Denise Ashby

The applicant, who suffered a spinal cord injury in a snowmobile accident, sought production of the insurer's complete adjuster's file from the date of the Application for Mediation onwards.

The insurer argued that documents created after the mediation application were protected by litigation or solicitor-client privilege.

The arbitrator found that the adjuster's file was reasonably relevant to the ongoing dispute over catastrophic impairment and a special award.

The arbitrator rejected the presumption that the file is automatically privileged after the mediation application date, ordering the insurer to disclose the entire file or provide a specific list of documents with a rationale for any claims of privilege.

The applicant, injured in a motor vehicle accident, sought statutory accident benefits from the insurer.

After the insurer terminated and denied certain benefits, the applicant applied for arbitration and sought a special award, alleging bad faith.

As a preliminary issue, the applicant brought a motion for the production of information regarding the insurer's setting of reserve amounts for his claim.

The arbitrator ordered the insurer to disclose the reserve information, finding it relevant to the applicant's claim that the file was adjusted unreasonably and to the potential quantification of a special award.

The issue of expenses was deferred to the hearing arbitrator.

The insurer, T.T.C. Insurance Company Limited, brought a motion for the production of the Toronto Police Service's investigation file regarding a motor vehicle accident involving the deceased applicant.

The insurer denied statutory accident benefits on the basis that the deceased was not struck by a streetcar, and sought the police file to assess liability and determine the cause of injuries.

Neither the Estate nor the Toronto Police Service appeared at the motion.

The Arbitrator found that the requirements of Rule 67.7 of the Dispute Resolution Practice Code were met and ordered the Toronto Police Service to disclose its investigation file to the insurer.

The parties were ordered to bear their own expenses for the motion.

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

The insurer denied her claims for income replacement, medical, attendant care, and housekeeping benefits.

At arbitration, the arbitrator found that the applicant's injuries, which included her left hand, wrist, and knee, took her impairments outside the Pre-Approved Framework Guideline.

The arbitrator awarded income replacement benefits for a specific period of disability, medical benefits for chiropractic and physiotherapy treatment, and attendant care and housekeeping benefits, finding the expenses were reasonable, necessary, and adequately supported by medical evidence.

Interest was also awarded on the overdue benefits.

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

At the arbitration hearing, the applicant failed to attend and tendered no evidence in support of his claims for income replacement and housekeeping benefits.

The arbitrator dismissed the claims, finding the applicant failed to meet his burden of proof on a balance of probabilities.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which were denied by the insurer.

The parties resolved all outstanding issues prior to the arbitration hearing, leaving only the issue of expenses.

The applicant submitted a Bill of Costs for $8,544.13.

The arbitrator reviewed the claimed fees and disbursements, noting the lack of supporting dockets and the uncomplicated nature of the case.

The arbitrator reduced the claimed fees but allowed the disbursements in full, awarding the applicant a total of $6,628.75 in expenses.

Following a fatal motor vehicle accident, the deceased's partner and her two children applied for spousal and dependant death benefits.

The insurer initially denied the claims due to insufficient evidence of cohabitation and dependency.

The applicants sought interest on the delayed benefit payments and arbitration expenses.

The arbitrator found that the partner was not entitled to interest because she failed to correct an error in her initial statement regarding the cohabitation date, which prevented the insurer from determining entitlement.

However, the children were awarded interest as the insurer had sufficient evidence of their dependency but delayed payment.

The applicants were also awarded their arbitration expenses, and a further hearing was ordered to determine if a special award was warranted for the delayed payments to the children.

The applicant was injured in a motor vehicle accident and sought post-104 week income replacement benefits.

The insurer terminated benefits, arguing the applicant continued to operate his horse farm.

The arbitrator found that the applicant suffered from severe chronic pain and depression, rendering him completely unable to engage in any employment for which he was reasonably suited, including his pre-accident work as a truck driver and farmer.

The arbitrator awarded income replacement benefits at $400 per week, interest on overdue payments, and a $25,000 special award against the insurer for unreasonably terminating benefits without sufficient medical or vocational investigation.

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

After mediation failed, the applicant applied for arbitration and obtained medical reports from an orthopaedic surgeon and a chiropractor.

The parties settled the substantive issues but disputed whether the cost of the medical reports were payable as arbitration expenses.

The arbitrator found that the reports were commissioned in contemplation of the arbitration proceeding to meet the applicant's evidentiary burden, rather than as examination expenses under section 24 of the Schedule.

The insurer was ordered to pay $1,200 for each report as arbitration expenses under subsection 282(11) of the Insurance Act.

The applicant was injured in a motor vehicle accident and received income replacement benefits.

The insurer later claimed an overpayment and sought repayment under section 47 of the Statutory Accident Benefits Schedule.

The arbitrator held that subsection 47(3) creates a 12-month limitation period running from the first payment made in error, not a rolling limitation period.

Because the insurer failed to give notice within 12 months of the first erroneous payment, the applicant was not required to repay the overpaid benefits.

Following an arbitration decision where the applicant was partially successful in claiming statutory accident benefits, both parties sought their expenses.

The arbitrator found that the applicant's success was significant to her, and denying expenses would undermine the consumer protection purpose of the Insurance Act.

The applicant was awarded her expenses at the Legal Aid rate, totaling $6,092.02 for the arbitration and $500.00 for the expense hearing.

The insurer's claim for expenses was dismissed.

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

After filing for arbitration, the applicant's counsel lost contact with him, and he failed to participate in the proceedings or attend the pre-hearing.

The insurer brought a motion to dismiss the arbitration without a hearing under Rule 68 of the Dispute Resolution Practice Code, or alternatively, to deem it withdrawn under Rule 70.

The arbitrator found insufficient evidence of bad faith to dismiss under Rule 68 but concluded the applicant had abandoned his claim.

The arbitration was deemed withdrawn under Rule 70, and the applicant was ordered to pay $1,000 in expenses to the insurer.

The insurer brought a motion to dismiss the applicant's arbitration for statutory accident benefits without a hearing.

The parties had previously negotiated a settlement, but the applicant drafted his own release, which the insurer rejected, and the applicant subsequently ceased communicating with the Commission and the insurer.

The arbitrator found that the applicant's conduct did not meet the high threshold for dismissal under Rule 68 as frivolous, vexatious, or in bad faith.

However, the arbitrator concluded that the applicant had abandoned his claim and deemed the arbitration withdrawn pursuant to Rule 70.

The applicant was ordered to pay $1,000 in expenses to the insurer.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including medical, caregiver, and housekeeping benefits.

The insurer denied certain treatment plans and terminated the weekly benefits.

The arbitrator found that the chiropractic treatment incurred up to June 30, 2005, was reasonable and necessary, awarding $2,509.00 for medical benefits.

However, the claims for caregiver and housekeeping benefits were dismissed, as the applicant was not the primary caregiver and any substantial inability to perform housekeeping tasks had resolved prior to the termination of benefits.

The applicant was injured in a motor vehicle accident and suffered a brain injury and conversion disorder.

During settlement discussions, the issue of her mental capacity to proceed in the dispute resolution process was raised.

The arbitrator found, based on medical evidence, that the applicant was incapable of managing her property, appointing a representative, or conducting her own case.

The arbitrator appointed the applicant's husband to act on her behalf in the arbitration process, effective nunc pro tunc to the date the Application for Mediation was filed.

Following a decision denying the applicant's claim for statutory accident benefits, the arbitrator determined the quantum of expenses payable by the applicant to the insurer.

The insurer sought full indemnity of $5,569.41.

The arbitrator found the proceeding was not complex and the preparation time claimed was excessive.

The arbitrator fixed the insurer's fees at $2,000 inclusive of GST and allowed disbursements of $1,461.16 plus GST, for a total of $3,461.16.

Neither party was awarded expenses for the expense hearing itself.

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

The insurer terminated or denied various benefits, and the applicant later applied for mediation and arbitration.

The insurer raised a preliminary issue that the applicant was statute-barred from proceeding to arbitration due to the expiry of the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule.

The arbitrator found that the insurer provided clear and unequivocal notice of refusal for the income replacement, transportation, and housekeeping benefits, meaning the limitation period had expired for those claims.

However, the notice of refusal for certain medical benefits (chiropractic, physiotherapy, and massage therapy) was deficient, so the limitation period was not triggered, and the applicant could proceed to arbitration for those claims.

The arbitrator also ruled on claims for out-of-country treatment and an examination expense, allowing the latter to proceed due to an administrative error in invoice delivery.

Neither party was awarded expenses.

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

The insurer terminated weekly caregiver and housekeeping benefits and denied medical benefits.

The arbitrator found that the applicant was substantially disabled from engaging in most caregiving activities for a period, and later was able to assume lighter duties but not strenuous sports activities.

The arbitrator awarded partial caregiver and housekeeping benefits, as well as medical benefits for chiropractic treatment.

The insurer's claim for repayment of caregiver benefits was dismissed because the applicant was the primary caregiver.

Interest was awarded on the overdue benefits.

The applicant sought a spousal death benefit following the fatal injury of her partner in a motor vehicle accident.

The insurer denied the benefit, arguing she was not a spouse under the Insurance Act, and paid the benefit amount into court pursuant to section 271 of the Act.

The insurer argued this payment transferred jurisdiction to the Superior Court of Justice, precluding arbitration.

The arbitrator held that section 271 does not interfere with an insured's unfettered right to choose the forum for dispute resolution under section 281.

The applicant was not precluded from proceeding to arbitration, and the request to stay the arbitration was denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, and housekeeping benefits, which the insurer denied.

The arbitrator found that the applicant suffered from accident-related depression that substantially disabled her from performing the essential tasks of her employment and housekeeping for a limited period.

The applicant was awarded income replacement and housekeeping benefits for the period from March to June 2005, along with interest.

Claims for ongoing income replacement, further medical benefits, examination expenses, and a special award were dismissed.