Adam Joseph Ezer

The applicant sought legal expenses following an arbitration decision where he was awarded $5,067 plus interest for medical services, but denied caregiver and housekeeping benefits.

The insurer argued both parties should bear their own costs due to divided success.

The arbitrator found the applicant achieved a significant degree of success and had served a reasonable offer to settle for $10,000 inclusive of costs, which he beat at arbitration.

The arbitrator also noted the insurer's late production of surveillance evidence prolonged the hearing.

The applicant was awarded $7,266.65 in legal expenses and disbursements.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including medical, caregiver, and housekeeping benefits.

The insurer denied certain treatment plans and terminated the weekly benefits.

The arbitrator found that the chiropractic treatment incurred up to June 30, 2005, was reasonable and necessary, awarding $2,509.00 for medical benefits.

However, the claims for caregiver and housekeeping benefits were dismissed, as the applicant was not the primary caregiver and any substantial inability to perform housekeeping tasks had resolved prior to the termination of benefits.

The insurer brought a motion to dismiss the insured's application for arbitration, arguing that the insured's repeated failure to attend insurer's examinations and failure to pay a prior expense order amounted to an abuse of process.

The arbitrator dismissed the motion, finding that the insurer failed to prove it had sent the notices of assessment to the insured's correct address, despite knowing he had moved.

The arbitrator also found that the failure to pay the prior expense order was not an abuse of process, as the insurer had taken no steps to collect it and the insured's former representative had been disbarred.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer claimed the applicant was precluded from receiving benefits under section 59 of the Schedule because he was entitled to receive WSIB benefits.

On a preliminary issue, the arbitrator held that the Financial Services Commission of Ontario lacks jurisdiction to determine whether an individual is entitled to WSIB benefits, as the Workplace Safety and Insurance Board has exclusive jurisdiction over that question.

Since there was no evidence the Board had made such a determination, section 59(1) did not apply, and the applicant was not precluded from receiving accident benefits.

Following a decision denying the applicant's claim for statutory accident benefits, the arbitrator determined the quantum of expenses payable by the applicant to the insurer.

The insurer sought full indemnity of $5,569.41.

The arbitrator found the proceeding was not complex and the preparation time claimed was excessive.

The arbitrator fixed the insurer's fees at $2,000 inclusive of GST and allowed disbursements of $1,461.16 plus GST, for a total of $3,461.16.

Neither party was awarded expenses for the expense hearing itself.

The applicant sought arbitration after the insurer denied his claim for medical benefits for treatment plans totaling $2,589 following a motor vehicle accident.

The arbitrator found the applicant lacked credibility, noting significant inconsistencies between his testimony of debilitating pain and the clinical notes of his long-time family doctor, which made no mention of the accident or musculoskeletal complaints.

The arbitrator gave no weight to the evidence of the applicant's chiropractors, as one failed to provide clinical notes or a reasonable explanation for his conclusions, and the other merely repeated progress reports without examining the applicant.

The arbitration was dismissed, and the claims for medical benefits and a special award were denied.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer terminated weekly caregiver and housekeeping benefits and denied medical benefits.

The arbitrator found that the applicant was substantially disabled from engaging in most caregiving activities for a period, and later was able to assume lighter duties but not strenuous sports activities.

The arbitrator awarded partial caregiver and housekeeping benefits, as well as medical benefits for chiropractic treatment.

The insurer's claim for repayment of caregiver benefits was dismissed because the applicant was the primary caregiver.

Interest was awarded on the overdue benefits.

The applicant sought statutory accident benefits for caregiving, housekeeping, and medical rehabilitation following a motor vehicle accident.

The arbitrator dismissed the claims for caregiving and housekeeping benefits, finding the applicant's evidence lacked credibility and was inconsistent with his return to full-time work and school.

However, the arbitrator allowed the claim for medical and rehabilitation benefits in the amount of $5,067, finding that the chiropractic and massage treatments provided reasonable pain relief and assisted the applicant's functional improvement.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, and housekeeping benefits.

The insurer terminated benefits, arguing the applicant's injuries fell within the Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II (WAD II).

The arbitrator found that the applicant's impairments did not fall outside the WAD II Guideline, relying on independent assessments and surveillance evidence showing the applicant working and driving.

The arbitrator dismissed the claims for further medical treatment, income replacement, and housekeeping benefits, and ordered the applicant to repay an overpayment of income replacement benefits.

The claim for a special award was also dismissed as the insurer acted reasonably.

The insurer brought a motion to amend its Response to an Application for Arbitration to include a claim for repayment of benefits under section 47 of the Statutory Accident Benefits Schedule, alleging the insured made misrepresentations.

The insured opposed the motion, arguing the insurer had not sufficiently pleaded the necessary elements of a claim for repayment.

The arbitrator granted the motion, finding that the insurer provided sufficient particulars to establish a genuine issue for the hearing and that the insured would not be prejudiced by the amendment.

The insurer brought a motion to add the Motor Vehicle Accident Claims Fund (MVAC) as a co-respondent or third party to an arbitration proceeding, arguing MVAC was responsible for any special award arising from its prior handling of the file.

The arbitrator dismissed the motion, finding no statutory jurisdiction under the Insurance Act to add an insurer to a proceeding over the applicant's objection.

The arbitrator also dismissed the insurer's motion to strike the applicant's claim for a special award, instead amending the issue to reflect the insurer's potential liability for both its own actions and those of MVAC.

The insurer was ordered to pay the legal expenses of both MVAC and the applicant.