Charles Matheson

The Applicant was previously found to have suffered a catastrophic impairment and was awarded an income replacement benefit and a special award.

In this expense hearing, the Applicant sought costs for the arbitration.

The arbitrator found the Applicant was wholly successful and entitled to expenses.

Applying a 4:1 ratio of preparation to hearing time and allowing costs for a preliminary issue hearing, the arbitrator awarded $28,306.50 in legal fees and $17,000.00 in disbursements, for a total of $45,306.50 inclusive of HST.

The applicant sought a special award under s. 282(10) of the Insurance Act, arguing that the insurer unreasonably withheld or delayed payments for statutory accident benefits, including a non-earner benefit and previously settled medical treatment plans.

The arbitrator dismissed the motion, finding that a special award cannot be ordered without a finding of an underlying entitlement to benefits under the Schedule.

Since no such finding of entitlement had been made, the arbitrator lacked jurisdiction to order a special award.

Following an arbitration where the applicant was largely successful in claiming statutory accident benefits, the parties could not agree on the quantum of expenses.

The applicant sought $43,405.26 in costs, while the insurer argued for a significantly reduced amount due to alleged delays, improper conduct, and excessive disbursement claims.

The arbitrator found that both parties contributed to procedural frustrations and applied a broad stroke approach, reducing certain excessive disbursements and correcting the law clerk's hourly rate.

The insurer was ordered to pay $38,000.00 in expenses.

The Applicant sought expenses following the settlement of his claim for an income replacement benefit arising from a motor vehicle accident.

The Insurer had initially denied the benefit, alleging the accident was staged, but agreed to pay after a jury in a bifurcated tort action found the accident was not staged.

The Arbitrator determined that the Applicant was entitled to expenses because he had to pursue arbitration to dispute the Insurer's position.

Taking a broad stroke approach, the Arbitrator awarded the Applicant $11,996.64 for legal fees, disbursements, and HST, rejecting claims for tort-related reports and fees.

The applicant sought a special award under s. 282(10) of the Insurance Act, arguing the insurer unreasonably withheld and delayed payment of income replacement benefits (IRB) and catastrophic impairment benefits following a motor vehicle accident.

The arbitrator found that while a special award could not be based solely on the catastrophic impairment determination, the insurer's handling of the IRB claim justified an award.

The insurer had relied on incomplete and inconclusive reports to terminate benefits, ignoring a multitude of conclusive medical reports, including from its own assessors, that supported the applicant's inability to work.

The arbitrator concluded this demonstrated stubborn, inflexible, and unreasonable behaviour, and ordered the insurer to pay a special award of 35% of the owing IRB total, plus 2% compound interest.

The Insurer, having been wholly successful at arbitration and on appeal regarding the Applicant's claims for statutory accident benefits, sought its expenses of the proceeding.

The Insurer claimed over $36,000 in legal fees and disbursements.

The Arbitrator reviewed the criteria under the FSCO Dispute Resolution Practice Code and found that while the dispute was legitimate, the Insurer was entitled to its reasonable expenses.

After reducing excessive claims for photocopies and expert witness fees, the Arbitrator fixed the expenses payable by the Applicant to the Insurer at $10,000.00, inclusive of fees, disbursements, and taxes.

The applicant was injured in a motor vehicle accident and sought income replacement benefits and a determination of catastrophic impairment.

The insurer denied the benefits, arguing the applicant's psychological impairments were caused by pre-existing conditions, including a history of sexual abuse.

The arbitrator found that the applicant was functioning as a productive member of society prior to the accident and that, but for the accident, she would not be in her current condition.

The arbitrator preferred the evidence of the applicant's expert, finding the applicant suffered a complete inability to engage in employment and sustained a catastrophic impairment due to marked psychological impairments.

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

The insurer brought a preliminary motion to dismiss the arbitration, arguing that a catastrophic determination without a claim for specified benefits was outside the arbitrator's jurisdiction.

The arbitrator dismissed the motion, finding jurisdiction to determine the status.

On the merits, the arbitrator preferred the evidence of the applicant's experts, finding that the insurer's psychiatrist failed to follow the AMA Guides by using a WSIB scale instead.

The arbitrator concluded the applicant suffered a Class 4 (Marked) impairment in deterioration or decompensation in a work or work-like setting, meeting the catastrophic impairment threshold.

The applicant's request for a special award was denied as no specific monetary benefits were unreasonably withheld.

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

After multiple pre-hearings and rescinded settlement offers, the applicant withdrew her application on the third day of the arbitration hearing, contingent on a $10,000 settlement.

The applicant subsequently rescinded the settlement.

The insurer sought its expenses for defending the application.

The arbitrator found that the applicant's constant rescissions demonstrated an abuse of the dispute resolution process.

The arbitrator permitted the withdrawal of the application and ordered the applicant to pay the insurer's reasonable expenses of $20,000, inclusive of HST and disbursements.

Following a successful arbitration where the applicant was found to be catastrophically impaired and entitled to income replacement and attendant care benefits, the applicant sought legal expenses of $95,580.97.

The insurer argued for a reduction based on a global assessment and alleged double-dipping of expert witness expenses.

The arbitrator agreed that a global assessment was appropriate, capped expert witness expenses, and adjusted the paralegal's hourly rate to that of an articling student.

The applicant was awarded $55,000.00 inclusive of disbursements and taxes.

The applicant withdrew his application for arbitration for statutory accident benefits after the insurer paid outstanding clinical amounts.

The insurer objected to the unilateral withdrawal without costs and requested an expense hearing under Rule 70.3 of the Dispute Resolution Practice Code, seeking $5,333.90 in costs.

The arbitrator found that while the insurer had the right to pursue costs for a contested withdrawal, the applicant's withdrawal was reasonable given his improved condition and the insurer's payment of service providers.

The arbitrator concluded that neither party was entirely successful and ordered the parties to bear their own expenses.

Following a substantive arbitration decision awarding the applicant certain medical and rehabilitation benefits, the parties disputed when the insurer was required to pay the ordered benefits, when interest began to accrue, and the quantum of the applicant's legal expenses.

The Arbitrator held that the insurer must pay deemed incurred expenses immediately upon receipt of the arbitral award, and that interest starts to accrue on the 31st day after receipt of the valid application for the benefit.

The Arbitrator also awarded the applicant his reasonable expenses for the arbitration fixed at $81,919.84.

The applicant, a taxi driver, was injured in a rear-end motor vehicle accident and sought statutory accident benefits.

The insurer terminated his income replacement benefits (IRBs) and denied certain medical and assessment treatment plans.

The arbitrator found that the applicant suffered from chronic pain syndrome and psychological impairments, entitling him to both pre-104-week and post-104-week IRBs.

The disputed medical and assessment plans were denied for lack of evidence of reasonableness and necessity at the time of submission.

The arbitrator awarded a maximum 50% special award against the insurer, finding it unreasonably withheld benefits by ignoring mounting medical evidence of the applicant's psychological and cognitive impairments and relying solely on outdated physical assessments.

The Applicant was injured in a motor vehicle rollover accident and applied for a determination of catastrophic impairment.

The Insurer disputed the claim.

At arbitration, multiple medical experts testified regarding the Applicant's physical, mental, and behavioural impairments.

The arbitrator found that the Applicant sustained a Class 4 (marked) impairment in Concentration, Pace and Persistence, and Adaptability, relying on the Applicant's neuropsychologist.

The arbitrator also found that the Applicant would have met the 55% Whole Person Impairment threshold based on a combination of physical and psychological ratings.

The arbitrator concluded that the Applicant sustained a catastrophic impairment within the meaning of the Statutory Accident Benefits Schedule.

Following the dismissal of the applicant's claim for statutory accident benefits, the insurer sought its arbitration expenses of $16,957.85, arguing they should be awarded personally against the applicant's counsel due to delayed communication and late disclosure.

The arbitrator declined to award costs personally against counsel, finding the conduct did not meet the threshold of extreme caution required by Young v. Young.

However, the arbitrator found the insurer was entitled to its reasonable expenses from the applicant, fixing the amount at $11,000 inclusive of disbursements and taxes, based on the applicable Legal Aid tariff rates.

The applicant was injured in a motor vehicle accident when she was struck by a car while crossing a street.

She applied for statutory accident benefits, including post-104 week income replacement benefits and various medical and rehabilitation benefits.

The arbitrator found that the applicant suffered from chronic pain but failed to prove a complete inability to engage in suitable employment, dismissing the claim for income replacement benefits.

The arbitrator granted entitlement to an occupational therapy re-assessment, a portion of physical rehabilitation, and a vocational assessment, finding the insurer's denials improper or the treatments reasonable and necessary.

Claims for further physical rehabilitation and orthotics were dismissed.

The arbitrator awarded interest on overdue payments but declined to order a special award against the insurer.

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

The central issues were whether he sustained a catastrophic impairment based on a Glasgow Coma Scale (GCS) score of 9 or less, and whether he was entitled to post-104 week income replacement benefits (IRBs) and attendant care benefits.

The Insurer argued the low GCS score was caused by a pre-accident drug overdose and high blood sugar, not a brain injury.

The arbitrator rejected this theory, finding the Applicant suffered a traumatic brain injury resulting in a GCS score of 9, meeting the catastrophic impairment definition.

The arbitrator also found the Applicant suffered a complete inability to engage in suitable employment due to cognitive and physical deficits, awarding ongoing IRBs.

The Applicant was deemed eligible for attendant care benefits pending a new Form 1.

Claims for a special award were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment, income replacement benefits, and attendant care benefits.

The insurer argued the applicant's low Glasgow Coma Scale score was due to a pre-accident drug overdose and high blood sugar, not a brain injury from the accident.

The arbitrator rejected the insurer's theory, finding the applicant sustained a catastrophic impairment due to a traumatic brain injury.

The arbitrator also awarded ongoing income replacement benefits and attendant care benefits, but declined to order a special award against the insurer.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment, income replacement benefits, housekeeping benefits, and costs of examinations.

The arbitrator found that the applicant did not meet the 55% whole person impairment threshold for catastrophic impairment, as his psychological and chronic pain impairments were moderate rather than marked.

The claim for income replacement benefits was dismissed because the applicant continued to work and his income increased post-accident, failing to meet the substantial inability test.

The claim for housekeeping benefits was dismissed as he was not catastrophically impaired.

The arbitrator awarded $2,000 for a coordinator's assessment fees but denied other examination costs.

The applicant sought income replacement benefits, medical benefits, and a determination of catastrophic impairment following a 2008 motor vehicle accident.

The arbitrator dismissed the claims, finding the applicant failed to prove a complete inability to engage in employment for the IRB claim.

The medical benefit claim was not properly linked to the 2008 accident.

The catastrophic impairment claim failed because the applicant's assessments did not properly account for pre-existing conditions as required by the AMA Guides, and the evidence did not establish a marked impairment resulting directly from the 2008 accident.