Applicant awarded $12,261.55 in arbitration expenses after achieving partial success exceeding the insurer's settlement offer.
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.
Arbitration application for statutory accident benefits dismissed on consent at the outset of the hearing.
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.
Insurer's request for arbitration expenses denied; parties ordered to bear their own costs despite insurer's substantial success.
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.
Motion to exclude insurer's medical reports denied; insurer has ongoing right to assess claims.
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.
Insurer not required to produce surveillance particulars unless it decides to rely on them at hearing.
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.
Arbitrator awards limited medical and housekeeping accident benefits, rejecting claims for extended treatment and assessment costs.
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.
Application for statutory accident benefits dismissed due to vague and unpersuasive evidence of impairment.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement, medical, transportation, and housekeeping benefits.
The insurer had terminated income replacement benefits and denied the other claims.
The arbitrator dismissed the application, finding the applicant's evidence regarding his inability to work due to pain to be vague and unpersuasive, particularly given his continued employment for months post-accident and significant unexplained bank deposits.
The claims for medical, transportation, and housekeeping benefits were also dismissed due to a lack of supporting evidence.
Applicant's insistence on videotaping a section 42 insurer's examination was not an unreasonable refusal to attend.
The insurer brought a motion to stay the arbitration hearing until the applicant attended a section 42 insurer's examination.
The applicant refused to attend the examination unless she was permitted to videotape it, citing a prior injury during an assessment and cognitive deficits.
The arbitrator applied the principles from Bellamy v. Johnson and found that the applicant's insistence on videotaping the assessment was not an unreasonable refusal to attend, provided the recording is conducted with safeguards to ensure objectivity and minimize disruption.
Income replacement and housekeeping benefits awarded for limited periods; applicant failed to prove ongoing disability.
The applicant was injured in a motor vehicle accident and sought income replacement and housekeeping benefits from his insurer.
The insurer terminated benefits, arguing the applicant failed to attend an insurer's examination and was no longer disabled.
The arbitrator found the applicant had a reasonable excuse for missing the examination due to confusing correspondence and language barriers.
The arbitrator awarded income replacement benefits for the initial period and up to February 17, 2004, finding insufficient evidence of disability beyond that date, as the applicant's leg numbness was likely a benign condition.
Housekeeping benefits were awarded at a reduced rate of $20 per week based on an in-home assessment, as the applicant's evidence regarding his pre-accident housekeeping was vague and unsupported.
Representative removed from record after losing contact with the applicant.
The applicant's representative, Mazin Rooz Mazin, brought a motion to be removed from the record in a statutory accident benefits dispute.
The representative had lost contact with the applicant, who failed to attend two pre-hearings and the motion hearing despite being served.
The arbitrator granted the motion pursuant to Rule 9.8 of the Dispute Resolution Practice Code, finding that the representative was unable to obtain instructions.
Representative removed from record after losing contact with applicant and being unable to obtain instructions.
The applicant's representative brought a motion to be removed from the record in a statutory accident benefits dispute.
The representative had lost contact with the applicant and was unable to obtain instructions despite serving notice of the motion at her last known address.
The applicant failed to attend two pre-hearings and did not appear at the motion.
The arbitrator granted the motion pursuant to Rule 9.8 of the Dispute Resolution Practice Code, removing the firm as the applicant's representative.
Representative removed from record after losing contact with applicant and failing to obtain instructions.
The applicant's representative brought a motion to be removed from the record.
The applicant had failed to attend two pre-hearings without explanation and the representative had lost contact with him, rendering them unable to obtain instructions.
The Motor Vehicle Accident Claims Fund took no position.
The arbitrator granted the motion pursuant to Rule 9.8 of the Dispute Resolution Practice Code, finding that the applicant had notice of the motion and that the representative had made efforts to contact him.
Application for caregiver and housekeeping benefits dismissed due to inconsistent and unpersuasive evidence.
The applicant was injured in a motor vehicle accident and sought caregiver and housekeeping benefits under the Statutory Accident Benefits Schedule.
The insurer paid benefits initially but terminated them.
The arbitrator dismissed the application, finding the applicant's evidence regarding his pre-accident responsibilities and post-accident needs to be inconsistent, contradictory, and lacking credibility.
The applicant failed to establish on a balance of probabilities that he suffered a substantial inability to perform his caregiving and housekeeping duties.
Arbitrator finds applicant catastrophically impaired, concluding accident trauma exacerbated pre-existing subdural haematoma.
The applicant, an 81-year-old man, was run over by his own vehicle, sustaining orthopaedic injuries.
He subsequently developed significant cognitive impairments.
The insurer denied catastrophic impairment benefits, arguing the cognitive decline was caused by a pre-existing subdural haematoma rather than the accident.
The arbitrator preferred the applicant's medical evidence, finding that the accident likely caused a minor head trauma that, combined with the pre-existing haematoma, resulted in brain edema and catastrophic impairment.
The applicant was awarded ongoing attendant care and housekeeping benefits.
Arbitration dismissed as abandoned after applicant failed to attend pre-hearings or contact counsel.
The applicant commenced an arbitration for statutory accident benefits but subsequently failed to attend scheduled pre-hearings or maintain contact with his counsel.
The insurer brought a motion to dismiss the arbitration as frivolous, vexatious, or commenced in bad faith under Rule 68.1 of the Dispute Resolution Practice Code.
The arbitrator granted the motion, finding the application had effectively been abandoned, and awarded the insurer $500 in expenses.
Insurer's motion for a neurological assessment based on fairness rather than section 42 dismissed.
State Farm brought a motion to adjourn or stay the arbitration hearing pending the applicant's attendance at a neurological assessment.
State Farm argued that fairness required the assessment to respond to late-filed expert reports from the applicant's neurosurgeon, relying on the underlying reasoning in F.S. and Belair rather than section 42 of the Statutory Accident Benefits Schedule.
The arbitrator dismissed the motion, finding that the hearing was still months away, State Farm had prior opportunities to assess the applicant, and fairness did not require an additional assessment outside the normal section 42 process at this time.
Insurer denied right to conduct private, one-sided pre-hearing preparation meetings with neutral DAC assessors.
The insurer brought a motion seeking an order confirming its right to speak privately with members of a Designated Assessment Centre (DAC) assessment team to prepare them for an upcoming arbitration hearing, and an order that it was not obliged to disclose the details of those conversations.
The arbitrator dismissed the motion, finding that DAC assessors hold a unique, neutral statutory role in the dispute resolution process.
Maintaining the actual and perceived neutrality of DAC assessors outweighs concerns about hearing efficiency and witness preparation.
Consequently, there is no right to one-sided partisan contact with a DAC assessor prior to a hearing.
Insurer cannot deny accident benefits where applicant reasonably believed her motorcycle insurance had been renewed.
The applicant was injured in a motorcycle accident and applied for statutory accident benefits.
The insurer denied the claim under section 30(1)(a) of the Schedule, arguing the applicant knew or ought to have known she was operating an uninsured vehicle.
The arbitrator found that the applicant reasonably believed her former partner had renewed her insurance and was not wilfully blind to the fact that she was uninsured.
The insurer was not entitled to rely on the exclusion.
Arbitration dismissed and solicitors removed from record after applicant abandoned the proceeding.
The applicant commenced an arbitration for statutory accident benefits but subsequently failed to participate or provide instructions to her counsel.
Her solicitors brought a motion to be removed from the record, and the insurer brought a motion to dismiss the arbitration.
The arbitrator granted both motions, removing the solicitors from the record and dismissing the arbitration as frivolous and vexatious due to abandonment.
The insurer was awarded $1,000 in expenses.
Income replacement benefits denied due to pre-existing injury; limited housekeeping benefits awarded.
The applicant was injured in a motor vehicle accident and sought income replacement and housekeeping benefits from her insurer under the Statutory Accident Benefits Schedule.
The insurer terminated her income replacement benefits in February 2004.
At arbitration, the arbitrator found that the applicant's inability to work was primarily due to a pre-existing shoulder injury from a prior workplace incident, and there was insufficient medical evidence to prove the car accident caused an ongoing inability to perform her pre-accident employment beyond the termination date.
The claim for income replacement benefits was dismissed.
The arbitrator awarded a limited housekeeping benefit of $15.00 per week for a period of approximately five months following the accident, based on an occupational therapy assessment.