Stephen Balfour MacAulay

In a preliminary issue hearing for a statutory accident benefits arbitration, the insurer sought to admit the medical report of an expert who died before the hearing, as well as a critique report by a different doctor to stand in his place.

The arbitrator admitted the deceased doctor's report, noting it was prepared at a crucial time when benefits were terminated and no other examination could be obtained, though its weight would be adjusted since he could not be cross-examined.

However, the arbitrator refused to admit the second doctor's report or allow him to testify, as there was no evidence he shared the same medical specialty as the deceased expert.

The applicants were injured in a motor vehicle accident and applied for statutory accident benefits from Wawanesa.

Wawanesa denied coverage, arguing the applicants were not insured under a policy with them at the time of the accident.

On a preliminary issue hearing, the arbitrator found that she had jurisdiction to determine whether Wawanesa was an insurer with an obligation to pay benefits.

The arbitrator also found that there was a sufficient nexus between the applicants and Wawanesa, and that Wawanesa was obligated to respond to the applicants' claim for accident benefits pending the resolution of any dispute under the Disputes Between Insurers process.

The respondent's daughter and son were killed in a motor vehicle accident in India.

The respondent did not notify her insurer, Liberty Mutual, of the accident for three and a half years.

She claimed death benefits and funeral expenses.

The arbitrator found that the respondent had a reasonable excuse for the delay due to her profound grief, disabilities, and language barriers.

The arbitrator also found that the respondent was principally dependent for care on her daughter, and that her son was financially dependent on her.

Liberty Mutual appealed.

The Director's Delegate dismissed the appeal, finding that the arbitrator's factual findings were supported by the evidence.

The applicant's two children were killed in a motor vehicle accident in India.

She applied for death benefits and funeral expenses over three years later.

The arbitrator held that territorial limits in the Insurance Act do not preclude accident benefits for out-of-country accidents.

The arbitrator also found that the applicant's profound grief, physical disability, and reliance on her deceased daughter constituted a reasonable excuse for the late notice.

The applicant was awarded death benefits for both children, having established she was dependent on her daughter for care and her son was financially dependent on her, along with $7,200 for funeral expenses.

The applicant was injured in a motor vehicle accident and received weekly income replacement benefits until the insurer suspended and then terminated them.

The applicant brought a motion for interim income replacement benefits, arguing the insurer failed to comply with the stoppage provisions in section 64 of the Statutory Accident Benefits Schedule.

The arbitrator found that the insurer terminated benefits without a Designated Assessment Centre report concluding the applicant was no longer disabled, which violated section 64.

The arbitrator ordered the insurer to pay interim income replacement benefits with interest, deferred the issue of a special award to the arbitration hearing, and awarded the applicant his reasonable expenses for the motion.

The appellant appealed an arbitration decision denying his claim for weekly income benefits following a motor vehicle accident.

The appellant argued the arbitrator failed to give proper weight to evidence of a flare-up of back problems and a bulging disc.

The Director's Delegate dismissed the appeal, finding that the arbitrator properly weighed the evidence, preferring the uniform opinions of several orthopaedic specialists over the appellant's general practitioner.

The arbitrator's conclusion that the appellant was not substantially unable to perform the essential tasks of his pre-accident work was supported by the evidence.

No appeal expenses were awarded.

The appellant appealed an arbitration order that denied him statutory accident benefits after his request for an adjournment was refused.

The appellant had retained new counsel shortly before the hearing, but his former counsel refused to release the file without an unconditional guarantee of his account.

The arbitrator, unaware of these specific efforts and the former counsel's refusal, denied the adjournment and dismissed the claim when no evidence was presented.

On appeal, the Director's Delegate found that the arbitrator had exercised his discretion based on misapprehended facts.

The appeal was allowed, the arbitration order was rescinded, and the matter was remitted for a new hearing.

The applicant, a self-employed taxi driver, was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied transportation expenses because the applicant paid a friend to drive him, and paid only the minimum weekly income benefits, arguing the applicant lacked sufficient financial records.

The arbitrator ordered the insurer to pay the transportation expenses, finding them reasonable and required.

The arbitrator also ordered the insurer to pay weekly income benefits based on the applicant's trip sheets, finding them to be the best evidence of income for a cash business, resulting in an award for the underpaid amount.

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

The applicant sought ongoing benefits, claiming substantial inability to perform the essential tasks of his employment in the music production industry due to physical and psychological injuries, including chronic pain syndrome.

The arbitrator found that while the applicant was employed at the time of the accident and suffered soft tissue injuries, the medical evidence from orthopaedic and psychiatric specialists did not support a finding of substantial disability beyond the termination date.

The claim for ongoing weekly income benefits was dismissed, but the applicant was awarded his reasonable arbitration expenses.

The applicant was injured when struck by an automobile while riding his bicycle.

He applied for statutory accident benefits from Guardian, which insured a vehicle owned by his father and on which the applicant was listed as the principal driver.

Guardian argued that Liberty Mutual, the insurer of the striking vehicle, should pay the benefits, claiming the applicant was not an 'insured person' or a 'dependant' under its policy.

The arbitrator found that the applicant was an 'insured' under the Guardian policy pursuant to sections 224 and 270 of the Insurance Act, as he was the principal driver for whom a specific premium was paid.

Alternatively, the arbitrator found the applicant was a dependant of his parents.

Guardian was held responsible for paying the statutory accident benefits.