25 total
Insurer ordered to pay university residence fees as a reasonable rehabilitation expense for accident victim unable to commute.
The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for university residence fees, arguing her injuries prevented her from commuting from home as originally planned.
The insurer paid for the first two years but disputed entitlement for subsequent years, alternatively arguing for a deduction of hypothetical commuting and meal costs.
The arbitrator found that the applicant's physical and psychological injuries, including whiplash and post-traumatic stress disorder, rendered her unable to commute daily.
The residence fees were deemed a reasonable rehabilitation expense under section 6 of the Statutory Accident Benefits Schedule.
The arbitrator also rejected the insurer's request to deduct hypothetical commuting costs, finding them speculative.
Taxi driver deemed a named insured under cab owner's policy for no-fault benefits priority.
The applicant, a taxi driver, was injured in a motor vehicle accident while driving a cab owned by another individual and insured by Canadian General.
She also owned a personal vehicle insured by Pilot.
Canadian General argued that she was not a named insured under its policy and must claim benefits from Pilot.
The arbitrator found that the cab was made available for the applicant's regular use and rented to her, bringing her within subsection 3(1) of the No-Fault Benefits Schedule.
This provision gave her the same rights as a named insured, allowing her to elect to claim benefits from Canadian General under subsection 268(5) of the Insurance Act.
Canadian General was held liable to pay the benefits.
Applicant who contributed full-time earnings to family pool was not financially dependent on parents.
The Applicant was injured in a motor vehicle accident and claimed no-fault benefits.
A priority dispute arose between State Farm (the father's insurer) and Pilot (the insurer of the vehicle the Applicant occupied).
The issue was whether the 20-year-old Applicant, who lived at home and contributed his full-time earnings to a family pool controlled by his father, was "principally dependent for financial support" on his parents under section 3(2) of the No-Fault Benefits Schedule.
The arbitrator found that the Applicant's financial contributions exceeded his share of household expenses, making him essentially self-supporting.
Despite his social and cultural dependence on his father, the statutory test requires financial dependence.
The arbitrator concluded the Applicant was not principally dependent on his parents and must seek benefits from Pilot.
Arbitration barred by valid release signed by unrepresented applicant during pre-hearing settlement discussions.
The applicant was injured in a motor vehicle accident and received no-fault benefits until they were terminated by the insurer.
The applicant applied for arbitration but subsequently signed a release settling all claims for $2,640 during a pre-hearing discussion.
Shortly after signing, the applicant had second thoughts and sought to proceed with the arbitration.
The arbitrator held that the release was a valid, final settlement reached without fraud, coercion, or unconscionability, and therefore the arbitration could not proceed.
The applicant was awarded expenses incurred after the date of the release.
Accident benefits claim dismissed; applicant ordered to repay overpayment after financial records found to be fabricated.
The applicant, a pedestrian struck by a motor vehicle, applied for statutory accident benefits, claiming ongoing substantial inability to perform his pre-accident work as a heavy manual labourer.
The insurer terminated weekly income benefits and disputed the quantum of the applicant's pre-accident income.
The arbitrator found that the applicant's financial records were fabricated after the accident and relied on forensic accounting evidence to limit his weekly income benefits to the statutory minimum.
The arbitrator also accepted medical evidence that the applicant's ongoing back issues were due to pre-existing degenerative disc disease, concluding he was no longer substantially disabled.
The applicant was ordered to repay an overpayment of benefits to the insurer, though the insurer was ordered to fund a four-week rehabilitation program.