Fred Sampliner

The applicant, a public transit passenger, sought statutory accident benefits for soft tissue injuries sustained when his streetcar collided with a truck.

He claimed over $13,000 for chiropractic treatment and the cost of an examination report.

The arbitrator found that the applicant significantly exaggerated his injuries, relying on surveillance evidence that contradicted his severe complaints.

The treating chiropractor's evidence was rejected as unreliable.

However, based on an independent assessment recommendation, the arbitrator awarded $380 for four treatment sessions.

A $200 special award was also granted because the insurer unreasonably denied payment for those four recommended sessions.

The applicant was struck by a bus and claimed ongoing income replacement benefits for soft tissue injuries.

The arbitrator dismissed the claim, finding the applicant lacked credibility because she had returned to part-time work and full-time college studies involving physical activity without disclosing this to health assessors.

The insurer's claim for repayment of $1,741.28 in benefits was also dismissed because the insurer failed to provide the required repayment notice within twelve months.

The applicant, a 62-year-old homemaker with a history of pre-existing depression and anxiety, was injured in a pedestrian knockdown.

She sought statutory accident benefits, including non-earner benefits, attendant care, housekeeping, prescription medication, and costs of examinations.

The arbitrator found that the accident significantly exacerbated her psychological condition, profoundly compromising her ability to engage in rewarding pre-accident activities such as babysitting, reading, and taking long walks.

Applying a qualitative approach to the non-earner benefit test, the arbitrator concluded she suffered a complete inability to carry on a normal life and awarded ongoing non-earner benefits and prescription medication costs.

Claims for attendant care and housekeeping were dismissed due to insufficient evidence.

The cost of a neurological assessment was allowed, but an orthopaedic assessment was denied as it did not address accident benefits.

A claim for a special award was also dismissed.

The applicant, injured in a motor vehicle accident, sought production of the insurer's complete adjusting notes in her claim for statutory accident benefits.

The insurer refused to produce notes created after the date the applicant filed for mediation, claiming litigation privilege.

The arbitrator dismissed the motion, finding that litigation privilege applied to the adjusting records from the date of the mediation application, as legal action was imminent and the dominant purpose of the notes was preparation for conflict.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including income replacement, medical and rehabilitation, housekeeping, and examination costs, as well as a special award.

The arbitrator found that the applicant's post-accident earnings as a real estate agent were substantially higher than his pre-accident earnings, creating a strong presumption against a substantial inability to perform his essential job tasks.

Surveillance evidence also contradicted his claims of severe disability.

The arbitrator dismissed the claims for income replacement, housekeeping, examination costs, and a special award.

However, the arbitrator awarded limited medical and rehabilitation benefits, including reimbursement for nerve block injections, massage therapy, and prescription medications, finding them reasonable and necessary for palliative pain relief.

The applicant sought production of the insurer's adjusting notes up to the date of mediation in her claim for income replacement benefits following a motor vehicle accident.

The insurer had terminated benefits on the basis that her injuries were limited to a Grade II Whiplash Associated Disorder.

The applicant argued the notes were relevant to her claim for a special award, as medical evidence suggested her injuries fell outside the WAD II framework.

The arbitrator granted the motion, finding sufficient foundation to support the applicant's entitlement to review the claims handling process.

The applicant sought interim caregiver benefits following a motor vehicle accident, claiming he was unable to care for his sick mother-in-law.

The arbitrator dismissed the motion, finding the applicant failed to establish a prima facie case due to a lack of expert health care opinion comparing his pre- and post-accident abilities.

Furthermore, the applicant failed to demonstrate an urgent need for the benefits, as he had already paid for the services using savings and borrowed funds, and there was no evidence of ongoing need or demands for repayment.

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

The insurer denied further physiotherapy, and the applicant failed to attend two scheduled Designated Assessment Centre (DAC) appointments.

The insurer argued her claims should be barred.

On a preliminary issue, the arbitrator found the applicant had a reasonable excuse for missing the first appointment due to an emergency move to a shelter.

While she lacked a reasonable excuse for the second missed appointment, the insurer improperly demanded immediate cash repayment of DAC no-show fees before scheduling a third appointment, contrary to the Schedule.

The arbitrator ruled the applicant's claims for medical and rehabilitation benefits could proceed to a full hearing.

The applicant sought production of the insurer's post-mediation adjusting file in a dispute over statutory accident benefits.

The insurer claimed litigation and solicitor-client privilege over 18 portions of the file.

The arbitrator reviewed the unedited file and ordered production of the portions relating to ongoing payment of undisputed benefits, while upholding privilege over entries concerning reserves, litigation strategy, and communications with legal counsel.

The applicant sustained soft tissue injuries in a rear-end motor vehicle collision and sought statutory accident benefits, including caregiver benefits, housekeeping expenses, medical rehabilitation, and the cost of a digital motion x-ray (DMX).

The insurer denied the claims, arguing the applicant's injuries should have resolved within normal healing times.

The arbitrator found the applicant suffered a substantial inability to perform her pre-accident caregiver and heavier housekeeping duties for a limited period, awarding reduced amounts due to exaggerated claims.

The arbitrator also awarded partial medical and rehabilitation benefits, finding the applicant's pre-existing poor posture delayed her recovery beyond the standard guidelines.

The claim for the DMX test was dismissed, as the technique lacked general diagnostic approval in Canada, the expert promoting it lacked independence, and the test was conducted too remotely from the applicant's treatment period to be considered a reasonable expense.

The applicant was injured in a motor vehicle accident and sought payment for a physiotherapy treatment plan and an in-home assessment.

The insurer denied the claims, arguing the applicant's ongoing symptoms were related to pre-existing health conditions rather than the accident.

The arbitrator found that while some symptoms were pre-existing, the accident was a significant contributing factor to the applicant's shoulder and neck pain.

The arbitrator ordered the insurer to pay for the portion of the physiotherapy plan related to the neck and shoulders, as well as the cost of the in-home assessment.

The applicant was injured in a work-related motor vehicle accident and claimed accident benefits from the insurer pending determination of his eligibility for workers' compensation benefits.

The insurer paid some benefits but refused housekeeping and attendant care claims.

The Workplace Safety and Insurance Board subsequently accepted his eligibility, ending his claim for further accident benefits.

The arbitrator held that subsection 59(5) of the Schedule does not mandate the insurer to automatically pay all claims as submitted while workers' compensation eligibility is being determined.

The claims for accident benefits were dismissed, but the applicant was awarded $169 for arbitration expenses due to the novelty of the legal question.

In a pre-hearing dispute over document production for a statutory accident benefits arbitration, the applicant sought the insurer's post-mediation adjuster's notes, while the insurer sought the clinical notes of the applicant's treating psychiatrist.

The arbitrator held that mediation serves as a convenient dividing line for when parties are in an adversarial position, but litigation privilege does not automatically attach to all post-mediation adjuster's notes.

The arbitrator reviewed the notes and ordered production of those not protected by litigation or solicitor-client privilege.

The arbitrator also ordered the applicant to produce the psychiatrist's clinical notes, finding them relevant and noting no evidence that disclosure would harm the patient, but restricted the insurer from releasing them outside the health care practitioners involved in the arbitration.

Following the dismissal of the applicants' claims for statutory accident benefits, the insurer sought $9,309.94 for its expenses of the arbitration.

The arbitrator found the insurer was entitled to expenses because the applicants failed to withdraw their claims, necessitating an unnecessary hearing of uncontested evidence.

However, the arbitrator reduced the quantum claimed, finding the preparation time excessive given the simplicity of the issues and denying travel time for retaining out-of-town counsel without justification.

The insurer was awarded $4,720.75 in expenses.

The applicants claimed they were injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied the claims, alleging the accident did not occur.

The applicants failed to attend the arbitration hearing.

Relying on the insurer's expert evidence in accident reconstruction, which demonstrated that the physical damage to the vehicles was inconsistent with the applicants' description of the collision, the arbitrator concluded that the accident did not occur.

The claims for statutory accident benefits were dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them.

The applicant applied for arbitration.

The insurer scheduled a further medical examination with an orthopaedic specialist who had previously examined the applicant twice.

The applicant refused to attend.

On a preliminary issue, the arbitrator held that the scheduled examination was not reasonable, rejecting the insurer's argument that examinations are automatically reasonable after a significant passage of time.

As the expert had already rendered full opinions and there was no evidence of a change in the applicant's condition, the applicant's failure to attend had no consequences and she was permitted to proceed to the arbitration hearing.

The applicant sought to withdraw from arbitration after the parties resolved his claims for statutory accident benefits.

The insurer objected, seeking an order that the applicant pay its $3,000 assessment fee and arbitration expenses as a condition of withdrawal.

The arbitrator allowed the withdrawal, finding the claims were properly brought and resolved prior to the pre-hearing discussion.

The insurer's request for expenses was dismissed as the proceeding was not frivolous or vexatious, and the claim for the assessment fee was dismissed because the statutory provision authorizing it had been repealed.

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

The insurer terminated his weekly income replacement benefits, and the applicant applied for arbitration.

The insurer requested that the applicant attend updated examinations with its medical and psychological experts, which the applicant refused.

On a preliminary issue, the arbitrator held that the insurer's request was not reasonable under section 42 of the Statutory Accident Benefits Schedule, as the applicant's condition had not changed and the insurer merely sought to bolster its evidence for the hearing.

The applicant's refusal to attend had no consequence.

The applicant was injured in a motor vehicle accident and claimed housekeeping benefits, acupuncture treatment, and a special award.

The arbitrator found the applicant was entitled to $3,676 for housekeeping expenses, as she suffered a substantial inability to perform her household tasks for a period following the accident.

The claim for further acupuncture treatment was denied because the medical evidence emphasized regular exercise rather than passive therapies.

The claim for a special award was dismissed as the insurer's denial of benefits was supported by an expert opinion and was not unreasonable.

The applicant sought statutory accident benefits, claiming she was injured in a rear-end collision.

The applicant and her representative failed to attend the arbitration hearing.

The insurer presented expert forensic engineering evidence demonstrating that the physical damage to the vehicles was inconsistent with a collision having occurred.

The arbitrator accepted the expert evidence, found that no accident occurred, dismissed the claim for benefits, and ordered the applicant to pay the insurer's arbitration expenses.