Janette Mills

Following a successful arbitration for statutory accident benefits, the applicant sought an award for expenses.

The arbitrator found the applicant was entitled to expenses based on his success at the hearing.

Applying a 4:1 ratio for preparation to hearing time, the arbitrator awarded counsel fees at the legal aid rate, partial paralegal fees, and disbursements, totaling $17,023.43.

Following an arbitration decision regarding statutory accident benefits, both parties applied for their expenses.

The Insurer's application was filed outside the 30-day time limit under Rule 79.1 of the Dispute Resolution Practice Code, but the arbitrator exercised discretion to waive the time limit.

The arbitrator found that the Applicant was significantly successful in the main proceeding and that the Insurer's settlement offers were unreasonable.

Consequently, the Insurer was not entitled to its expenses.

The Applicant was awarded his expenses, including legal fees, disbursements, and expert witness fees, totaling $46,918.59.

The Applicant was injured in a motor vehicle accident and sought non-earner, attendant care, and medical benefits from the Insurer.

The arbitrator found that the Applicant did not suffer a complete inability to carry on a normal life, as she was able to participate in most of her pre-accident activities to some extent.

The claim for attendant care benefits was denied because the services provided by her son were not 'incurred' expenses, as there was no promise or legal obligation to pay him.

The claims for medical benefits were also dismissed because the treatment plans were not incurred, not signed by the Applicant, and not completed by a regulated health professional as required by the Schedule.

The Applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits from the Insurer.

The Insurer terminated IRBs and denied certain treatment plans.

The Arbitrator found that the Applicant suffered from chronic pain and was substantially unable to perform the essential tasks of his pre-accident employment, and completely unable to engage in any reasonably suited employment post-104 weeks, entitling him to ongoing IRBs.

The Arbitrator also approved the disputed medical benefits and the cost of an OCF-3 certificate.

Furthermore, the Arbitrator ordered the Insurer to pay a special award of 50% of the outstanding IRBs and interest, finding that the Insurer had unreasonably withheld payments by failing to assess quantum or pay IRBs despite the Applicant's eligibility.

Following an arbitration where the insured was unsuccessful on all issues, the parties requested an expense hearing.

The parties subsequently agreed on the quantum of expenses.

The Arbitrator ordered the insured to pay the insurer's expenses fixed at $12,289.81, inclusive of fees, disbursements, and HST, finding the agreed amount to be reasonable.

The Applicant was injured in a motor vehicle accident and sought accident benefits from the Insurer.

The Insurer determined that the Applicant's injuries fell within the Minor Injury Guideline (MIG) and paid the maximum $3,500 limit.

The Applicant argued that her pre-existing injuries, chronic pain, and psychological impairments warranted removal from the MIG.

The Arbitrator found that the Applicant failed to provide compelling evidence of a pre-existing condition that would prevent her from achieving maximal recovery within the MIG.

The Arbitrator also found no persuasive evidence of chronic pain or psychological impairment resulting from the accident.

As the Insurer had already paid the maximum amount under the MIG, the Applicant's claims for additional medical benefits and examination costs were dismissed.

The Applicant was injured in a motorcycle accident and sought accident benefits.

The parties agreed that the motorcycle was not actually insured at the time of the accident.

The Insurer argued that the Applicant was excluded from receiving benefits under s. 31(1)(a)(i) of the Schedule because he knew or ought reasonably to have known that the motorcycle was uninsured.

The Applicant had purchased what he believed to be insurance from a customer at his smoke shop on a First Nations reserve, paying partly in cash and partly by bartering cigarettes.

The Arbitrator found that the Applicant had a subjective belief that he had purchased legitimate insurance, and that this belief was objectively reasonable given that cash payments and bartering are accepted ways of life on the reserve.

The exclusion did not apply.

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

At the scheduled arbitration hearing, the applicant failed to attend.

Her counsel brought a motion to be removed from the record due to a complete breakdown in the solicitor-client relationship, as the applicant had not responded to numerous communications.

The arbitrator granted the motion to remove counsel.

The insurer requested that the application be dismissed due to the applicant's non-attendance and failure to provide requested productions.

The arbitrator dismissed the application, finding the applicant failed to meet her onus, and awarded the insurer $567.30 in expenses.

The applicant, a minor at the time of the motor vehicle accident, applied for non-earner benefits.

The insurer denied the claim and later argued the applicant was statute-barred from proceeding to arbitration because the limitation period had expired, asserting that the applicant's mother acted as a litigation guardian.

The arbitrator found that a parent acting as a representative or substitute decision-maker is not a litigation guardian under the Limitations Act, 2002, and therefore the limitation period did not begin to run until the applicant reached the age of majority.

The arbitrator also found that although the applicant did not file a Disability Certificate that met the criterion for non-earner benefits, she had provided sufficient information to establish a potential claim, allowing the application to proceed to arbitration.

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

The insurer terminated benefits and later requested an Examination Under Oath (EUO), which the applicant refused to attend, arguing the request was outside the 10-day limit in section 36(4) of the Schedule.

On a preliminary issue hearing, the Arbitrator held that the insurer is entitled to an EUO, as the 10-day limit does not restrict the ongoing right to request one under section 33.

However, following appellate authority, the Arbitrator found she lacked jurisdiction to compel attendance or adjourn the hearing sine die.

The insurer's remedy for non-attendance is the suspension of benefits.

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

The Insurer requested that the Applicant attend an independent medical examination (IME) with a psychiatrist to assess his treatment plan, Minor Injury Guideline applicability, and entitlement to non-earner benefits.

The Applicant failed to attend, arguing that the IME should be conducted by a psychologist, not a psychiatrist.

The Arbitrator found that there was a reasonable nexus between the Insurer's choice of a psychiatrist and the Applicant's injuries, given the overlap in specialties and the Applicant's pre- and post-accident psychiatric issues.

The Applicant is precluded from moving to an Arbitration Hearing until he complies with the scheduled IME.