Todd J. McCarthy

The applicant was injured in a motor vehicle accident and received statutory accident benefits until May 1992.

He sought further weekly benefits, rehabilitation expenses, and a special award.

The arbitrator found the applicant lacked credibility and that he was substantially able to perform his essential tasks after May 1992, dismissing the claim for ongoing weekly benefits.

Furthermore, the arbitrator found the applicant had attended school full-time between January and May 1992, precluding him from receiving benefits during that period, and ordered him to repay the benefits received.

The insurer was ordered to pay an outstanding rehabilitation account that had been pre-approved.

The insurer was also awarded $500 because the applicant's conduct unreasonably prolonged the proceedings and parts of the claim were without merit.

The appellant was injured in a motor vehicle accident but did not submit an application for statutory accident benefits until more than two years later.

The insurer denied the claim as out-of-time.

The appellant argued the insurer waived or was estopped from relying on the time limits because it failed to provide an application form, investigated the late claim, and obtained medical information without a non-waiver agreement.

The Director's Delegate upheld the arbitrator's decision, finding no intentional relinquishment of rights by the insurer and no detrimental reliance by the appellant.

The appeal was dismissed and expenses were denied.

The Applicant was injured in a motor vehicle accident while driving a taxi in the course of his employment.

He applied for statutory accident benefits from Allstate, which insured his personal vehicle.

Allstate argued that Wellington, which insured the taxi, was responsible.

The arbitrator determined that the Applicant was an 'insured person' under the Allstate policy and not a 'named insured' under the Wellington policy.

Therefore, Allstate was held responsible for paying the Applicant's statutory accident benefits.

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

The insurer terminated weekly income benefits at the three-year mark.

The applicant sought ongoing benefits under section 12(5) of the Schedule, claiming continuous inability to engage in suitable employment due to soft tissue injuries, fibromyalgia, and depression.

The arbitrator found evidence of symptom embellishment and concluded the applicant was capable of sedentary work or returning to his previous administrative courier duties.

The arbitrator awarded a brief extension of benefits for a four-month 'work hardening' period, terminating on January 29, 1994.

The applicant was injured in a motor vehicle accident while driving a vehicle insured by Pilot Insurance Company.

She was listed as a driver on her parents' policy with State Farm Mutual Automobile Insurance Company.

The issue was which insurer was responsible for paying her statutory accident benefits.

The arbitrator found that the applicant was an unnamed insured under the State Farm policy pursuant to the Insurance Act, and that this statutory definition prevailed over the regulatory definition in the Statutory Accident Benefits Schedule.

Therefore, State Farm was responsible for the benefits.

The arbitrator also found that the applicant was not principally dependent on her parents for financial support at the time of the accident.

The applicants claimed accident benefits arising from the death of a New York resident in an Ontario motor vehicle accident.

The deceased was insured by Aetna under a New York policy with standard benefits, and was an occupant in a vehicle insured by Zurich under an Ontario policy with optional increased death benefits.

The arbitrator held that under section 45(1) of the Insurance Act, the out-of-province policy is deemed to include standard Ontario accident benefits, but the deceased is not deemed to have purchased optional benefits.

Furthermore, under the priority rules in section 268(2), the applicants must seek recourse from the deceased's own insurer (Aetna) and cannot claim the optional benefits from the vehicle's insurer (Zurich).