Fred Sampliner

The applicant was seriously injured in a motorcycle accident and received income replacement benefits until the insurer terminated them in March 2010.

The applicant sought ongoing benefits, arguing he was completely unable to engage in suitable employment until he completed computer repair training.

The insurer relied on surveillance and medical assessments to argue he could return to light sedentary work.

The arbitrator found that the applicant's completion of high school equivalency and demonstrated ability to sit for extended periods during commutes and classes indicated he was capable of resuming sedentary office work by September 2012.

Income replacement benefits were awarded for the closed period from March 2010 to September 2012.

The claim for a special award was dismissed, as the insurer's reliance on surveillance to terminate benefits was reasonable.

The insurer brought a motion to dismiss the applicant's claims for statutory accident benefits after the applicant failed to communicate with his former counsel, failed to attend a pre-hearing, and failed to attend the motion hearing.

The arbitrator found the arbitration to be frivolous due to the applicant's failure to appear or file any supporting material.

The applicant's claims were dismissed, and the insurer was awarded $400 for its expenses of the arbitration.

Three family members sought statutory accident benefits following a minor motor vehicle collision.

The arbitrator dismissed all claims for income replacement, caregiver, attendant care, housekeeping, and medical/rehabilitation benefits.

The arbitrator found the applicants were not credible, relying heavily on surveillance evidence that contradicted their reported disabilities.

Furthermore, the applicants' expert medical evidence was rejected due to altered clinical records, failure of experts to testify, and reliance on inaccurate self-reporting.

Claims for interest, a special award, and arbitration expenses were also dismissed.

The applicant sought his expenses of the arbitration after being granted income replacement benefits but denied other claims.

The insurer sought reimbursement of its expenses, arguing the applicant prolonged and obstructed the process.

The arbitrator found no evidence of delay or obstruction by the applicant and noted his modest success entitled him to a modest recovery of expenses.

The arbitrator applied a ratio method to reduce the claimed legal fees and disallowed or reduced several disbursements, including rejecting an expert report that violated the expert's duty to the Tribunal.

The insurer was ordered to pay the applicant $18,918.77 for his arbitration expenses.

The Applicants claimed statutory accident benefits following an alleged motor vehicle accident.

The Insurer denied the claims on the basis that the Applicants were not involved in the accident.

At the preliminary issue hearing, the Applicants failed to appear or provide evidence.

The Arbitrator accepted the Insurer's evidence, including an examination under oath of the driver, which confirmed the Applicants were not passengers in the vehicle.

The claims were dismissed, and the Applicants were ordered to pay the Insurer's arbitration expenses.

The applicant sustained catastrophic injuries, including a traumatic brain injury, in a motor vehicle accident.

A dispute arose regarding the quantum of attendant care benefits under section 16 of the Statutory Accident Benefits Schedule.

The insurer reduced benefits from $6,000 to $2,132 per month, arguing the applicant's increased needs were due to post-accident drug abuse and traffic charges rather than the accident.

The arbitrator found the drug abuse was caused by the accident and that the applicant required 24-hour supervision until his rehabilitation stabilized in early 2011.

The applicant was awarded $6,000 per month for the disputed period up to March 2011, and $2,132 per month ongoing thereafter.

The applicant's counsel brought a motion to be removed from the record in a statutory accident benefits arbitration.

The counsel provided evidence that the applicant had not responded to numerous letters, telephone calls, and emails over several months.

The applicant did not attend the motion hearing or object to the request.

The arbitrator found that the lawyer-client relationship had broken down and granted the motion to remove counsel from the record.

The applicant sought accident benefits after his vehicle struck an unknown object on the highway, causing mechanical failure and alleged soft tissue injuries.

The insurer denied the claim, arguing no accident occurred and the applicant was not injured, relying on an engineering expert and the applicant's initial statements.

The arbitrator found the applicant's version of events was corroborated by reliable records and that his initial statements were affected by a language barrier.

The arbitrator concluded the applicant suffered an impairment as a result of the accident and ordered the insurer to pay $500 in expenses for the preliminary issue hearing.

The applicant, injured in a motor vehicle accident, sought an order for the production of various internal documents from the insurer, including re-insurance records, committee minutes, adjusters' performance reviews, and the file of the broker who arranged the insurer's medical examinations.

The arbitrator dismissed the request, noting that the arbitration process is intended to be more expedient and restricted in scope than the court system.

The applicant had not claimed a special award, and there was no evidence that a re-insurer was involved in adjusting the claim or that the broker had edited medical reports.

The requested productions were deemed irrelevant and contrary to the efficiency goals of the arbitration process.

The insurer sought its expenses of the arbitration process after successfully appealing a preliminary decision that had allowed the insured to continue his claims for statutory accident benefits.

The Director's Delegate had ruled on appeal that the insured was excluded from the Schedule and properly belonged under the Workplace Safety and Insurance Act.

The arbitrator found that the insurer had the greatest degree of success and was entitled to its expenses.

The arbitrator awarded the insurer $1,246.14 for legal fees, deferring the issue of disbursements to the Director's Delegate.

The applicant sought statutory accident benefits following two motor vehicle accidents in 2007.

The arbitrator found the applicant's evidence to be unreliable due to poor recall and contradictions with documentary evidence, including Ontario Works records showing he had returned to work.

Relying on the medical evidence, particularly the applicant's orthopaedic surgeon, the arbitrator concluded the applicant suffered a complete inability to engage in suitable employment for a limited period.

The applicant was awarded income replacement benefits from July 7, 2009, to August 1, 2010, but his claims for various assessment costs and a special award were dismissed.

The applicant's law firm brought a motion to be removed as legal counsel, citing an inability to obtain instructions and a breakdown in the solicitor-client relationship.

The arbitrator denied the motion, finding that allowing counsel to withdraw at this critical stage—when the applicant faced a $13,512.61 expense claim from the insurer—would leave the applicant significantly disadvantaged and bring the administration of justice into disrepute.

The law firm was ordered to continue representing the applicant and file reply submissions.

The applicant was struck by a car and claimed statutory accident benefits.

At the hearing, the insurer conceded the applicant suffered a catastrophic impairment due to a mental or behavioural disorder.

The parties disputed the quantum of attendant care benefits.

The applicant sought the maximum $6,000 per month based on an occupational therapy assessment recommending 24-hour care, while the insurer argued for approximately $2,000 per month based on surveillance footage showing greater independence.

The arbitrator awarded $2,987.47 per month, preferring the insurer's second expert regarding supervisory care but rejecting her reductions for personal hygiene.

The arbitrator also ordered a $6,000 special award against the insurer for unreasonably withholding the differential attendant care benefits for 15 months without seeking a professional review of its own expert's maximum-care recommendation.

The insurer applied to vary or revoke a 2007 order to pay income replacement benefits, but sought to withdraw the application during the hearing, claiming its psychological expert changed his opinion.

The arbitrator allowed the withdrawal but imposed a term precluding the insurer from filing further applications regarding the 2007 order until it substantiated the expert's change of opinion.

The arbitrator also assessed the insured's expenses, awarding $18,204.83 for legal fees and disbursements, including reduced amounts for several expert reports that were deemed inefficient or of limited value.

The insurer applied to vary or revoke an order granting the insured ongoing income replacement benefits.

During the hearing, the insurer sought to withdraw its application after its psychological expert changed his opinion to support the insured's disability claim.

The insured opposed the withdrawal, seeking instead a dismissal with terms requiring the production of clinical notes and an addendum from the expert.

The arbitrator deferred ruling on the dismissal and expenses, but ordered the insurer to produce a written statement from its expert explaining the change in opinion, while allowing the parties to make further written submissions.

The applicant applied for arbitration at the Financial Services Commission of Ontario after being denied statutory accident benefits by the insurer following a motor vehicle accident.

The applicant claimed entitlement to caregiver benefits, assistive devices, housekeeping services, and examination costs.

Neither party attended the scheduled arbitration hearing nor submitted any evidence to support their respective claims.

Consequently, the arbitrator dismissed the applicant's claims for benefits and both parties' claims for arbitration expenses.

The applicant claimed lost educational expenses under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The applicant failed to attend the arbitration hearing, and the arbitrator initially proceeded and closed the hearing after refusing an adjournment.

However, upon realizing that the Commission had failed to provide the applicant with proper advance written notice of the hearing date, the arbitrator found that deciding the claim would violate due process.

The arbitrator ordered the hearing re-opened under Rule 43 of the Dispute Resolution Practice Code.

Following an arbitration decision regarding statutory accident benefits, both the applicant and the insurer claimed their arbitration expenses under subsection 282(11) of the Insurance Act.

The arbitrator denied both claims.

The insurer was largely successful but failed to make any settlement offer, which undercut the conciliatory nature of the process.

The applicant had a comparatively small degree of success and made an inflated settlement offer that did not encourage an amicable resolution.

Consequently, neither party was awarded expenses.

The applicant, a parking attendant, was injured when a car struck his booth.

He applied for both statutory accident benefits and WSIB benefits.

The WSIB denied his claim due to a lack of medical documentation, stating it was unable to allow the claim but would review additional information if submitted.

The insurer brought a motion arguing this was not a final decision and the applicant was precluded from receiving accident benefits under section 59(1) of the Statutory Accident Benefits Schedule.

The Arbitrator held that the WSIB letter was a final appealable order denying entitlement, and therefore the applicant was not precluded from pursuing his claim for statutory accident benefits.

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

The insurer brought a motion to exclude the applicant from receiving income replacement and housekeeping benefits under s. 30(1)(a) of the Schedule, arguing he knew or ought reasonably to have known he was driving without insurance.

The applicant's policy had been cancelled for non-payment, but he denied receiving the registered cancellation letter or being informed of the cancellation by his broker.

The arbitrator found that the insurer failed to prove the applicant received the cancellation notice or was clearly informed of the cancellation.

The arbitrator concluded the applicant reasonably believed his policy was still in effect and dismissed the insurer's motion.