Ruban Thangarasa v. Gore Mutual Insurance Company – Reasons for Interim Decision

April, 30 2005

Linda Wolanski represented Ruban Thangarasa, who was injured in a motor vehicle accident on March, 1998. He applied for and received statutory accident benefits from Gore Mutual Insurance Company. The parties were unable to resolve their disputes through mediation, and Mr. Thangarasa applied for arbitration at the Financial Services Commission of Ontario.

Ruban Thangarasa v. Gore Mutual Insurance Company – Reasons for Interim Decision

Issues:

The Applicant, Ruban Thangarasa, was injured in a motor vehicle accident on March 31, 1998. He applied for and received statutory accident benefits from Gore Mutual Insurance Company (“Gore Mutual”), payable under the Schedule.1 The parties were unable to resolve their disputes through mediation, and Mr. Thangarasa applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended.

The issues in this hearing are:

1. Is Mr. Thangarasa entitled to receive a weekly income replacement benefit from February 5, 2001, claimed pursuant to section 4 of the Schedule?
2. What is the amount of weekly income replacement benefit that Mr. Thangarasa is entitled to receive pursuant to section 6 of the Schedule? Mr. Thangarasa claims a weekly income replacement benefit of $340.53 per week.
3. Is Gore Mutual liable to pay a special award pursuant to subsection 282(10) of the Insurance Act because it unreasonably withheld or delayed payments to Mr. Thangarasa?
4. Is Gore Mutual liable to pay Mr. Thangarasa’s expenses in respect of the arbitration under section 282(11) of the Insurance Act.
5. Is Mr. Thangarasa liable to pay Gore Mutual’s expenses in respect of the arbitration under section 282(11) of the Insurance Act.
6. Is Mr. Thangarasa entitled to interest for the overdue payment of benefits pursuant to section 46(2) of the Schedule.

Result:

1. Mr. Thangarasa is entitled to receive a weekly income replacement benefit from February 5, 2001, as claimed pursuant to section 4 of the Schedule.
2. Mr. Thangarasa is entitled to receive $340.53 as the amount of weekly income replacement benefit pursuant to section 6 of the Schedule. Payment of this amount shall commence forthwith, and continue pending resolution of the outstanding issues.The parties shall have 30 days to resolve the issue of the quantum of all outstanding benefits and interest and to make joint submissions as to the appropriate amount, failing which I will receive further evidence and submissions on this issue.
3. Gore Mutual is liable to pay a special award pursuant to subsection 282(10) of the Insurance Act because it unreasonably withheld or delayed payments to Mr. Thangarasa, the amount of which remains to be determined.
4. The liability of Gore Mutual to pay Mr. Thangarasa’s expenses in respect of the arbitration under section 282(11) of the Insurance Act remains to be determined.
5. The liability of Mr. Thangarasa to pay Gore Mutual’s expenses in respect of the arbitration under section 282(11) of the Insurance Act remains to be determined.

Notes:

1The Statutory Accident Benefits Schedule — Accidents on or after November 1, 1996, Ontario Regulation 403/96, as amended.

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Ruban Thangarasa  v. Gore Mutual Insurance Company – Reasons for Interim Decision