Anne Sone

The applicant's law firm brought a motion to be removed as solicitors of record after the applicant passed away and the firm was unable to obtain instructions from a representative of her estate.

The insurer and the solicitor acting on matters relating to the estate consented to the withdrawal.

The arbitrator granted the motion pursuant to Rule 9.8 of the Dispute Resolution Practice Code.

The applicant was involved in a motor vehicle accident and claimed statutory accident benefits from the insurer, relying on a liability certificate he allegedly obtained from an independent broker.

The insurer denied coverage, arguing the certificate was fraudulent and it had no connection to the applicant.

The arbitrator found the applicant's evidence regarding the purchase of the insurance to be completely lacking in credibility and concluded the certificate was a forgery.

Applying the 'nexus' test, the arbitrator held that there was no objective or subjective connection between the applicant and the insurer.

Therefore, the insurer had no duty to adjust the claim and was not obliged to respond to the application for accident benefits.

The applicant was involved in three motor vehicle accidents and commenced a civil action against two insurers, Wawanesa and Belair, claiming various accident benefits.

He subsequently applied for arbitration at the Financial Services Commission of Ontario against Wawanesa only, seeking attendant care benefits, a determination of catastrophic impairment, and a special award.

Wawanesa brought a preliminary motion to bar the arbitration on the basis of the rule against multiplicity of proceedings.

The Arbitrator applied the principles from King v. Royal Insurance, finding that the issues in the arbitration and the civil action were substantially similar and inextricably intertwined.

To avoid the risk of inconsistent results and duplication of proceedings, the Arbitrator stayed the arbitration pending the outcome of the civil action.

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

In a pre-hearing dispute, the applicant requested that the insurer produce and pay for the clinical notes and records of doctors who performed medical examinations on the insurer's behalf.

The insurer agreed to produce the records but objected to paying for them.

The arbitrator ordered the insurer to pay for the production of the records, noting the consumer protection perspective of the Schedule, subject to the insurer's right to claim its expenses at the conclusion of the arbitration hearing.

The applicant applied for arbitration after the insurer terminated her statutory accident benefits following a motor vehicle accident.

After the applicant failed to attend three scheduled pre-hearings and her counsel was permitted to withdraw due to a lack of instructions and contact, the insurer sought to dismiss the proceeding.

The arbitrator found that the applicant had effectively abandoned her case and dismissed the application without a hearing as vexatious pursuant to Rule 68.1 of the Dispute Resolution Practice Code.

The insurer brought a motion for an order compelling two third-party clinics, Focus Rehabilitation Group and Century Diagnostic and Assessment Centre, to produce the applicant's clinical notes and records relating to three motor vehicle accidents.

The applicant consented to the production.

The arbitrator found that the insurer had made reasonable efforts to obtain the documents, which were in the third parties' control and reasonably required for a fair hearing.

The motion was granted, and the clinics were ordered to produce the records, subject to the insurer paying an outstanding $150 invoice to one of the clinics.

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

At a pre-hearing discussion, two production issues arose.

The applicant sought production of the insurer's adjusters' notes and records up to the date of the application for mediation, which the arbitrator granted, noting that the applicant was claiming a special award.

The insurer sought production of the applicant's bank records for two months before and after the accident to verify her income, as she claimed to have worked for her brother-in-law for only one month prior to the accident and was paid by direct deposit.

The arbitrator ordered the production of the bank records, finding them relevant given the lack of arms-length employment and independently verifiable evidence.

The insurer brought a motion to compel the production of clinical notes, records, and social assistance files from various third-party medical practitioners, clinics, and the City of Toronto.

The applicant consented to the motion.

The arbitrator found that the insurer had made reasonable efforts to obtain the documents, the documents were in the third parties' possession, and they were reasonably required for a fair hearing.

The motion was granted for all third parties who were properly served, but denied with respect to one doctor who could not be served.

The applicant's solicitors, Mazin Rooz Mazin, brought a motion to be removed as solicitors of record for the applicant in her statutory accident benefits arbitration.

The applicant had failed to attend scheduled pre-hearings and her solicitors were unable to contact her or obtain meaningful instructions despite numerous attempts.

The arbitrator granted the motion, finding that the solicitors had complied with the Dispute Resolution Practice Code requirements for withdrawal.

Following a preliminary issue hearing where the applicant's claim for statutory accident benefits was dismissed as statute-barred, the insurer sought its expenses.

The arbitrator found that the insurer was entirely successful and that its conduct did not prolong or hinder the proceeding.

The applicant was ordered to pay the insurer's expenses, fixed at $3,474.36 based on the legal aid rate, as the insurer was not an 'insured person' entitled to the higher maximum hourly rate under the Dispute Resolution Practice Code.

The applicant, an Alberta resident insured under an Alberta policy, was injured in a motor vehicle accident in Ontario while a passenger in a friend's vehicle.

He applied for statutory accident benefits in Ontario.

The insurer brought a preliminary issue motion arguing that the Financial Services Commission of Ontario lacked jurisdiction.

The arbitrator agreed, finding that the Insurance Act only confers jurisdiction for automobile contracts formed in Ontario or for out-of-province contracts where the insured automobile was operated in Ontario.

Since neither scenario applied, the arbitration was dismissed for lack of jurisdiction.

The insurer sought expenses against the applicant and her former representative following an arbitration decision regarding statutory accident benefits.

A hearing was convened to determine whether the former representative should be held personally liable for expenses under section 282(11.2) of the Insurance Act.

During the hearing, the parties engaged in settlement discussions and reached an agreement on the expense issue.

On consent of the parties, the arbitrator dismissed the application for expenses.

The applicant's claims for statutory accident benefits were previously dismissed after he failed to attend the arbitration hearing.

The insurer sought its expenses for the proceeding.

The arbitrator found that the insurer was entirely successful, the applicant's failure to attend delayed the proceedings, and the insurer's second attendance was unnecessary.

Applying the criteria under Regulation 664, the arbitrator ordered the applicant to pay the insurer's legal fees and disbursements totaling $2,601.55.

The applicant sought production of the insurer's complete statutory accident benefits file, including adjuster notes, up to the date of his second Application for Mediation.

The insurer claimed litigation privilege over the file from the date of the first Application for Mediation in 1996.

The arbitrator found that while litigation privilege attached at the time of the first mediation, the insurer subsequently closed its file due to inactivity.

The activity on the file from when it was closed in 1997 until the second Application for Mediation in 2004 constituted adjusting the file rather than preparing for litigation.

The arbitrator ordered production of the file for that specific period.

The applicant was injured in a motor vehicle accident and received income replacement benefits until they were terminated by the insurer following a Designated Assessment Centre (DAC) report.

The applicant brought a motion for interim benefits pending the arbitration hearing, arguing the DAC report was flawed and the insurer blatantly disregarded the Statutory Accident Benefits Schedule.

The arbitrator dismissed the motion, finding no blatant disregard of the Schedule, no extraordinary financial urgency or necessity, and contradictory medical evidence that did not establish a clear prima facie case for entitlement.

Both parties were ordered to bear their own expenses.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer disputed.

After the applicant failed to attend multiple pre-hearing resumptions and failed to comply with undertakings to produce documents, the insurer sought to dismiss the proceeding without a hearing under Rule 68.1 of the Dispute Resolution Practice Code.

The arbitrator declined to dismiss the proceeding, noting the applicant eventually provided an explanation for her absence and agreed to sign authorizations for the required documents.

However, the arbitrator awarded the insurer $300 in expenses due to the unnecessary delay and expense caused by the applicant's conduct.

The applicant was injured in two motor vehicle accidents and claimed statutory accident benefits for chiropractic treatment.

The insurer sought production of the applicant's collateral benefit carrier file and group insurance contract to determine if collateral benefits were available.

The applicant refused, arguing the request was a bad faith delay tactic and not raised during mediation.

The arbitrator ordered production, finding the documents relevant to calculating the medical benefits owed and noting the insurer had previously raised the issue of collateral benefits.

The applicant sought statutory accident benefits following a motor vehicle accident where he was struck while riding a bicycle.

The applicant failed to attend the scheduled arbitration hearing, and the hearing proceeded in his absence.

The applicant later requested to reopen the hearing, claiming he was unaware of the date.

The arbitrator found that proper notice had been given in accordance with the Statutory Powers Procedure Act and declined to reopen the hearing, as no exceptional circumstances were shown.

The applicant's claims for income replacement, medical, transportation, and housekeeping benefits were dismissed for lack of evidence.

The insurer brought a motion for the production of documents from third parties in a dispute over statutory accident benefits arising from a motor vehicle accident.

The insurer sought clinical notes and records from the applicant's family doctor, income tax returns from Revenue Canada, and a letter from the applicant's accountant.

The arbitrator found that the insurer had made reasonable efforts to obtain the documents, the third parties had been properly served, and the documents were relevant to the applicant's claims for income replacement and other benefits.

The motion was granted, and the third parties were ordered to produce the requested documents at the insurer's expense.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment, housekeeping services, and a functional capacity evaluation.

The arbitrator found the applicant's credibility was compromised by inconsistent statements and questionable documentation.

The arbitrator awarded $673 for the outstanding balances of the first two chiropractic treatment plans, finding them reasonable and necessary.

The claims for further chiropractic treatment, housekeeping benefits, and the functional capacity evaluation were dismissed for lack of persuasive evidence.

Interest was awarded on the overdue medical benefits.