Edward Lee

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

After the applicant's counsel withdrew due to a breakdown in communication, the insurer moved to dismiss the application.

The arbitrator scheduled a hearing to give the applicant an opportunity to present evidence, but the applicant failed to attend.

The arbitrator dismissed the application for lack of participation and ordered the applicant to pay $1,000 in expenses to the insurer.

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

The matter proceeded to an arbitration hearing, but neither the applicant nor a representative attended.

As the applicant bore the burden of proof and failed to present any evidence or representations, the arbitrator dismissed the application for lack of participation.

The applicant dismissed his counsel during a teleconference and requested an adjournment of the scheduled hearing.

The insurer objected and sought costs thrown away against the former counsel personally, or alternatively against the applicant, arguing the proceeding was commenced without authority or was frivolous.

The arbitrator dismissed the motion for costs, finding no evidence that the application was commenced without authority or that it was frivolous, as the matter had not yet been adjudicated on the merits.

The arbitrator also found no evidence that any preparation costs were actually thrown away.

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

After failing to attend a pre-hearing discussion and the subsequent arbitration hearing, the applicant's counsel withdrew from the record, citing an inability to contact the applicant who had reportedly left the country.

As the applicant bore the burden of proof and presented no evidence, the insurer's request to dismiss the application was granted.

The applicant was ordered to pay $500 in expenses to the insurer.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to 29 treatment plans, attendant care, housekeeping, and examination costs.

The arbitrator found the applicant lacked credibility, noting he minimized pre-accident health issues and submitted false invoices.

The arbitrator rejected the applicant's expert evidence and found the claimed treatments were not reasonable or necessary.

However, six treatment plans totaling $6,398.23 were payable because the insurer failed to respond to them, resulting in deemed approval under the Schedule.

All other claims were dismissed.

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

The arbitrator found the applicant lacked credibility, noting numerous contradictions and inconsistencies in his testimony and medical evidence.

The applicant had resumed working as a personal fitness trainer and participating in bodybuilding competitions during the period he claimed to be disabled.

The claims for income replacement, attendant care, and housekeeping benefits were dismissed due to a lack of credible evidence.

However, the arbitrator approved one treatment plan for $3,510.00 and the cost of an MRI for $569.80, finding them reasonable and necessary based on the credible testimony of the treating chiropractor.

The applicant was entirely successful in a five-day arbitration regarding statutory accident benefits and was awarded expenses.

The parties could not agree on the quantum of expenses.

The arbitrator assessed the legal fees and disbursements, allowing the maximum hourly rate for counsel but reducing the claim for double-billed settlement discussions, travel time billed as legal fees, and certain disbursements such as interest charges and excessive overnight expenses.

Legal fees were fixed at $23,099.00 and disbursements at $31,094.43 plus GST/HST.

The applicant sought attendant care and housekeeping benefits following a motor vehicle accident, claiming services were provided by family members and a lawn care company.

The insurer denied the claims on the basis that the expenses were not 'incurred' under section 3(7)(e) of the Schedule because the family members did not sustain an economic loss and the lawn care company did not provide services in the course of its ordinary employment.

The arbitrator rejected the applicant's expert economic evidence that 'economic loss' includes mere loss of time or opportunity, finding it must relate to a financial or monetary loss.

The arbitrator concluded the family members failed to prove any economic loss and dismissed the claims for benefits and a special award.

The applicant, a minor at the time of the accident, sought to reopen his arbitration file and resume a pre-hearing discussion after a reported settlement failed to obtain court approval.

The insurer argued the file had been administratively dismissed by FSCO and that the applicant delayed too long in seeking to resume the matter.

The arbitrator found that the file was never closed, as court approval for the minor's settlement was never obtained and settlement funds were never paid.

The arbitrator held that the delay did not unduly prejudice the insurer and granted the motion to resume the pre-hearing discussion.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) after the insurer terminated them.

The insurer argued the applicant's pain complaints were not credible and lacked objective medical evidence.

The arbitrator found the applicant to be a credible witness whose testimony was corroborated by lay witnesses and medical professionals.

The arbitrator concluded the applicant suffered a substantial inability to perform his pre-accident employment and a complete inability to engage in any employment for which he is reasonably suited.

The applicant was awarded pre-104 week and post-104 week IRBs, interest, and arbitration expenses.

The applicant sought an interim order for income replacement and housekeeping benefits, arguing the insurer breached sections 37(1)(a) and 37(9) of the Statutory Accident Benefits Schedule when terminating her benefits.

The arbitrator held that a procedural breach of section 37(1)(a) alone, without evidence of a prima facie case, compelling need, or urgency, does not entitle an insured to an interim order for benefits.

The arbitrator also found that any breach of section 37(9) was irrelevant as the termination was based on a different medical report.

The motion for interim benefits was dismissed.

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

The insurer denied claims for physiotherapy, caregiving, housekeeping, and back cream.

The applicant applied for mediation more than two years after the denials.

The insurer argued the claims were statute-barred.

The arbitrator found that the Right to Dispute forms sent for the physiotherapy, caregiving, and housekeeping claims met the requirements for a valid refusal under Smith v. Co-operators, triggering the limitation period.

Therefore, those claims were statute-barred.

However, the arbitrator found that a valid refusal was not issued for the back cream claim, so it was not statute-barred and could proceed to arbitration.

The parties settled a statutory accident benefits dispute on the morning of the scheduled arbitration hearing.

As part of the settlement, the insurer agreed to pay the applicant's expenses, but the parties could not agree on the quantum.

The arbitrator reduced the preparation time claimed for one of the applicant's lawyers from 100.8 hours to 70.0 hours, finding the original amount somewhat high given that no hearing was conducted.

The arbitrator also reduced the disbursement claimed for an expert report to the $1,500 maximum permitted under the Expense Regulation.

The applicant was awarded total expenses of $14,653.71.

The applicant brought a motion for an order declaring that the in-person medical examinations proposed by the insurer to determine catastrophic impairment were not reasonably necessary.

The applicant argued that the insurer already had sufficient medical information from recent assessments for post 104-week income replacement benefits.

The arbitrator found that the tests for catastrophic impairment differ from those for post 104-week benefits, and the insurer reasonably required the new examinations.

The motion was dismissed, and the proceedings were stayed until the applicant attends the scheduled examinations.

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

The applicant's counsel was permitted to withdraw due to a complete breakdown in communications.

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

As the applicant bore the burden of proof and presented no evidence, the application was dismissed.

The applicant was injured in a motor vehicle accident and claimed income replacement benefits under the Statutory Accident Benefits Schedule.

The insurer terminated benefits, arguing the applicant was self-employed or a part-owner of the convenience store where she worked, rather than an employee.

The arbitrator found that the insurer was not estopped from raising the self-employment argument.

However, based on the credible testimony of the applicant and her witnesses, the arbitrator concluded she was an employee.

The lack of formal financial documentation was reasonably explained by the business operating on a First Nations reserve on a cash basis.

The applicant was awarded income replacement benefits of $400.00 per week.

The applicant was receiving income replacement benefits following a motor vehicle accident.

The insurer terminated these benefits based on a revised section 42 psychological report.

The applicant brought a preliminary issue arguing the insurer breached procedural requirements under sections 35, 37, and 42 of the Statutory Accident Benefits Schedule, and that this non-compliance entitled her to ongoing benefits.

The arbitrator found that the insurer did breach the procedural requirements by failing to provide timely notice and failing to request a new disability certificate.

However, applying appellate jurisprudence, the arbitrator held that these procedural flaws did not invalidate the clear and unequivocal notice of termination, nor did they automatically entitle the applicant to ongoing benefits.

The preliminary issue was dismissed, and the matter was ordered to proceed to a full hearing on the merits.

The parties sought costs following an arbitration hearing where the insurer successfully refuted the applicant's claims for statutory accident benefits.

The insurer also sought to make the applicant's representative personally liable for costs, which was dismissed on a summary judgment motion.

The arbitrator awarded the insurer $4,509.21 in expenses for the arbitration hearing, finding its claimed hours excessive and applying a 1:1 ratio for preparation to hearing time.

The arbitrator awarded the representative $500 for the summary judgment motion, finding the insurer's conduct unreasonable.

The arbitrator declined to allow the insurer to set off its costs award against the amount owed to the representative.

The insurer raised preliminary issues arguing that the insured's claims for a catastrophic impairment determination and post-104 week housekeeping benefits were barred by limitation periods, res judicata, and failure to bring claims in a timely fashion.

The Arbitrator held that there was no limitations defence for the catastrophic impairment claim, as no claim had been previously submitted and denied.

The catastrophic impairment claim was also not barred by res judicata from prior arbitration orders.

However, the claim for post-104 week housekeeping benefits was barred by res judicata, as it should have been raised during the final arbitration hearing before Arbitrator Rogers.

The Arbitrator also found no section 50 defence regarding timely notice.

Following an arbitration decision regarding statutory accident benefits where both parties achieved partial success, the parties made written submissions on expenses.

The arbitrator found that the insurer's degree of success was greater, having successfully refuted claims for housekeeping and a functional abilities evaluation, while sharing success on the income replacement benefit issue.

After deducting unallowable disbursements such as court reporting and preparation fees for expert witnesses, the arbitrator ordered the applicant to pay the insurer $3,000.00 in expenses.