William McClelland

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

The insurer terminated benefits, and the applicant sought ongoing benefits under section 12(5)(b) of the Statutory Accident Benefits Schedule, claiming she was continuously prevented from engaging in any suitable employment due to back, shoulder, and psychiatric issues.

The arbitrator found that the applicant's pre-existing osteoarthritis and deconditioning were the primary causes of her ongoing complaints, and that she had recovered sufficiently from her accident-related soft tissue injuries to return to her pre-accident employment as a cleaner.

The application for ongoing benefits and a special award was dismissed, though the applicant was awarded her expenses for the arbitration.

The applicant was injured in motor vehicle accidents in 1991 and received weekly income benefits until the insurer terminated them.

The insurer raised a preliminary issue that the applicant's request for arbitration was barred by the two-year limitation period under section 281(5) of the Insurance Act.

The arbitrator found that the insurer provided clear and unequivocal notice of termination on November 22, 1993, after an independent medical examination.

The arbitrator rejected the applicant's arguments that the insurer waived the limitation period through ongoing negotiations, that a rolling limitation period applied, or that the arbitrator had jurisdiction to extend the statutory limitation period.

The application for arbitration was dismissed as statute-barred, but the applicant was awarded expenses.

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

She applied for arbitration, claiming she developed a chronic pain condition rendering her continuously disabled from returning to work.

The arbitrator found the applicant's credibility to be seriously questionable due to inconsistencies and denials of her physical abilities.

Relying on medical evidence that identified pre-existing degenerative disease, emotional depression, and other psycho-social factors as the primary causes of her ongoing disability, the arbitrator concluded the accident was not a significant contributing factor.

The claim for further weekly income benefits was dismissed, though the applicant was awarded her reasonable expenses of the arbitration.

The applicant was involved in two motor vehicle accidents and received weekly income benefits from the insurer.

The insurer terminated benefits, alleging the applicant was no longer disabled and had post-accident earnings resulting in an overpayment.

The arbitrator found the applicant failed to establish a substantial inability to perform her essential tasks after the termination date, relying on surveillance evidence and the unreliability of her testimony.

The arbitrator recalculated the benefit amounts and determined the insurer had overpaid the applicant by $14,664 due to a failure to deduct post-accident income.

However, the arbitrator declined to order repayment, finding the overpayment resulted primarily from the insurer's own adjusting errors rather than the applicant's misrepresentations.

The insurer appealed a preliminary arbitration decision finding that the insured was not disentitled to weekly income benefits under section 16(2) of the Schedule, as she had not worked for a continuous period of 90 days after the two-year anniversary of the accident.

The insured appealed a subsequent arbitration decision finding she was no longer eligible for weekly income benefits under section 12(1).

The Director's Delegate dismissed both appeals, upholding the arbitrator's interpretation of section 16(2) as referring to continuous periods of work, and finding no error in the arbitrator's evaluation of the evidence regarding the insured's eligibility.

The insurer was ordered to pay the insured's expenses for the preliminary issue appeal, but no expenses were awarded for the eligibility appeal.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for her inability to perform essential housekeeping and childcare tasks.

The insurer terminated her weekly benefits, arguing symptom exaggeration based on some medical assessments.

The arbitrator reviewed conflicting medical and psychological evidence, including diagnoses of severe post-traumatic stress disorder from multiple specialists.

The arbitrator concluded that the applicant suffered a substantial inability to complete her essential tasks as a homemaker and mother due to the psychological effects of the accident, and awarded weekly benefits, interest, and expenses.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits until the Insurer terminated weekly income benefits.

The Applicant applied for arbitration, claiming ongoing entitlement due to fibromyalgia and chronic pain syndrome.

The arbitrator found that the Applicant had returned to work and performed her essential tasks regularly for ten months prior to being laid off due to corporate downsizing.

The arbitrator concluded the Applicant did not suffer a substantial inability to perform the essential tasks of her employment and dismissed the claim for ongoing weekly income benefits, though the Applicant was awarded the expenses of the arbitration.

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

The Insurer raised a preliminary issue that the Applicant was no longer eligible for benefits under section 16(2) of the Schedule because she had returned to work for an aggregate of more than 90 days after the second anniversary of the accident.

The Arbitrator held that the phrase 'for periods of up to ninety days' in section 16(2) means one or more continuous periods of up to 90 days each, not an aggregate of shorter periods.

Since the Applicant had not worked for a continuous period of 90 days, she remained eligible for benefits.