The arbitrator concluded there was a material change in circumstances and revoked the order for ongoing benefits.

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 received statutory accident benefits.

The insurer terminated weekly income replacement benefits, and the applicant requested a Designated Assessment Centre (DAC) assessment.

The applicant later cancelled the assessment with insufficient notice, incurring a cancellation fee, and applied for mediation and arbitration.

The arbitrator held that the applicant failed to establish a bona fide change of mind regarding his election to proceed by way of a DAC assessment.

Consequently, the applicant is precluded from proceeding to mediation and arbitration until he completes the requested DAC assessment.

The insurer appealed an arbitrator's decision awarding the respondent ongoing weekly income benefits beyond the 156-week mark.

The respondent, a student at the time of the accident, suffered from chronic pain syndrome and post-traumatic headaches.

The Director's Delegate upheld the arbitrator's refusal to grant an adjournment for late-requested medical assessments, finding the request untimely.

The Delegate also upheld the finding that the respondent was continuously prevented from engaging in any suitable occupation or employment, noting the uncontradicted medical evidence supporting her severe limitations.

The appeal was dismissed.

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

The applicant commenced a court action and subsequently applied for mediation and arbitration at the Ontario Insurance Commission.

The insurer argued the applicant must elect a single forum.

The arbitrator held that the applicant cannot proceed in both forums for the same issue and must withdraw her court action to continue the arbitration for weekly benefits.

Additionally, the arbitrator ruled that the applicant's claim for post-156 week benefits did not require separate mediation, as it was part of the same matter already mediated.

The appellant, a pedestrian injured in a motor vehicle accident, appealed an arbitration decision that terminated his weekly income benefits and ordered him to repay overpaid benefits.

The Director of Arbitrations upheld the arbitrator's findings that the appellant was no longer substantially unable to perform the essential tasks of his occupation, based on medical and rehabilitation evidence.

Furthermore, the Director affirmed the arbitrator's conclusion that the appellant's financial records were unreliable and constructed after the accident, justifying the calculation of his income benefits at the minimum rate.

The appeal was dismissed.

The appellant applied for arbitration regarding accident benefits but withdrew her application shortly after the pre-hearing discussion.

The arbitrator found the application was entirely without merit, denied the appellant her arbitration expenses, and ordered a global penalty of $2,700 against the appellant and two other applicants under section 282(11.2) of the Insurance Act.

On appeal, the Director's Delegate upheld the denial of expenses and the finding that the application was frivolous and an abuse of process.

However, the Delegate amended the penalty order to impose individual liability of $900 on each applicant, rather than a global amount.

The Applicant was injured in a motor vehicle accident and sought ongoing weekly income benefits under section 13 of the Statutory Accident Benefits Schedule after the Insurer terminated them.

The arbitrator found that the Applicant was capable of returning to her pre-accident activities by October 7, 1994, and was therefore entitled to benefits up to that date.

However, because the Applicant received Canada Pension Plan and Workers' Compensation benefits that exceeded her accident benefits entitlement, she was not owed any further payments.

Furthermore, the arbitrator ordered the Applicant to repay $1,100.00 in overpaid benefits to the Insurer and denied her costs of the arbitration due to her exaggeration of her pre- and post-accident condition.

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

The insurer terminated the benefits, and the applicant sought ongoing benefits under s. 12(5)(b) of the Statutory Accident Benefits Schedule, arguing she was continuously prevented from engaging in any occupation or employment for which she was reasonably suited.

The arbitrator found that the applicant did not have the physical capacity or stamina to do reasonably suitable full-time work, and that part-time work would not be sufficiently remunerative.

The arbitrator concluded that the insurer acted unreasonably in terminating the benefits given the medical evidence of the applicant's ongoing hip problems and need for further surgery.

The applicant was awarded ongoing weekly income benefits and a special award of $2,000.

The insurer appealed an arbitration decision determining the insured's weekly income benefits at $600 per week.

The central issue was when real estate commissions become income for the purpose of calculating pre-accident income under the Statutory Accident Benefits Schedule.

The Director's Delegate held that real estate commissions are earned when there is an unconditional agreement of purchase and sale, rejecting both the 'closing date' and 'work completed' approaches.

Applying this principle, the insured's weekly income benefits were recalculated to $348.61 per week.

The issue of whether the insured must repay any overpayment was referred back to arbitration.

The Applicant was injured in a motor vehicle accident and claimed statutory accident benefits.

The parties attended mediation and signed a settlement agreement for $16,900.

The Applicant later sought to arbitrate the claims, arguing he was confused during mediation and that the Insurer failed to pay outstanding physiotherapy expenses.

The Arbitrator found that the Applicant understood the settlement, signed a release, and failed to rescind it within the two-day cooling-off period.

The preliminary issue was resolved in favour of the Insurer, barring the Applicant from proceeding to arbitration.

The Applicant's request for expenses was denied as the application was deemed frivolous.

The Applicant was injured in a motor vehicle accident when struck as a pedestrian.

She received weekly income benefits until July 27, 1993, and subsequently applied for arbitration claiming ongoing entitlement and payment for a medical report.

The arbitrator found that the Applicant was substantially able to perform the essential tasks of her pre-accident job as an industrial sewing machine operator, preferring the evidence of orthopaedic surgeons over her pain management physician.

The claim for the medical report was also dismissed as it was deemed a medicolegal report rather than a certificate under the Schedule.

The Applicant was awarded her arbitration expenses.

The Applicant was injured in a motor vehicle accident and received weekly income benefits until the Insurer terminated them after 156 weeks.

The Applicant, who was a prospective university student at the time of the accident, claimed ongoing entitlement under section 12 of the Statutory Accident Benefits Schedule.

The arbitrator found that the Applicant's essential occupational tasks included those of an undergraduate student.

Accepting the medical evidence that the Applicant suffered from chronic pain and post-traumatic headaches, the arbitrator concluded that she was continuously prevented from engaging in full-time post-secondary studies or any comparable employment.

The Applicant was awarded ongoing weekly income benefits and her arbitration expenses, but her claim for a special award was dismissed.

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

The insurer paid a minimum weekly income benefit of $185.60, disputing the applicant's self-reported income as an independent newspaper carrier.

Following an arbitration hearing, the arbitrator determined that independent documentation corroborated the applicant's income, entitling him to the maximum weekly benefit of $600.

The arbitrator also granted a $4,000 special award against the insurer for unreasonably withholding benefits despite possessing independent verification of the applicant's income.

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

The parties attended mediation, where the insurer claimed a settlement was reached, but the applicant later denied it and sought arbitration.

The arbitrator found that the applicant, represented by counsel, had fully understood and agreed to the settlement terms at mediation.

The arbitrator concluded that the applicant was merely having second thoughts and held that a binding settlement had been reached, precluding the applicant from proceeding to arbitration.

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

A dispute arose regarding the correct calculation of his pre-accident income from self-employment.

The arbitrator found that the applicant failed to provide sufficient documentation to prove his net income exceeded the minimum threshold, entitling him only to the minimum benefit of $185.60 per week.

Consequently, the insurer was entitled to repayment of $15,951.51 in overpaid benefits, while the applicant was awarded his arbitration expenses.

The unrepresented applicant reached a lump sum settlement with the insurer during a pre-hearing discussion and signed a full and final release.

Shortly after, she attempted to revoke the settlement, arguing it was unfair and that there was an inequality of bargaining power.

The arbitrator found the settlement binding.

On appeal, the Director of Arbitrations upheld the arbitrator's decision, finding no evidence of unconscionability, undue influence, or other vitiating factors, and noting that the pre-hearing arbitrator had taken appropriate steps to ensure the applicant understood the consequences of signing the release.