David Muir

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for medical treatments and housekeeping.

The insurer denied the claims.

The arbitrator found that the applicant suffered injuries outside the WAD II PAF Guideline, specifically radiculopathy, and awarded medical benefits for chiropractic, physiotherapy, and acupuncture treatments.

The arbitrator also awarded partial housekeeping benefits for the initial four weeks post-accident, finding the applicant's evidence of ongoing need unreliable.

The third treatment plan was denied as not reasonable or necessary.

The applicant brought a motion requesting that the arbitrator recuse himself on the basis of a reasonable apprehension of bias.

The applicant argued that a prior letter from the arbitrator, which recorded a procedural agreement between the parties, lacked an evidentiary foundation and therefore indicated bias.

The arbitrator dismissed the motion, finding that the letter itself was the record of the agreement reached during a telephone conference, and an informed person would not conclude that the arbitrator would not decide the issues fairly.

The applicant sought to withdraw her arbitration proceeding regarding statutory accident benefits following a motor vehicle accident.

The insurer consented to the withdrawal but sought its expenses and an order requiring the applicant to pay the $3,000 arbitration fee if she recommenced the proceeding.

The arbitrator permitted the withdrawal and ordered the applicant to pay $1,200 in expenses, representing 50% of the insurer's allowable expenses, as well as $3,000 to the insurer only in the event she commences a new arbitration in respect of the same issues.

The applicant claimed statutory accident benefits following a motor vehicle accident and applied for arbitration after mediation failed.

Following the commencement of the arbitration, the applicant failed to attend scheduled pre-hearings or participate in the process, leading her representative to withdraw.

The insurer requested an order dismissing the arbitration pursuant to Rule 68 of the Dispute Resolution Practice Code.

The arbitrator found that the arbitration had become frivolous due to the applicant's failure to participate in any meaningful way and dismissed the proceeding.

No expenses were awarded.

The insurer brought a motion seeking an order to compel the applicant to produce tort materials or prepare an Affidavit of Documents of tort materials.

The arbitrator dismissed the motion, finding the request was overbroad, unparticularized, and brought too late.

Furthermore, the insurer failed to provide compelling reasons why the medical reports obtained pursuant to the Statutory Accident Benefits Schedule were insufficient, and ordering production of discovery transcripts from the tort action would unfairly distort the arbitration process.

Following the dismissal of the applicants' claims for statutory accident benefits, the insurer sought $33,500 in expenses.

The arbitrator found that while the insurer was completely successful in defending the claims, it had spent excessive time pursuing an unproven conspiracy theory regarding a fraud ring.

The arbitrator reduced the allowable preparation and hearing time, disallowing expenses for the days devoted entirely to the conspiracy theory.

The applicants were ordered to pay a total of $12,013.36 in expenses, apportioned between them based on their respective involvement in the hearing.

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

The insurer requested an examination under oath pursuant to section 33(1.1) of the Statutory Accident Benefits Schedule.

The applicant failed to attend the scheduled examination, arguing that notice was improperly sent to his counsel rather than to him personally, and that the insurer failed to reasonably accommodate his schedule.

The arbitrator found that notice to the applicant's solicitor was sufficient under section 68(2)(a) of the Schedule and that the applicant's counsel failed to respond to scheduling attempts.

Consequently, the insurer is not liable to pay benefits from the date of the missed examination until the applicant complies.

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

A preliminary issue hearing was held to determine whether the applicant had the mental capacity to proceed in the dispute resolution process.

Based on medical reports and direct questioning of the applicant, the arbitrator found that the applicant lacked the mental capacity to proceed.

The arbitrator appointed the applicant's daughter to act on his behalf pursuant to Rule 10.5 of the Dispute Resolution Practice Code.

The applicant sought statutory accident benefits, specifically an income replacement benefit, following an alleged motor vehicle accident.

The insurer denied the claim, alleging that the applicant was part of a fraudulent ring and had misrepresented her pre-accident employment at a hair salon.

The arbitrator found that while the insurer did not conclusively prove the applicant's participation in a fraudulent ring, the applicant's evidence regarding her employment and post-accident disability was riddled with inconsistencies, gaps, and admitted untruths.

Due to profound credibility issues and a lack of credible medical evidence supporting a substantial inability to perform her pre-accident employment tasks, the application for an income replacement benefit and a special award was dismissed.

The Applicant claimed statutory accident benefits, including income replacement benefits, following an alleged motor vehicle accident.

The Insurer denied the claims, alleging the Applicant was part of a ring to defraud insurers and that her employment was fabricated.

The Arbitrator found insufficient evidence to prove the Applicant was a knowing participant in a fraud ring, but dismissed her claim for income replacement benefits due to significant contradictions in her evidence regarding her pre-accident employment and a lack of credible evidence demonstrating an inability to perform the essential tasks of her employment.

The claim for a special award was also dismissed.

The applicant sought statutory accident benefits and a special award following a motor vehicle accident.

The applicant failed to attend the arbitration hearing and had previously lost contact with his representative, who was removed from the record.

The arbitrator dismissed the application for arbitration due to the absence of any evidence tendered in support of the claims.

The applicant was ordered to pay the insurer's reasonable expenses in the amount of $1,800.

The applicant was injured in a motor vehicle accident and his claim for statutory accident benefits was dismissed in a prior arbitration decision.

In this subsequent decision on expenses, both parties sought their costs of the arbitration.

The arbitrator found that the applicant's case lacked merit, as he brought almost no evidence to support his claims.

Applying the criteria under the Expense Regulation, the arbitrator concluded that the insurer was entitled to its reasonable expenses.

The insurer was awarded $2,785.41 in fees and disbursements, taking into account the applicant's conduct that protracted the process.

The insurer brought a motion to dismiss the insured's application for arbitration, arguing that the insured's repeated failure to attend insurer's examinations and failure to pay a prior expense order amounted to an abuse of process.

The arbitrator dismissed the motion, finding that the insurer failed to prove it had sent the notices of assessment to the insured's correct address, despite knowing he had moved.

The arbitrator also found that the failure to pay the prior expense order was not an abuse of process, as the insurer had taken no steps to collect it and the insured's former representative had been disbarred.

Following the dismissal of the applicant's claim for statutory accident benefits, the insurer sought its expenses for the arbitration.

The arbitrator found that the applicant's claims were completely unmeritorious and that he was entirely unsuccessful.

Applying the criteria under the Expense Regulation, the arbitrator awarded the insurer its expenses, fixed at $5,000 plus GST, noting that the insurer had kept an unmeritorious preliminary issue alive for strategic purposes.

The applicant sought expenses following an arbitration decision in which he was partially successful in his claims for statutory accident benefits.

The insurer argued that the parties should bear their own expenses or that the applicant should pay the insurer's expenses, relying on a $10,000 settlement offer.

The arbitrator reviewed the criteria under section 12 of O. Reg. 664 and the history of the expenses regime.

The arbitrator found that the applicant's limited success was materially greater than the settlement offer, which also required a full and final release.

The arbitrator awarded the applicant his reasonable expenses, reducing the claimed amounts for legal fees and disbursements, resulting in an award of $12,261.55 inclusive of GST.

The applicant applied for arbitration at the Financial Services Commission of Ontario following a motor vehicle accident and a dispute over statutory accident benefits.

At the outset of the hearing, the applicant advised that he did not wish to proceed.

The arbitrator dismissed the application on consent, with each party bearing their own expenses.

The insurer sought an order for expenses following an arbitration hearing regarding statutory accident benefits, arguing that it was substantially successful and therefore entitled to its expenses.

The insured person argued that the parties should bear their own expenses given her limited means and mixed success.

The arbitrator rejected a 'winner take all' approach to expenses under the Statutory Accident Benefits scheme, noting it is consumer protection legislation.

Because the insured person raised a legitimate issue and achieved some limited success, the arbitrator ordered that each party bear their own expenses.

The applicant sought a preliminary order to exclude several insurer's medical reports and prohibit their authors from testifying at an upcoming arbitration hearing.

The applicant argued that the insurer was not entitled to request further assessments under section 42 of the Schedule after having previously terminated income replacement benefits based on a WAD II diagnosis.

The arbitrator dismissed the motion, finding that an insurer has an ongoing right and obligation to assess a claim as it progresses, particularly when new medical information suggests the injuries may be more severe than initially diagnosed.

The exclusion of evidence was deemed an extraordinary remedy not justified in these circumstances.

The Applicant, injured in a motor vehicle accident, sought statutory accident benefits and applied for arbitration.

At a pre-hearing, the Applicant requested an order for the production of particulars related to surveillance conducted by the Insurer, regardless of whether the Insurer intended to rely on it at the hearing.

The Arbitrator, bound by a previous appeal decision, held that the Insurer is not obligated to disclose surveillance evidence unless and until it decides to rely upon it at the arbitration hearing.

The request for production was denied.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for medical treatment, housekeeping, and an assessment.

The insurer denied the claims.

The arbitrator found that the applicant was entitled to medical benefits for two treatment plans, accepting evidence of ongoing objective signs of injury, but denied further treatment plans due to insufficient evidence of need.

The arbitrator also awarded a nominal housekeeping benefit of $5 per week for a two-month period, finding the applicant's claim of total inability to perform housekeeping for 15 months implausible.

The claim for the cost of a follow-up assessment was denied as no treatment plan was submitted for it.

The insurer was ordered to pay 50% of the applicant's arbitration expenses.