Denise Ashby

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for caregiving, housekeeping, and home maintenance.

The insurer terminated these benefits, arguing the applicant failed to provide requested information under section 33 of the Schedule and that she was no longer disabled.

The arbitrator found that the applicant's pre-existing chronic pain was significantly exacerbated by the accident, resulting in a substantial inability to perform her pre-accident caregiving and housekeeping duties.

The arbitrator also held that the insurer's requests for additional medical information and an Election of Benefits were unreasonable, as the insurer already had sufficient information to determine entitlement.

The applicant was awarded the claimed benefits and interest on the overdue amounts.

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

The insurer initially denied certain medical benefits and examination expenses, leading the applicant to apply for arbitration.

At a pre-hearing discussion, the applicant brought a motion to withdraw his application because the insurer had paid the service provider and assessor directly, leaving no issues in dispute.

The insurer consented to the motion.

The arbitrator granted the motion to withdraw the application pursuant to Rule 70 of the Dispute Resolution Practice Code and closed the file.

The applicant's representative sought to be removed from the record due to an irreparable breakdown in the solicitor-client relationship.

The applicant opposed the removal, citing his inability to represent himself.

Applying the principles from R. v. Cunningham, the arbitrator granted the request to withdraw, noting that there were no scheduled proceedings requiring an adjournment and the withdrawal was sought for ethical reasons.

The arbitrator declined the insurer's request to order the representative to produce documents directly to the insurer, instead ordering the representative to release the file to the applicant to avoid prejudicing the applicant's ability to claim privilege.

Following a decision on statutory accident benefits where the applicants were partially successful, the applicants sought their expenses of the arbitration.

The insurer argued that the parties should bear their own costs.

The arbitrator found that the applicants were entitled to their expenses as they achieved partial success.

After assessing the bill of costs, including reductions for unsupported time claims and excessive supervision hours, the arbitrator ordered the insurer to pay the applicants $9,002.60 plus GST for their arbitration expenses.

The insurer brought a motion for production of various medical and financial records.

The applicant subsequently sought an adjournment of the hearing and an order to change his representative of record.

The arbitrator granted the change of representative and adjourned the hearing to allow new counsel to prepare.

On the production motion, the arbitrator ordered the applicant to produce specific diagnostic scan reports and clinical notes from certain treating physicians, but declined to order production of records beyond one year pre-accident, personal bank statements, or records from third parties who had not been given notice.

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

The insurer denied a non-earner benefit based on an initial disability certificate indicating the applicant did not suffer a complete inability to carry on a normal life.

More than two years later, the applicant submitted a new disability certificate supporting a complete inability and sought to arbitrate the denial.

The insurer argued the arbitration was statute-barred by the two-year limitation period.

The arbitrator held that the initial denial was not a valid refusal because there was no valid application for a non-earner benefit at that time, as the applicant had accepted his doctor's opinion that he was ineligible.

Therefore, the limitation period did not commence, and the applicant was not precluded from proceeding to arbitration.

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

The insurer denied benefits, and the applicant applied for arbitration at the Financial Services Commission of Ontario.

The insurer brought a preliminary motion to dismiss the arbitration on the basis that the applicant had an ongoing civil action in the Superior Court of Justice involving substantially the same issues.

The arbitrator applied the principles from King and Royal Insurance Company of Canada, finding that the civil action was broader in scope, there was no impediment to the court dealing with the accident benefits claims, and permitting the arbitration to proceed would unduly duplicate proceedings.

The application for arbitration was dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on a post-104 week disability assessment.

The applicant returned to work but later underwent surgery and sought reinstatement of benefits after his long-term disability benefits expired.

The insurer refused, and the applicant applied for arbitration.

The arbitrator held that the applicant was precluded from proceeding to arbitration because the application was filed beyond the two-year limitation period, which began to run when the insurer initially terminated the benefits.

The arbitrator rejected the argument that a change in circumstances allowed for a new application and a new limitation period.

The applicants, a husband and wife, were injured in a motor vehicle accident and sought statutory accident benefits from their insurer.

The insurer denied various claims for medical benefits, attendant care, and housekeeping.

At arbitration, the arbitrator awarded both applicants partial medical benefits for chiropractic treatment, finding the treatment reasonable and necessary given their chronic symptoms.

Claims for psychological counselling were denied due to a lack of objective evidence of improvement.

The wife was awarded attendant care and housekeeping benefits for a limited period based on in-home assessments by an occupational therapist.

The husband's claim for housekeeping benefits was dismissed as he was found capable of performing his pre-accident tasks.

The insurer was ordered to pay interest on the overdue benefits.

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

The Insurer denied a Treatment Plan and scheduled an in-home assessment.

The Applicant declined to participate in the assessment, citing lack of space and interference with his sister's work.

The Insurer argued the Applicant unreasonably declined to participate.

The Arbitrator found that the Applicant reasonably declined to participate because the assessment would interfere with his sister's work at home, and the Insurer's assessor compromised her professional neutrality by threatening the Applicant with consequences for non-participation.

The applicant's representative brought a motion to be removed from the record after losing contact with the applicant, who had left the country and failed to provide updated contact information.

The arbitrator found that the breakdown in communication prevented the representative from obtaining instructions, making it impossible to continue the representation.

The motion was granted, and the applicant was ordered to provide updated contact information and advise of her intentions regarding future representation.

The applicant sought arbitration for medical, attendant care, and housekeeping benefits following a motor vehicle accident.

The insurer argued the application was filed beyond the two-year limitation period.

The arbitrator found that the insurer's initial refusals were either not clear and unequivocal or failed to properly inform the applicant of the dispute resolution process as required by the Schedule and the rule in Smith v. Co-operators.

Consequently, the limitation period was not triggered or had not expired, and the applicant was not precluded from proceeding to arbitration.

The applicant sought to exclude the insurer from participating in the arbitration because it filed its response 12 days late.

The insurer brought a motion to extend the time to file its response under Rule 81 of the Dispute Resolution Practice Code.

The arbitrator found the delay was unintentional, the insurer had a potential defence on the merits, and the applicant suffered no prejudice.

The arbitrator extended the time for the insurer to file its response nunc pro tunc.

The applicant was awarded her expenses for the preliminary issue hearing in the amount of $532.44 plus GST.

The applicant's representative brought a motion to be removed from the record and to seal the motion record, arguing that the record contained information protected by solicitor-client privilege.

The representative had not served the motion record on the insurer.

The arbitrator ordered the representative to serve the motion record on the insurer, finding nothing within it that could not reasonably be disclosed.

The motion to be removed from the record and to seal the record was adjourned to be heard orally by the preliminary issue hearing arbitrator.

The applicant was injured in a motor vehicle accident and applied for income replacement and housekeeping benefits, which the insurer denied.

The insurer raised a preliminary issue, arguing the applicant was precluded from proceeding to arbitration because the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule had expired.

The arbitrator found that for the income replacement benefits, the limitation period did not begin to run until the insurer confirmed its refusal following a DAC assessment, making the application timely.

For the housekeeping benefits, the insurer's initial denial was equivocal and its subsequent denial lacked a proper basis, meaning neither constituted a valid refusal to trigger the limitation period.

The arbitrator concluded the applicant was not statute-barred from proceeding to arbitration.

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

After a history of failing to participate meaningfully in the arbitration process, the applicant failed to attend the scheduled hearing.

The arbitrator found that the insurer did not prove the applicant was precluded from proceeding under section 50(b) of the Schedule.

However, because the applicant presented no evidence, all claims for benefits were dismissed.

The applicant was ordered to pay the insurer's arbitration expenses of $1,311.08 due to his conduct.

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

The parties settled all issues except for expenses.

The insurer argued that its expenses from a preliminary issue hearing should be deducted from the applicant's expenses.

The arbitrator found that the release signed by the parties unambiguously required the insurer to pay the applicant's reasonable expenses.

The arbitrator awarded the applicant $35,430.00 for the arbitration expenses and an additional $150.00 for the expense hearing.

The applicant was found outside his truck after it struck three parked vehicles.

He suffered a severe stroke and later died.

His estate sought statutory accident benefits, arguing the stroke was caused by the collision or a panic-induced spike in blood pressure resulting from the collision.

The insurer argued the stroke occurred spontaneously prior to the collisions.

The arbitrator found that the applicant's panic reaction to the first impact caused a precipitous rise in blood pressure, which, combined with his susceptibility to stroke and possible head trauma, caused the stroke.

Therefore, the impairments were sustained as a result of an 'accident' under the Schedule.

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

A dispute arose regarding the calculation of his pre-accident earning capacity (PEC) and residual earning capacity (REC) for the purpose of determining his loss of earning capacity benefit (LECB).

The arbitrator determined the PEC based on the insurer's accountant's calculation of the best 52 weeks of income in the 156 weeks prior to the accident.

The REC was determined based on two REC DAC assessments, finding the applicant capable of working as a mechanical assembler and later as a warehouseman.

The arbitrator ordered the insurer to pay the calculated LECB amounts and interest on any outstanding benefits, but denied the applicant's claim for a special award.

The insurer brought a preliminary motion seeking an order that the insured attend orthopaedic and psychiatric examinations under section 42 of the Statutory Accident Benefits Schedule, and a stay of the arbitration proceedings pending her attendance.

The arbitrator found that the orthopaedic examination was not reasonably necessary, as the insurer already had sufficient medical information and there was no new diagnosis or change in condition.

However, the psychiatric examination was found to be reasonably necessary because the insured's physician had recommended it and she had not yet been psychiatrically assessed in respect of the proceedings.

The arbitration was stayed pending the insured's attendance at the psychiatric assessment.