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E.H. v. Wawanesa Mutual Insurance Company – Reasons for Decision

30/03/2001
E.H. v. Wawanesa Mutual Insurance Company – Reasons for Decision

May, 30 2001

Bogoroch & Associates successfully represented applicant E.H. after he was injured in a 1995 motor vehicle accident.

E.H. v. Wawanesa Mutual Insurance Company – Reasons for Decision

Before: Lawrence Blackman
Heard: May 29 and 30, 2001, at the offices of the Financial Services Commission of Ontario in Toronto.
Appearances: Bogoroch & Associates for E.H.
Andrew Lee for Wawanesa Mutual Insurance Company

Issues:

The Applicant, E.H., was injured in a motor vehicle accident on September 8, 1995. He applied for and received weekly income replacement benefits from Wawanesa Mutual Insurance Company (“Wawanesa”), payable under the Schedule.1Wawanesa began paying E.H. weekly loss of earning capacity benefits of $347.60 on February 15, 1999, in accordance with a Residual Earning Capacity Designated Assessment Centre (REC DAC) report of Providence Continuing Care Centre (Providence).

Both parties dispute the REC DAC’s findings. The parties were unable to resolve their disputes through mediation and E.H. applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended (the Insurance Act).

Accordingly, the issues in this hearing are:

 

  1. What is the correct quantum of E.H.’s loss of earning capacity benefit, pursuant to section 20 of the Schedule?
  2. Is E.H. entitled to interest on any overdue payments, pursuant to section 68 of the Schedule?
  3. Is E.H. entitled to his expenses in respect of this arbitration proceeding, pursuant to subsection 282(11) of the Insurance Act?
  4. Is Wawanesa entitled to its expenses in respect of this arbitration proceeding, pursuant to subsection 282(11) of the Insurance Act?

Result:

 

  1. E.H. is entitled to a weekly loss of earning capacity benefit of $411.81 (subject to indexation under section 79 of the Schedule) ongoing from February 15, 1999, together with interest on any overdue amounts in accordance with section 68 of the Schedule.
  2. E.H. is entitled to his expenses in respect of this arbitration proceeding, pursuant to subsection 282(11) of the Insurance Act.

 

Notes:

1The Statutory Accident Benefits Schedule – Accidents after December 31, 1993 and before November 1, 1996, Ontario Regulation 776/93, as amended by Ontario Regulations 635/94, 781/94, 463/96 and 304/98.

 

For the full decision, click to download:

E.H. v, Wawanesa Mutual Insurance Company – Reasons for Decision