Anne Sone

The insurer brought a motion seeking production of a defence medical report prepared by a rehabilitation psychologist in the context of the insured's tort claim.

The insured opposed production, arguing the report was irrelevant, would unduly complicate the arbitration, and that the insurer already had sufficient medical reports.

The arbitrator ordered production of the report, finding it relevant to the insured's claim for a non-earner benefit and noting that the insurer's existing assessments were over a year old and lacked vocational rehabilitation expertise.

The arbitrator concluded that having the best evidence available outweighed the potential for lengthening the hearing.

The applicant claimed statutory accident benefits following an alleged motor vehicle accident.

The insurer denied the claims, relying on engineering reports suggesting the accident did not occur as reported and may have been staged.

The applicant failed to attend the arbitration hearing.

The arbitrator found that the applicant failed to prove she was involved in an accident or sustained an impairment, dismissing all claims for benefits.

The applicant was ordered to pay the insurer's arbitration expenses due to her failure to attend and pursue her claim, which rendered the proceeding improper, vexatious, and unnecessary.

Following a preliminary issue hearing where it was determined that the applicants were not involved in a motor vehicle accident, the insurer sought its expenses.

The arbitrator found that the insurer was entirely successful and that the applicants' failure to make reasonable efforts to obtain new representation had prolonged the proceedings.

The applicants were ordered to jointly and severally pay the insurer's legal fees and disbursements, assessed at $7,373.11 based on Legal Aid Tariff rates.

Following an arbitration decision awarding the applicant ongoing income replacement benefits, the parties disputed the applicant's entitlement to interest on the overdue benefits and the expenses of the proceeding.

The arbitrator held that the applicant was entitled to interest on the overdue benefits, distinguishing the case law regarding medical and rehabilitation benefits.

The arbitrator also awarded the applicant her arbitration expenses, including legal fees and disbursements, based on her success in the proceeding and the insurer's conduct.

In a pre-hearing decision regarding a claim for statutory accident benefits, the insurer sought production of the applicant's bank statements from one year prior to the accident to date to verify post-accident income.

The arbitrator dismissed the request, finding that the amount of the weekly income replacement benefit was not in dispute and the insurer had no evidentiary basis to suspect the applicant was employed during the disputed period.

The arbitrator concluded that ordering production based on speculation alone would be unnecessarily intrusive and contrary to the Dispute Resolution Practice Code.

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

The insurer requested a Designated Assessment Centre (DAC) assessment and required the applicant to sign an OCF-14 form to release health information.

The applicant failed to provide the signed form for 28 months.

The arbitrator held that this unreasonable delay constituted a failure to make herself reasonably available for the assessment under s. 43(2) of the Statutory Accident Benefits Schedule.

Consequently, under s. 50(c), the Financial Services Commission of Ontario lacked jurisdiction to mediate or arbitrate the claim for the disputed medical benefits.

The applicant, who sustained a severe closed head injury in a motor vehicle accident, brought a motion to add issues to an upcoming arbitration hearing regarding statutory accident benefits.

The proposed additional issues concerned estate management expenses and out-of-pocket travelling expenses for family members.

The arbitrator dismissed the motion, finding that adding the complex estate management issues so close to the hearing date would prejudice the insurer.

The arbitrator also refused to add the travelling expenses issue because it had not been formally mediated, which is a statutory prerequisite under the Insurance Act.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated her income replacement benefits.

The applicant claimed ongoing entitlement due to physical pain and severe psychological impairments, including panic disorder and claustrophobia, which prevented her from using elevators, public transit, or driving.

The arbitrator found the applicant to be a credible witness and accepted the evidence of her treating psychiatrist, family doctor, and a vocational assessor over the insurer's DAC assessors.

The arbitrator concluded that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment for the first 104 weeks, and a complete inability to engage in any suitable employment thereafter.

The insurer was ordered to pay ongoing income replacement benefits.

The insurer brought a motion for the production of the applicant's employment records from a non-party employer.

The applicant did not object to the production, but the employer failed to respond to requests and evaded service.

The arbitrator found that the parties had made reasonable efforts to obtain the documents, the documents were in the employer's control, the employer had a reasonable opportunity to respond, and the documents were reasonably required for a fair hearing.

The motion was granted, and the employer was ordered to produce the records within 30 days.

The insurer brought a motion for the production of medical and employment records from several non-parties.

The applicant did not object to the production and had previously attempted to obtain the records.

The arbitrator ordered the non-party doctors to produce their complete charts, finding that reasonable efforts had been made and the doctors had a reasonable opportunity to respond.

However, the arbitrator declined to order the non-party employer to produce employment records, as there was insufficient evidence that the employer had been properly served with the motion record and given an opportunity to respond.

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

He commenced a civil action and subsequently applied for arbitration.

After being determined catastrophically impaired, he filed a supplementary application for arbitration claiming attendant care and case manager benefits, and sought to combine it with his scheduled arbitration.

The insurer objected, arguing that the applicant could not proceed with both a court action and arbitration for the same benefits under section 281 of the Insurance Act.

The arbitrator allowed the applicant to continue and combine the arbitration proceedings on the condition that he amend his civil statement of claim to withdraw all overlapping claims.

The arbitrator found this approach would prevent duplication, avoid inconsistent results, and address the urgency of the applicant's need for attendant care.

The applicant sought expenses following a successful arbitration claim for income replacement benefits against the insurer.

The arbitrator found the applicant was entitled to his reasonable arbitration expenses due to his success on the major issue and the professional conduct of the hearing.

After reviewing the claimed hourly rates, allowable hours, and disbursements, the arbitrator awarded the applicant $8,954.64 inclusive of GST.

The applicants were injured in a motor vehicle accident and applied for statutory accident benefits from Wawanesa.

Wawanesa denied coverage, arguing the applicants were not insured under a policy with them at the time of the accident.

On a preliminary issue hearing, the arbitrator found that she had jurisdiction to determine whether Wawanesa was an insurer with an obligation to pay benefits.

The arbitrator also found that there was a sufficient nexus between the applicants and Wawanesa, and that Wawanesa was obligated to respond to the applicants' claim for accident benefits pending the resolution of any dispute under the Disputes Between Insurers process.

The applicant was injured in a motor vehicle accident and sought income replacement benefits for work performed at an equine centre in exchange for boarding her horses.

The insurer denied the claim, arguing the arrangement was not employment or, alternatively, was self-employment.

The arbitrator found that the applicant was an employee, not self-employed, and that her income included the value of the payment in kind (horse boarding).

The applicant was awarded $1,639.90 in income replacement benefits.

Claims for a special award and for a frivolous arbitration penalty were dismissed.

The applicant, a 47-year-old welder with limited education and functional illiteracy, was injured in a motor vehicle accident and could no longer perform his pre-accident job due to chronic neck and back pain.

He found alternative employment as a car jockey earning significantly less.

The insurer terminated his income replacement benefits at the 104-week mark, arguing he could perform other skilled trades or driving jobs.

The arbitrator found that the applicant suffered a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience, preferring the applicant's psycho-vocational evidence that he lacked the literacy and physical capacity for the insurer's suggested occupations.

The applicant was awarded ongoing income replacement benefits and costs for certain assessments, but claims for housekeeping, a spinal corset, and a special award were dismissed.

In an arbitration for statutory accident benefits, the parties disputed the production of certain documents.

The insurer sought production of insurer's medical examinations from the applicant's two prior motor vehicle accidents to address causation.

The applicant objected, citing the implied undertaking rule.

The arbitrator held that under section 22 of the Insurance Act, arbitrators have the same powers as a court to grant relief from the implied undertaking rule under Rule 30.1.01(8).

Finding that the documents were relevant to causation and that the interests of justice outweighed any prejudice to the applicant, the arbitrator ordered their production.

The arbitrator also ordered the insurer to produce certain adjuster correspondence created prior to the mediation application, finding no litigation privilege attached.

The applicant, an elderly pedestrian, sustained a closed head injury when struck by a vehicle.

She claimed statutory accident benefits for care-giving services provided by her daughter and travel expenses for her granddaughter.

The arbitrator found that the accident materially contributed to the applicant's cognitive impairments.

However, applying the Court of Appeal's decision in Monochino, the arbitrator held that the applicant was not entitled to care-giver benefits because her daughter did not lose income and did not qualify as a professional care-giver.

The claim for travel expenses was dismissed as the trip was not for the applicant's benefit.

The claim for a special award was also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits, physiotherapy expenses, travel expenses, and the cost of a medical assessment report.

The arbitrator dismissed the claims for income replacement benefits and physiotherapy, finding the applicant's evidence lacked credibility and noting inconsistencies in his testimony regarding his job duties and post-accident conduct.

The arbitrator awarded $52 for travel expenses and $963 for the cost of a physiatry report, finding those expenses reasonable and necessary.

The claim for a special award was dismissed as the insurer's cautious approach was justified given the credibility concerns.

The applicant was injured in a motor vehicle accident and received income replacement benefits from the insurer.

The insurer terminated the benefits after 104 weeks but did not provide a loss of earning capacity offer.

The applicant sought an order for a loss of earning capacity offer and ongoing income replacement benefits pending the offer.

The arbitrator held that because the insurer paid benefits past the 104-week mark without invoking stoppage provisions, it was estopped from arguing the applicant did not qualify for a loss of earning capacity offer.

However, based on medical and DAC assessments, the applicant did not suffer a substantial inability to perform the essential tasks of his employment after February 1997, so he was not entitled to ongoing income replacement benefits.

The insurer's claim for repayment of an overpayment was dismissed as it was out of time.