Beth Allen

The applicants claimed statutory accident benefits following two alleged motor vehicle accidents on July 15 and July 30, 2002.

The insurer denied the claims, arguing that the incidents did not meet the definition of an "accident" under section 2(1) of the Statutory Accident Benefits Schedule.

At a preliminary issue hearing, the arbitrator heard evidence from the applicants and three accident reconstruction experts retained by the insurer.

The arbitrator found the applicants' accounts of both incidents to be unreliable and implausible.

Relying on the expert evidence, which demonstrated that the vehicle damage was inconsistent with the applicants' descriptions, the arbitrator concluded that the applicants were not involved in accidents within the meaning of the Schedule and were therefore precluded from proceeding to arbitration.

The applicant applied for statutory accident benefits following a motor vehicle accident.

The insurer terminated weekly caregiver benefits, and the applicant applied for arbitration.

Neither the applicant nor her agent attended the arbitration hearing.

The insurer brought a motion to dismiss the arbitration and sought its expenses and assessment fee.

The arbitrator dismissed the arbitration, finding the applicant failed to discharge her burden of proof.

The arbitrator awarded the insurer $3,000 in arbitration expenses and its $3,000 assessment fee, concluding that the applicant's conduct and failure to provide basic documentation constituted an abuse of process.

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

The insurer denied the claims, arguing the applicant did not have a legitimate contract of employment and was not substantially disabled.

The arbitrator found that the applicant had a valid employment contract as a van driver/delivery person and that his accident-related injuries substantially disabled him from performing the heavy lifting and repetitive movements required for the job.

The arbitrator awarded income replacement benefits, medical benefits, and the cost of a disability certificate.

Furthermore, the arbitrator ordered the insurer to pay a $15,000 special award, finding that the insurer had unreasonably delayed and withheld benefit payments by failing to properly investigate the employment contract and by ignoring procedural notice requirements.

The applicant was injured in a motor vehicle accident and applied for enhanced statutory accident benefits, claiming a catastrophic impairment based on a brain impairment resulting in a Glasgow Coma Scale (GCS) score of 9 or less.

The insurer denied the claim, arguing the GCS scores were confounded by medical interventions and seizures, and that the applicant did not maintain the score for a reasonable time.

The arbitrator found that the applicant maintained a GCS score of 9 or less for about one hour after the accident, which was a reasonable time given the circumstances, and that the scores were not confounded by intubation during that period.

The applicant was designated as catastrophically impaired.

The insurer sought to require the insured to attend an insurer's examination under section 42 of the Statutory Accident Benefits Schedule to assess her entitlement to post-104 week income replacement benefits.

The insurer had only made an oral request at a pre-hearing discussion and did not provide written notice specifying the benefit to which the examination related.

The arbitrator held that the insurer failed to meet the basic notice requirements of section 42, which implicitly require written notice detailing the health professional and the affected benefit.

The insurer's request was denied, and the insured was awarded her expenses for the motion.

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

The insurer alleged the accident was staged and part of a fraud ring.

Mid-hearing, the applicant's representative unsuccessfully sought an adjournment and to withdraw the application, then abandoned the hearing.

The arbitrator found the insurer failed to prove the accident was staged, but dismissed all benefit claims due to severe credibility issues and lack of evidence regarding the applicant's employment and housekeeping needs.

The arbitrator awarded the insurer $5,000 in expenses and a $1,500 assessment fee due to the applicant's frivolous claims and abusive conduct.

The applicant was injured in a motor vehicle accident and sought income replacement benefits, claiming the accident aggravated pre-existing neck, back, and shoulder injuries from a prior accident.

The insurer denied the claim, arguing the applicant's disability stemmed entirely from his pre-existing conditions.

The arbitrator dismissed the claim, finding that the applicant's pre-existing conditions were the principal cause for him leaving his pre-accident job weeks before the subject accident.

The arbitrator concluded that the subject accident did not appreciably change or worsen the applicant's pre-existing disabilities.

The applicant was shot and stabbed by unknown assailants during a carjacking while sitting in his parked vehicle.

He applied for statutory accident benefits, which the insurer denied on the basis that the incident was not an 'accident' under the Schedule.

The arbitrator held that the use or operation of the automobile did not directly cause the applicant's injuries; rather, the assault was an intervening act and the direct cause.

The applicant was therefore precluded from proceeding to arbitration for accident benefits.

The applicant applied for arbitration seeking statutory accident benefits following a motor vehicle accident.

The applicant failed to attend the hearing or communicate with his counsel, the insurer, or the Commission.

The arbitrator dismissed the applicant's claims in their entirety due to a lack of evidence.

The insurer's claim for repayment of $2,447.72 in overpaid income replacement benefits was granted.

The arbitrator also ordered the applicant to pay the insurer's arbitration expenses of $1,742.00 and an additional $1,000 for abuse of process, finding that the applicant's failure to participate unnecessarily prolonged the proceedings.

The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought interim attendant care benefits for a period of hospitalization and interest on overdue attendant care benefits.

The arbitrator dismissed the claim for interim benefits, finding that the applicant failed to establish a prima facie case, urgency, or a blatant disregard for the Insurance Act by the insurer.

However, the arbitrator ordered the insurer to pay interest on previously agreed attendant care benefits, as the payment was overdue.

Following a finding that the parties had reached a binding settlement of all claims arising from a motor vehicle accident, the insurer sought its arbitration expenses.

The arbitrator found that the insurer was fully successful and that the arbitration was unnecessarily prolonged by the insured's manifestly unfounded attempt to resile from the settlement.

The insured was ordered to pay the insurer's arbitration expenses in the amount of $2,004.65.

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

The parties engaged in settlement discussions and reached an oral agreement for a full and final settlement, which was confirmed in writing.

The insurer subsequently sent the required settlement notice, disclosure statement, and release.

The Applicant attempted to rescind the settlement over a month after the 48-hour cooling-off period had expired.

The arbitrator held that the delay in forwarding the settlement documents did not invalidate the agreement and that the Applicant was bound by the settlement.

The Applicant was therefore precluded from proceeding to arbitration.

The parties were ordered to bear their own expenses.

The applicant sought statutory accident benefits for psychological treatment, physiotherapy, housekeeping, and the cost of assessments following a motor vehicle accident.

The arbitrator dismissed all claims, finding that the applicant suffered from significant credibility issues, having failed to disclose a prior accident and pre-existing conditions to medical assessors.

The arbitrator relied on the findings of the insurer's examiners and the Med/Rehab DAC assessors, who concluded that further treatment was not reasonable or necessary.

The claims for housekeeping and assessment costs were also dismissed for lack of evidence and medical referral.

Due to the applicant's lack of success and her representative's problematic conduct during the hearing, the parties were ordered to bear their own arbitration expenses.

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

The insurer requested that the applicant attend neurological, neuro-psychological, and occupational therapy examinations to reassess his attendant care needs, which the applicant refused to attend.

The insurer argued that the applicant was barred from proceeding to arbitration under section 50(b) of the Statutory Accident Benefits Schedule for failing to attend the examinations required under section 42.

The arbitrator found that the insurer's notice of examination was materially defective because it failed to specify the benefits to which the examinations related.

Furthermore, the requested examinations were not reasonably necessary, as the applicant had recently undergone numerous similar assessments, including a Designated Assessment Centre (DAC) evaluation, and the insurer was merely seeking to challenge the DAC's findings rather than assessing a new claim or ongoing entitlement.

The arbitrator concluded that the applicant was not precluded from proceeding to arbitration.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for nerve block injections, botox injections, massage treatments, and a special award for delayed payment of psychological and vocational assessments.

The arbitrator found that the nerve block injections were a reasonable and necessary treatment for short-term pain relief, ordering the insurer to pay the $800 cost.

However, the claim for botox and massage was dismissed, as the arbitrator accepted expert evidence that botox is an experimental treatment for chronic pain.

The arbitrator also awarded a special award of $1,170 against the insurer for unreasonably denying psychological treatment without requesting a Designated Assessment Centre (DAC) assessment, despite the insurer settling the claim shortly before the hearing.

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

At the arbitration hearing, the applicant's representative brought preliminary motions alleging institutional bias against FSCO, requesting an adjournment pending an appeal in another case, and seeking the appointment of a private arbitrator.

The arbitrator dismissed the preliminary motions, finding no evidence of bias and no authority to appoint a private arbitrator.

The applicant's representative then alleged personal bias against the arbitrator and refused to proceed with the hearing on the merits.

The arbitrator dismissed the substantive claims for want of evidence and ordered the applicant to pay $1,000 towards the insurer's expenses and assessment fee due to the representative's disruptive and unfounded conduct.

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

Prior to the arbitration hearing, the parties engaged in settlement discussions.

The insurer argued that a binding oral agreement was reached to fully and finally settle all claims, which was confirmed in writing the next day.

The applicant's paralegal representative argued the amount discussed was merely a proposal and no binding agreement was formed.

The arbitrator found the insurer's evidence more credible, concluding that an unconditional oral agreement was reached and confirmed in writing in compliance with the Settlement Regulation.

As the applicant failed to rescind the agreement within the statutory two-day cooling-off period, the settlement was binding and the arbitration was dismissed.

In a dispute over statutory accident benefits, the insurer requested production of examination for discovery transcripts from a related tort action arising from the same motor vehicle accident.

The applicant objected, relying on the deemed undertaking rule in Rule 30 of the Rules of Civil Procedure.

The arbitrator held that under sections 20 and 22 of the Insurance Act, arbitrators have the jurisdiction to grant relief from the deemed undertaking rule pursuant to Rule 30.1.01(8).

Finding the transcripts relevant to credibility issues regarding pre-accident employment and earnings, and noting that the applicant waived privacy rights by disclosing the transcripts in the tort action involving the same insurer, the arbitrator ordered the applicant to produce the transcripts.

The applicant sought expenses following an arbitration decision where he was unsuccessful in claiming rehabilitation benefits for the non-legal services of a law clerk.

The insurer opposed the request and sought reimbursement of its assessment fee under subsection 282(11.2) of the Insurance Act.

The arbitrator found that the applicant's claim, while unsuccessful, raised a novel issue and was not manifestly unfounded, frivolous, or vexatious.

The arbitrator awarded the applicant his reasonable expenses and dismissed the insurer's claim for reimbursement of its assessment fee.

The applicant was injured in a motor vehicle accident and received caregiver benefits.

The insurer terminated these benefits and made a loss of earning capacity (LEC) offer of zero.

The applicant claimed a higher LEC benefit, transportation expenses, housekeeping expenses, and a special award.

The arbitrator found that the applicant was not entitled to a LEC offer because she did not have the functional capacity to earn income at the time of the accident due to severe pre-existing psychiatric problems.

The arbitrator awarded the claimed transportation and housekeeping expenses, but denied the special award.