Law firm permitted to withdraw as representative due to breakdown in solicitor-client relationship.
The law firm representing the applicant in a statutory accident benefits dispute brought a motion to withdraw as his representative, citing a breakdown in the solicitor-client relationship.
The applicant opposed the motion.
The arbitrator granted the motion, finding that the relationship had broken down, and ordered the firm to cooperate with the applicant's attempt to find new representation and provide a copy of his file.
Insurer awarded $2,171.40 in expenses after successfully defending against claims for statutory accident benefits.
The applicant's claims for non-earner and attendant care benefits were previously dismissed.
The parties were unable to resolve the issue of expenses.
The arbitrator applied the criteria set out in the Expense Regulation and found that the insurer was entitled to its reasonable expenses, given its success in the proceeding and the applicant's failure to provide evidence supporting its claims.
The insurer was awarded expenses in the amount of $2,171.40.
Representative permitted to withdraw and notice given of intention to dismiss abandoned arbitration.
The applicant applied for statutory accident benefits following a motor vehicle accident.
At a pre-hearing discussion, the applicant's representative sought to be removed from the record due to a breakdown in the relationship, as the applicant failed to respond to numerous attempts at contact.
The arbitrator granted the representative's motion to withdraw without conditions.
Additionally, as the applicant appeared to have abandoned the arbitration, the arbitrator gave notice of the intention to dismiss the arbitration without a hearing on the grounds that the proceeding is frivolous, vexatious, or commenced in bad faith.
Motion for reinstatement of benefits dismissed; insurer not required to follow Bill 59 procedures for Bill 68 claim.
The applicant, who was injured in a 1991 motor vehicle accident, brought a motion seeking reinstatement of income replacement benefits.
He argued that the insurer improperly terminated his benefits by failing to comply with the notice requirements under sections 37 and 49 of the Statutory Accident Benefits Schedule (Bill 59).
The arbitrator dismissed the motion, finding that the applicant's claims arose under the Bill 68 Schedule, which was in effect at the time of the accident.
As Bill 68 did not contain the procedural requirements found in Bill 59, the insurer was not required to follow them when terminating the benefits.
Insurer's motion for a stay pending late-requested medical assessments dismissed as unauthorized and prejudicial.
The insurer brought a pre-hearing motion seeking a stay of the arbitration until the insured attended three requested medical assessments under section 42 of the Statutory Accident Benefits Schedule.
The insured had refused to attend the assessments, which were requested approximately two months prior to the scheduled arbitration hearing.
The arbitrator found that the assessments were not authorized by section 42, as they were requested long after the issue of post-104-week income replacement benefits had crystallized.
The arbitrator concluded that the assessments were sought to buttress the insurer's case rather than to determine entitlement, and that the late request would cause prejudice to the insured.
The motion for a stay was dismissed.
Claims for non-earner and attendant care benefits dismissed due to insufficient evidence of impairment.
The applicant, a 74-year-old pedestrian, was struck by a vehicle and sustained injuries including a fractured knee.
He later passed away from unrelated causes.
His Estate sought non-earner and attendant care benefits.
The arbitrator dismissed the claims, finding that the applicant did not suffer a complete inability to carry on a normal life, as he resumed most pre-accident activities after his cast was removed.
The claim for attendant care benefits was also dismissed due to a lack of evidence regarding the services provided, by whom, and for what period, as no Form 1 was submitted.
Motion to reopen arbitration hearing to introduce fresh evidence of a subsequent injury granted.
The applicant sought to reopen an arbitration hearing to introduce fresh evidence regarding a fall and subsequent injuries that occurred after the conclusion of the evidence but before closing arguments.
The applicant claimed the fall was related to the motor vehicle accident and affected her ongoing entitlement to income replacement benefits.
The arbitrator applied the Palmer test for fresh evidence and granted the motion, finding that the circumstances were exceptional and the new evidence was relevant, reasonably capable of belief, and could affect the result.
Arbitrator lacks jurisdiction to order costs against a former representative summonsed as a witness.
The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.
The parties resolved the substantive issues and consented to dismiss the arbitration with costs of $500 payable to the insurer.
A preliminary issue arose regarding a joint motion by the parties seeking an expense order against the applicant's former representative, who had been summonsed as a witness but failed to attend the initial hearing date due to illness without notifying counsel.
The arbitrator dismissed the motion, finding no statutory authority under section 282(11.2) of the Insurance Act to award expenses against a non-party or a former representative who was summonsed merely as a witness.
Insurer's request for a section 42 neurological assessment denied due to defective notice and prejudicial timing.
The applicant was injured in a motor vehicle accident and received statutory accident benefits until they were terminated by the insurer.
The insurer subsequently sought to compel the applicant to attend a neurological assessment under section 42 of the Statutory Accident Benefits Schedule, shortly before the scheduled arbitration hearing.
The applicant refused to attend, arguing the assessment was not authorized.
The arbitrator found that the insurer's notice was technically defective because it failed to link the assessment to a specific benefit claimed and did not warn of the consequences of non-attendance.
Furthermore, the timing of the request was highly prejudicial to the applicant, as the insurer had notice of the potential brain injury months earlier but delayed its request until the eve of the arbitration.
The arbitrator ruled the assessment was not authorized.
Insurer ordered to produce accident benefits file up to mediation date; insurer's medical assessment request denied.
The applicant, who was injured in a motor vehicle accident, sought production of the insurer's entire accident benefits file, including adjusters' notes, internal memoranda, and solicitor-client communications.
The insurer claimed litigation and solicitor-client privilege.
The arbitrator ordered production of the file up to the date the issues were referred to mediation, finding that the insurer failed to establish that the dominant purpose of the documents created before that date was for litigation or that legal advice was sought.
The insurer's cross-motion for a medical assessment under section 42 of the Schedule was dismissed, as the arbitrator found it was sought primarily to bolster the insurer's case at the upcoming arbitration rather than to determine entitlement to a benefit.
Caregiver benefit denied because applicant did not reside with her brother in the mental health facility.
The applicant was injured in a motor vehicle accident and applied for a caregiver benefit under section 13 of the Statutory Accident Benefits Schedule, claiming she was the primary caregiver for her adult brother who suffers from schizophrenia and resides in a mental health facility.
The arbitrator found that the applicant did not qualify for the benefit because she did not reside with her brother, as required by the Schedule, and because the facility staff, rather than the applicant, provided the primary caregiving services.
The preliminary issue was resolved in favour of the insurer.
Arbitration dismissed and expenses awarded to insurer after applicant failed to attend the hearing.
The Applicant applied for statutory accident benefits following a motor vehicle accident.
When the matter proceeded to an arbitration hearing, the Applicant failed to attend.
The Arbitrator dismissed the application for arbitration due to the Applicant's failure to lead evidence.
The Insurer sought its expenses and a special award for a frivolous or vexatious proceeding.
The Arbitrator ordered the Applicant to pay the Insurer's reasonable expenses of $2,554.89 but declined to order a penalty for a frivolous proceeding because the relevant statutory provision had been repealed and the Insurer failed to provide advance notice of the claim.
Interim income replacement benefits ordered where insurer failed to comply with termination provisions of the Schedule.
The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them.
The applicant brought a motion for interim benefits pending the resolution of the dispute.
The insurer ultimately did not oppose the order for interim benefits but sought a ruling on whether an interim benefits order is available where an insurer is already paying the benefits, relying on a previous decision.
The arbitrator ordered the insurer to pay interim income replacement benefits, finding that the insurer failed to comply with the Schedule when terminating the benefits, and distinguished the previous decision relied upon by the insurer.
The claim for a special award was dismissed on consent.
Applicant ordered to pay insurer's expenses and a $3,000 penalty for commencing a frivolous arbitration.
After failing to attend an insurer's examination and failing to return required forms, the insurer raised preliminary issues.
The applicant and her representative failed to attend the preliminary issue hearing.
The insurer sought its expenses of the arbitration and a special award under section 282(11.2) of the Insurance Act.
The arbitrator found that the applicant had authorized the arbitration but subsequently failed to participate, making the proceeding frivolous and an abuse of process.
The applicant was ordered to pay the insurer's reasonable expenses of $6,965.21 and an additional $3,000 for commencing a frivolous arbitration.
Insurer not bound by pre-104 week positive DAC for post-104 week benefits, but cannot terminate based merely on changed medical condition.
The applicant sought interim income replacement benefits after the insurer terminated them despite a positive disability Designated Assessment Centre (DAC) report.
The arbitrator held that an insurer is not bound by a pre-104 week positive DAC assessment for post-104 week benefits, as the test for entitlement changes significantly at that threshold.
However, the arbitrator ruled that a mere change in the insured's medical condition does not allow an insurer to bypass the dispute resolution process and terminate benefits contrary to a positive DAC, unless the change is as significant and material as the passage of the 104-week mark.
Applicant ordered to attend insurer's psychovocational assessment to ensure fairness after filing late expert report.
The applicant in a statutory accident benefits dispute served a late psychovocational assessment report shortly before the arbitration hearing.
The insurer brought a motion seeking an order that the applicant attend a psychovocational assessment by its own expert to respond to the late report.
The arbitrator granted the motion, holding that fairness and the arbitrator's duty to control the hearing process required that the insurer be given a reasonable opportunity to respond, which included an independent assessment of the applicant.
Applicant awarded ongoing income replacement benefits; HOOPP disability pension found not deductible from benefits.
The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits beyond the 104-week mark, as well as the cost of a golf cart as a rehabilitation expense.
The insurer terminated benefits, arguing the applicant's inability to work was due to a pre-existing back injury and that she was capable of working with accommodations.
The insurer also argued that the applicant's HOOPP disability pension should be deducted from any income replacement benefits.
The arbitrator found that the motor vehicle accident materially contributed to the applicant's impairments, rendering her completely unable to perform any suitable occupation.
The arbitrator also held that the HOOPP pension was not an income continuation plan or temporary disability benefit, and thus was not deductible.
The applicant was awarded ongoing income replacement benefits and the cost of the golf cart.
Arbitration dismissed with costs and penalty after finding applicant was not in the vehicle during the accident.
The applicant sought statutory accident benefits, claiming she was a passenger in a vehicle involved in a collision.
The insurer denied the claim, asserting she was not in the vehicle.
At the preliminary issue hearing, the applicant failed to appear.
The arbitrator accepted the evidence of the other driver and passenger, as well as the responding police officer, who all testified that there were only three people in the vehicle, none of whom was the applicant.
The application was dismissed.
The arbitrator awarded the insurer $2,668.33 in expenses and ordered the applicant to pay a $3,000 penalty for commencing a frivolous and vexatious arbitration based on a misrepresentation.
Applicant precluded from arbitration for failing to provide OCF-14; representative permitted to withdraw.
The insurer brought a preliminary motion arguing the applicant was precluded from proceeding to arbitration because she failed to attend scheduled insurer's examinations and failed to return an OCF-14 form required for a Designated Assessment Centre (DAC) assessment.
The applicant's representative also brought a motion to withdraw due to a breakdown in the relationship and the applicant's failure to provide a required authorization.
The arbitrator allowed the representative to withdraw without conditions.
On the preliminary issue, the arbitrator found that while the insurer's notice for the examinations was deficient, the applicant's failure to provide the OCF-14 constituted non-compliance with section 43(2) of the Schedule.
Consequently, the applicant was precluded from proceeding to mediation and arbitration for the disputed medical benefits.
Arbitration stayed pending pre-hearing to address multiple unmediated treatment plans and prevent multiplicity of proceedings.
The insurer brought a motion to stay the applicants' arbitration proceedings for statutory accident benefits until all outstanding, unmediated treatment plans were mediated and combined into a single proceeding.
The insurer also sought to exclude the applicants' representative.
The arbitrator granted a stay of the arbitrations pending the resumption of a pre-hearing to prevent a potential abuse of process and multiplicity of proceedings.
The requests to immediately add the unmediated plans and to exclude the representative were dismissed as premature and unwarranted, respectively.
The insurer was awarded $300 in expenses.