Scott W. Densem

The appellant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them.

The insurer argued the appellant's subsequent application for arbitration was time-barred under the two-year limitation period.

Applying the Supreme Court of Canada's decision in Smith v. Co-operators General Insurance Co., the Director's Delegate found that the insurer's termination notice was deficient because it failed to inform the appellant of the right to sue or arbitrate if mediation failed.

Consequently, a valid refusal was not given, the limitation period was not triggered, and the appellant's right to arbitrate was not barred.

Following a preliminary decision dismissing the applicant's claims for caregiver, housekeeping, and medical and rehabilitation benefits as time-barred, the parties sought expenses for the preliminary hearing.

However, the parties subsequently advised that certain medical rehabilitation expenses were not time-barred and would proceed to arbitration.

The arbitrator deferred the issue of expenses for the preliminary hearing to the arbitrator hearing the remaining outstanding issues.

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

The insurer terminated medical, rehabilitation, and caregiver benefits in 1998.

The applicant applied for arbitration in December 2000, beyond the two-year limitation period.

The applicant argued the insurer was estopped from relying on the limitation period because it failed to provide a copy of the accident benefits file upon request.

The arbitrator found the insurer gave clear and unequivocal notice of termination and that its failure to respond to file requests did not constitute a waiver or create an estoppel.

The arbitration was dismissed as statute-barred.

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

The insurer denied certain treatment plans and requested the applicant attend insurer's examinations and a Designated Assessment Centre (DAC).

The applicant failed to return the required OCF-14/59 forms for the DAC and did not attend the insurer's examinations.

On a preliminary issue, the arbitrator held that the insurer's notice for the examinations was defective for failing to specify the benefits to which they related, meaning the applicant was not barred from arbitrating other issues.

However, the applicant's failure to return the DAC forms constituted a failure to make himself reasonably available for an assessment, barring him from arbitrating the specific treatment plans related to those DACs.

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

The Fund purported to terminate his other disability benefits in May 1997.

The applicant applied for mediation more than two years later.

The Fund argued the application was time-barred under section 281(5) of the Insurance Act.

The arbitrator found that the Fund's notice of refusal was not clear and unequivocal, and that the Fund failed to comply with the mandatory termination requirements of section 64 of the Statutory Accident Benefits Schedule.

Therefore, the limitation period never began to run, and the applicant was not precluded from proceeding to arbitration.

The applicant was injured in a rear-end motor vehicle accident and sought ongoing income replacement benefits after the insurer terminated them.

The arbitrator found no objective physical injury but accepted that the applicant developed significant emotional and psychological problems resulting in a substantial inability to perform her essential job tasks.

However, evidence showed she was functionally able to operate a chip wagon business on her own by the summer of 1997.

The arbitrator ordered the insurer to pay income replacement benefits from the date of termination until June 1, 1997.