Denise Ashby

The insurer sought its expenses of an arbitration proceeding against the applicant's former representative, Alon Rooz, personally.

The arbitrator found that the representative commenced the arbitration without the authority of the insured person, who had moved to Ukraine and had no knowledge of the claim.

The representative was ordered to personally pay the insurer's expenses of $4,621.17 pursuant to subsection 282(11.2) of the Insurance Act.

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 under Rule 10.3(a) of the Dispute Resolution Practice Code.

The arbitrator reviewed medical evidence and observed the applicant's participation in teleconferences, concluding that there was insufficient evidence to rebut the presumption of capacity.

The arbitrator found that the applicant had the mental capacity to proceed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic, massage, and active rehabilitation treatment.

The insurer denied the medical benefits, relying on a Designated Assessment Centre report that found only a portion of the treatment was reasonable and necessary, and that a transition to self-directed care was appropriate.

The arbitrator preferred the DAC assessor's opinion over the applicant's treating chiropractors, finding the applicant's experts failed to provide a rationale for the ongoing treatment.

The arbitrator also found that the applicant's right knee pain was unrelated to the accident.

The application for medical benefits was dismissed, and the applicant was found liable to pay the insurer's arbitration expenses.

The applicant was injured in a motor vehicle accident and sought ongoing caregiver benefits beyond the 104-week mark, claiming a complete inability to carry on a normal life due to chronic pain and depression.

The arbitrator found that the applicant's severe chronic pain disorder and major depression continuously prevented her from engaging in substantially all of her pre-accident activities, including caring for her three special needs children.

The arbitrator awarded the maximum weekly caregiver benefit of $350.00, plus interest, but denied the applicant's claim for a special award, finding the insurer's termination of benefits was not unreasonable based on the medical reports available at the time.

In a dispute over statutory accident benefits, both parties brought motions for the production of documents.

The insurer sought the applicant's employment and tax records to test the reliability of medical reports regarding work-related limitations.

The arbitrator ordered the applicant to produce employment records related to collateral medical benefits from one year pre-accident to the present.

The applicant sought the immediate production of all surveillance evidence obtained by the insurer.

The arbitrator held that surveillance information is subject to early disclosure to facilitate dispute resolution, finding that the applicant's interest in knowing the nature of the surveillance trumped the insurer's litigation privilege.

The insurer was ordered to produce existing and future surveillance information within 30 days.

The applicant failed to attend scheduled pre-hearings and ceased communicating with his counsel regarding his claim for statutory accident benefits.

The insurer brought a motion to dismiss the application without a hearing, and the applicant's counsel moved to be removed as representatives of record.

The arbitrator granted the counsel's motion to be removed.

Rather than dismissing the claim as frivolous or vexatious, the arbitrator deemed the application withdrawn under Rule 70 of the Dispute Resolution Practice Code.

The applicant was ordered to pay $1,000 in expenses to the insurer due to his failure to participate.

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

The arbitrator found that the accident materially contributed to the applicant's development of chronic pain syndrome, rendering her completely unable to engage in any employment for which she was reasonably suited.

The arbitrator awarded ongoing income replacement benefits and a closed period of housekeeping benefits, along with interest.

The claim for a special award was dismissed, as the insurer's actions, while mistaken, were not unreasonable given the complex medical history.

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

The insurer denied his entitlement to weekly income replacement benefits.

The applicant failed to attend the arbitration hearing despite receiving notice.

The arbitrator proceeded in his absence pursuant to Rule 37.7 of the Dispute Resolution Practice Code.

As the applicant presented no evidence, he failed to meet his burden of proof, and his claims were dismissed.

The applicant applied for arbitration at the Financial Services Commission of Ontario after the insurer terminated his statutory accident benefits.

The applicant failed to attend the hearing and presented no evidence to support his claims.

The arbitrator proceeded in his absence, dismissed his claims for income replacement benefits, medical benefits, and examination costs, and ordered him to pay the insurer's expenses fixed at $1,300.

The applicant, who was catastrophically injured in a motor vehicle accident and resides in a long-term care facility, sought additional attendant care benefits for personal care, financial management, and clothing care provided by his family.

The arbitrator found that the daily care provided by the facility was reasonable and adequate, denying additional daily personal care benefits.

However, the arbitrator awarded a nominal monthly amount of $37.10 for financial management and clothing care services provided by family members, interpreting section 16 of the Schedule conjunctively to allow concurrent expenses for a facility and an aide.

Claims for a special award were dismissed, but interest on overdue payments was granted.

The insurer brought a preliminary issue motion seeking an order that a proposed orthopaedic examination of the applicant is reasonably necessary under section 42 of the Statutory Accident Benefits Schedule.

The insurer argued the examination was needed to reassess its termination of the applicant's income replacement benefits, given contradictory opinions from a previous medical assessor.

The applicant opposed the motion, arguing there was no change in condition to warrant a further assessment.

The arbitrator found that the examination was reasonably necessary for the fair and effective adjusting of the claim, rather than to bolster the insurer's case for arbitration, and ordered the applicant to attend.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement, medical, and housekeeping benefits.

The applicant failed to attend the arbitration hearing or provide any evidence to support her claims.

The arbitrator relied on the insurer's medical evidence, which concluded the applicant suffered no objective impairment leading to disability.

The application was dismissed, and the applicant was ordered to pay the insurer's arbitration expenses.

The applicant, a self-employed hairstylist, was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer terminated his income replacement and housekeeping benefits.

The arbitrator found that the insurer's termination of the income replacement benefit was fatally flawed because it relied on a functional abilities evaluation that had not actually been conducted at the time of termination.

The applicant was awarded pre-104 week income replacement benefits, as his chronic pain substantially disabled him from performing the essential tasks of his employment, though he did not meet the post-104 week test of complete inability to engage in any suitable employment.

The arbitrator also awarded housekeeping and home maintenance benefits, the cost of an in-home assessment, and a special award of $2,000 against the insurer for unreasonably relying on the flawed termination notice.

The insurer brought a motion for preliminary issues seeking an order requiring the insured to produce a co-op placement file and attend three insurer examinations pursuant to section 42 of the Statutory Accident Benefits Schedule.

The insured consented to using best efforts to produce the file.

The arbitrator dismissed the request for the insurer examinations, finding that the insurer's notice was invalid due to incomprehensible wording and that the assessments were sought to bolster the insurer's case at the upcoming arbitration rather than to adjust the claim.

The insurer brought a motion to dismiss the applicant's claim for statutory accident benefits or to have it deemed withdrawn.

The applicant had returned to Ukraine in 2003 and did not attend the pre-hearing or the motion.

The arbitrator found no evidence that the application was frivolous, vexatious, or commenced in bad faith, but concluded that the applicant did not intend to pursue the claim.

The application was deemed withdrawn pursuant to Rule 70.3 of the Dispute Resolution Practice Code, and the insurer was awarded its expenses.

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

During a preliminary issue hearing, the applicant exhibited signs of mental difficulty, prompting the arbitrator to direct a hearing on his mental capacity to proceed.

The applicant brought a motion for interim expenses to retain counsel and undergo a capacity assessment.

The arbitrator granted the motion, awarding 5 hours of legal fees and up to $1,500 for a capacity assessment, finding that the applicant's mental difficulty constituted an extraordinary situation warranting interim expenses to ensure a fair hearing.

Each party was ordered to bear its own expenses for the motion.

The insurer brought a motion seeking an order that the claimant attend a neurological and psychiatric assessment under s. 42(3) of the Statutory Accident Benefits Schedule, and for an adjournment of the upcoming arbitration hearing.

The claimant opposed, arguing the assessment was sought for evidentiary purposes rather than to adjust the file.

The arbitrator found that the insurer had been aware of the potential need for such assessments since 2002 but failed to request them until shortly before the hearing, and offered to cancel the assessment if the claimant abandoned her neuropsychological claims.

The arbitrator concluded the assessment was sought to bolster the insurer's case at arbitration and was not reasonably necessary.

The motion was dismissed, and the insurer was ordered to pay $500 in expenses.

The applicant was injured in a motor vehicle accident and subsequently developed a severe psychiatric disorder, regressing to a child-like state.

She applied for catastrophic impairment designation and various statutory accident benefits, which the insurer denied, arguing her condition was pre-existing and unrelated to the accident.

The arbitrator preferred the evidence of the applicant's treating physicians and experts, finding that the accident materially contributed to her regressed state and that she suffered a catastrophic impairment.

The applicant was awarded post-104 week attendant care, housekeeping, and income replacement benefits, along with interest and arbitration expenses.

The insurer's claim for repayment of a without prejudice advance was dismissed.

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

The arbitrator found that the applicant was substantially disabled from his pre-accident employment as a vacuum installer due to an exacerbation of a pre-existing back condition, entitling him to income replacement benefits for the 104-week period.

However, he did not meet the test for a complete inability to engage in any employment thereafter.

The arbitrator also awarded partial medical benefits, noting the insurer failed to comply with the Schedule's procedures for denying treatment plans, but denied other medical benefits as not reasonable or necessary.

Interest and arbitration expenses were awarded to the applicant.

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

After failing to attend medical examinations, pre-hearings, and failing to communicate with his counsel, the insurer brought a motion to dismiss the application and sought expenses against both the applicant and his counsel.

The applicant's counsel also brought a motion to withdraw as representative of record.

The arbitrator deemed the application withdrawn due to the applicant's failure to pursue his claim.

The applicant's counsel was permitted to withdraw and was not held personally liable for the insurer's expenses, as they acted within the normal scope of representation.

The applicant was ordered to pay $750 in expenses to the insurer.