Irvin H. Sherman

The applicant sought expenses following an arbitration hearing where she was successful on issues of catastrophic impairment and income replacement benefits, but unsuccessful on medical benefits and a special award.

The arbitrator applied Rule 75.2 of the Dispute Resolution Practice Code and reduced the applicant's claimed expenses by 40 percent due to divided success.

The arbitrator also disallowed certain disbursements, including duplicate claims for catastrophic assessment reports under both the Schedule and the DRPC, and the cost of a chiropractor's report whose treatment plans were found unreasonable.

The insurer was ordered to pay the applicant $55,572.80 in expenses, inclusive of disbursements and HST.

The applicant sought arbitration for entitlement to a non-earner benefit following a motor vehicle accident.

The insurer argued the application should be dismissed because it had never denied the benefit, having only requested a completed disability certificate (OCF-3) which the applicant failed to provide in a timely manner.

The arbitrator found that the applicant failed to adhere to the mandatory provisions of section 36 of the Schedule by not submitting the OCF-3, meaning there was no deemed denial of the benefit.

The application for arbitration was dismissed as statute-barred.

The insurer brought a motion arguing that the applicant's claim for a non-earner benefit was statute-barred because he failed to apply for mediation within two years of the insurer's refusal to pay.

The arbitrator found that the applicant had not actually applied for the non-earner benefit when the insurer issued its initial denial in 2013.

Therefore, the insurer could not validly refuse a benefit that had not been claimed.

The limitation period did not begin to run until the insurer's subsequent denial in 2015, making the applicant's mediation request timely.

The motion was dismissed.

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

The arbitrator found that the applicant sustained a catastrophic impairment due to a marked impairment in the adaptation domain (deterioration or decompensation in a work-like setting) under the AMA Guides.

The applicant was awarded ongoing income replacement benefits of $400 per week, as she suffered a complete inability to engage in any employment for which she was reasonably suited.

Claims for various medical benefits and a special award were dismissed.

The applicant's request for an anonymity order was also denied.

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

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

As the applicant bore the onus of proving entitlement to the claimed benefits and presented no evidence, the arbitrator dismissed the application for arbitration.

No expenses were awarded.

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

After his counsel was removed from the record due to a lack of instructions, the applicant failed to participate in the arbitration process or respond to communications from ADR Chambers.

The arbitrator dismissed the application for arbitration due to the applicant's failure to participate and ordered the applicant to pay the insurer's expenses fixed at $1,500.

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

A mediation was scheduled but the Applicant and her representative failed to attend without excuse.

The Insurer brought a motion to permanently stay the arbitration on the basis that the Applicant failed to participate in the mediation process, a statutory precondition to arbitration under the Insurance Act.

The Arbitrator agreed, finding that the Applicant's failure to attend meant the mediation did not take place, and therefore the statutory preconditions under sections 281(1) and (2) of the Insurance Act were not met.

The application for arbitration was permanently stayed.

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

After mediation failed, the applicant applied for arbitration.

The applicant's counsel was previously removed from the record due to a breakdown in the professional relationship.

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

The arbitrator dismissed the application for arbitration and ordered the applicant to pay the insurer's expenses fixed at $1,500.

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

At the scheduled arbitration hearing, the applicant failed to attend, and his counsel successfully moved to be removed from the record due to a breakdown in the solicitor-client relationship.

The hearing was adjourned, and the applicant was notified but failed to respond or attend the rescheduled hearing.

The insurer moved to dismiss the application.

The arbitrator granted the motion, dismissing the application for arbitration due to the applicant's failure to attend and pursue the claim, and awarded the insurer $2,000 in expenses.

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

The arbitrator found the applicant suffered a substantial inability to perform the essential tasks of her employment as an educational assistant and awarded pre-104 week income replacement benefits.

However, the arbitrator dismissed the claim for post-104 week income replacement benefits, finding the applicant did not suffer a complete inability to engage in suitable employment, as she had returned to work part-time.

The arbitrator also awarded medical benefits for assistive devices, including a soaker tub, mattress, ergonomic desk, and treadmill, but denied the claim for physiotherapy and yoga.