Anne Morris

The Applicant was involved in three motor vehicle accidents (2003, 2005, 2006).

In a previous arbitration decision, it was determined that the Applicant was catastrophically impaired as a result of the 2003 accident.

The Applicant sought a determination that he was also catastrophically impaired as a result of the 2005 and/or 2006 accidents, arguing that they materially contributed to his impairment.

The Arbitrator dismissed the claim, applying the reasoning from a recent appeal decision that a person who is already catastrophically impaired for a mental or behavioural disorder cannot become 'more' catastrophically impaired by subsequent accidents.

The Arbitrator also held that the 'but for' test of causation applied, and since the Applicant was already catastrophically impaired from the 2003 accident, the subsequent accidents did not cause the catastrophic impairment.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including non-earner, medical, attendant care, and housekeeping benefits.

The insurer suspended benefits after the applicant failed to attend an examination under oath, though a previous arbitrator found the notices defective.

The arbitrator found the applicant entitled to the disputed medical treatment plans, as well as attendant care and housekeeping benefits for a limited period due to the insurer's procedural breach in failing to provide assessment reports in a timely manner.

However, the claim for non-earner benefits was dismissed as the applicant did not meet the test of a complete inability to lead a normal life.

The request for a special award was also denied.

The applicant was involved in three motor vehicle accidents and sought a determination that he was catastrophically impaired as a result of the second and third accidents.

A previous arbitration decision had already found him catastrophically impaired due to a mental or behavioural disorder arising from the first accident.

The arbitrator applied the 'but for' test of causation and found that the subsequent accidents did not make the applicant more catastrophically impaired, as he had already crossed the threshold for enhanced benefits.

The claim for catastrophic impairment arising from the later accidents was dismissed.

Following an arbitration decision regarding statutory accident benefits, the parties were unable to resolve the issue of expenses.

The insurer claimed success on the post-104-week income replacement benefit issue and three of six medical issues, seeking $22,912.12 in fees and $8,351.16 in disbursements.

The applicant also claimed partial success.

The arbitrator found the insurer was entitled to its expenses but reduced the amount to reflect the applicant's degree of success, principles of reasonableness, consumer protection, and access to justice.

The insurer was awarded $5,000 inclusive of fees, disbursements, and HST.

The applicant, a personal support worker, was injured while riding as a passenger on a bus that was struck by a car.

She sought income replacement benefits (IRBs), medical benefits, and attendant care benefits (ACBs) after the insurer terminated them.

The arbitrator found the applicant was entitled to IRBs for both the pre-104 week and post-104 week periods, as well as the disputed medical benefits, but denied the claim for ongoing ACBs.

The arbitrator also ordered the insurer to pay a $6,500 special award for unreasonably terminating the applicant's IRBs despite objective medical evidence of a severe knee condition.

In a preliminary ruling, the arbitrator removed the insurer's in-house legal department as representatives of record due to a disqualifying conflict of interest, finding that the mandatory firewall between the insurer's accident benefits and tort files had been breached.

Following an arbitration where the insurer successfully defended all claims for statutory accident benefits, the parties could not agree on expenses.

The insurer sought $39,474.46 in expenses.

The arbitrator found the insurer was entitled to expenses based on its complete success.

Applying a broad-strokes approach and a 2:1 ratio of preparation to hearing time, the arbitrator reduced the claimed amounts and awarded the insurer $10,955.87 inclusive of fees, disbursements, and HST.

The applicant sought expenses following an arbitration hearing where he had mixed success.

The insurer was successful on the catastrophic impairment, attendant care, medical benefit, and special award issues, while the applicant was successful on the income replacement benefit issue.

Considering the monetary benefit the applicant received and the insurer's considerable success, the arbitrator awarded the applicant 50% of his claimed expenses, totaling $15,462.58 inclusive of fees, disbursements, and HST.

Following an arbitration hearing where the applicant was awarded statutory accident benefits, the parties were unable to agree on expenses.

The arbitrator found the applicant was entitled to his expenses given his significant success.

After assessing the claimed legal fees and disbursements for reasonableness, the arbitrator reduced the amounts claimed for expert reports, witness fees, and other disbursements to align with the Expense Regulation maximums.

The applicant was awarded $48,597.95 in total expenses.

Following an arbitration hearing where the insurer was entirely successful in denying the applicant's claims for statutory accident benefits, the insurer sought its expenses.

The arbitrator found that the insurer was entitled to its expenses based on its complete success.

Applying a broad strokes approach and a 2:1 ratio of preparation to hearing time, the arbitrator awarded the insurer $14,351.09 for legal fees and disbursements, inclusive of HST.

The Applicant was injured in a motor vehicle accident and sought accident benefits from the Insurer.

The underlying arbitration was dismissed because the Applicant failed to attend section 44 insurer examinations.

In this expense hearing, both parties sought their expenses.

The Arbitrator found that the Insurer was completely successful in the preliminary issue hearing and was entitled to its expenses.

The Arbitrator awarded the Insurer $5,419.07 in legal fees and disbursements, taking into consideration principles of reasonableness, consumer protection, and access to justice.

The applicant sought expenses following a successful preliminary issue hearing regarding statutory accident benefits.

The arbitrator awarded the applicant $19,629.68 in expenses, inclusive of fees, disbursements, and HST, applying a 1:4 ratio for hearing to preparation time and utilizing the legal aid hourly rate.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits and medical benefits for chronic pain.

The insurer had paid benefits up to the Minor Injury Guideline (MIG) limit and terminated income replacement benefits based on insurer examinations.

The arbitrator found that the applicant's injuries fell within the MIG, rejecting the chronic pain diagnosis due to credibility issues, positive Waddell signs, and invalid psychometric testing results.

The arbitrator also concluded that the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The claims for income replacement and medical benefits were dismissed, though the cost of a disability certificate was allowed.

The Applicant sought to withdraw his application for arbitration at the Financial Services Commission of Ontario shortly before a rescheduled hearing, citing a desire to avoid a multiplicity of proceedings given parallel Superior Court actions.

The Insurer objected and sought its expenses.

The Arbitrator found the late withdrawal unjustified and awarded the Insurer $5,500.00 in expenses for costs thrown away, applying principles of reasonableness and consumer protection.

The Applicant was catastrophically injured in a motor vehicle accident, sustaining a traumatic brain injury and chronic pain.

He applied for statutory accident benefits, including non-earner, attendant care, and housekeeping benefits, which the Insurer denied or underpaid.

The Arbitrator found that the Applicant suffered a complete inability to lead a normal life and awarded non-earner benefits.

The Arbitrator also deemed past attendant care and housekeeping expenses to have been incurred under s. 3(8) of the Schedule, finding that the Insurer unreasonably withheld benefits by failing to advise the impecunious and functionally illiterate Applicant that it would pay for professional services.

However, the Arbitrator declined to order a special award, finding the Insurer's conduct was not sufficiently egregious.

Following an arbitration where the applicant was found catastrophically impaired but was largely unsuccessful on the quantum of attendant care benefits, the parties disputed the entitlement to and quantum of expenses.

The arbitrator awarded the applicant his reasonable expenses but reduced them by one-third to reflect the insurer's success on the significant issue of attendant care quantum.

After assessing the claimed legal fees and disbursements, the arbitrator ordered the insurer to pay the applicant $41,039.34 for expenses.

Following an arbitration where the applicant withdrew all issues except the cost of catastrophic impairment assessments, and the arbitrator ruled in favour of the insurer on that remaining issue, the insurer sought its expenses of the arbitration.

The insurer claimed $23,931.42 in fees and disbursements.

The arbitrator found that the insurer was successful, as the applicant withdrew the catastrophic impairment issue shortly before the hearing and lost on the assessment cost issue.

However, the insurer's claimed expenses were excessive and lacked supporting documentation for disbursements.

Taking a pragmatic approach, the arbitrator awarded the insurer $1,500.00 inclusive of fees, disbursements, and taxes.

The applicant was injured in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder.

The insurer argued that the applicant was not credible, that causation was not established due to pre-existing issues and subsequent accidents, and that her impairment was only mild to moderate.

The arbitrator found the applicant credible despite memory lapses, and concluded that the accident caused her major depressive disorder with psychotic features and posttraumatic stress disorder.

Preferring the evidence of the applicant's psychiatric assessor, the arbitrator held that the applicant sustained a marked (Class 4) impairment and was therefore catastrophically impaired.

The Applicant sought payment for the outstanding costs of catastrophic impairment assessments, arguing that the $2,000 cap under the new SABS did not apply because the assessments were rebuttal reports, a vested right under the old SABS.

The Arbitrator held that while the right to reimbursement for a rebuttal report survived as a vested right, the legislature expressed a clear intention in the new SABS to cap the costs of all assessments at $2,000, regardless of whether the entitlement arose under the old or new SABS.

The claim for the outstanding amount of $10,359.90 was dismissed.

The applicant was injured in a motor vehicle accident and sought accident benefits, claiming he sustained a catastrophic impairment.

The insurer denied the claim, arguing that any catastrophic impairment was the result of a stroke the applicant suffered two years after the accident.

The arbitrator found that the applicant's psychological impairments resulting from the accident met the threshold for catastrophic impairment, and that the accident materially contributed to the stroke.

The arbitrator awarded attendant care benefits for incurred professional services but denied them for family-provided care due to a lack of evidence of economic loss.

A special award was granted against the insurer for unreasonably withholding payments.

The applicant sought statutory accident benefits following a motor vehicle accident.

At the hearing, the applicant requested to withdraw the claims, but the insurer did not consent.

The applicant did not call any evidence to support his claims.

As the applicant failed to discharge his burden of proof, the arbitrator dismissed the claims in their entirety.

The insurer was awarded $3,500.00 in expenses.