Jeffrey Rogers

The applicant applied for statutory accident benefits following a motor vehicle accident, which the insurer denied on the basis that she was not involved in an 'accident'.

The applicant failed to attend the scheduled arbitration hearing.

Her representatives brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, and the insurer moved to dismiss the arbitration.

The arbitrator granted both motions, removing the representatives from the record and dismissing the arbitration due to the applicant's failure to present evidence.

The applicant was injured in a motor vehicle accident and submitted an Application for Accident Benefits along with a Disability Certificate that marked non-earner benefits (NEBs) as 'N/A'.

The insurer purported to terminate NEBs in December 2006.

The applicant applied for mediation more than two years later.

The insurer argued the claim was statute-barred.

The arbitrator held that the limitation period was not triggered because the applicant had not submitted a completed application for NEBs at the time of the purported denial.

The applicant was therefore not precluded from proceeding to arbitration.

Following a finding that the applicant sustained a catastrophic impairment in a motor vehicle accident, the parties disputed the quantum of arbitration expenses.

The applicant claimed $99,184.04, including a premium for beating an offer to settle.

The arbitrator rejected the claim for a premium, finding no jurisdiction to award it.

Applying a 4:1 ratio for preparation to hearing time, the arbitrator assessed reasonable legal fees and disbursements, ultimately awarding the applicant $28,890.86 inclusive of HST.

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

Following a dispute, the applicant applied for arbitration at the Financial Services Commission of Ontario.

The applicant's counsel was removed from the record at a pre-hearing discussion, and the applicant subsequently failed to attend the rescheduled pre-hearing and the arbitration hearing itself.

The arbitrator dismissed the application for arbitration due to the applicant's non-attendance and failure to provide evidence to support the claims.

The insurer was awarded $1,000 in expenses based on its complete success.

The applicant, who was injured in a motor vehicle accident, applied for statutory accident benefits.

After his counsel was removed from the record, the applicant represented himself but was found to lack the ability to meaningfully participate in the dispute resolution process.

The hearing was adjourned to allow him to seek representation or for the Public Guardian and Trustee to intervene.

When the applicant failed to attend the rescheduled hearing, the insurer requested that the arbitration be dismissed.

The arbitrator denied the request, finding it would be unfair to extinguish the applicant's rights while he lacked capacity, and instead ordered the arbitration stayed.

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

After disputes arose, the applicant applied for arbitration but failed to attend two pre-hearings and the scheduled hearing.

The arbitrator dismissed the application for arbitration due to the applicant's non-attendance and failure to provide evidence.

The insurer was awarded its expenses of the arbitration in the amount of $2,805.57, with legal fees limited to the applicable legal aid rate.

The applicant sought expenses following an arbitration hearing where he achieved partial success, primarily on the issue of income replacement benefits.

The insurer argued for a reduction in expenses to reflect this partial success and challenged certain witness fees.

The arbitrator allowed the witness fees as prudent preparation and found the preparation time reasonable.

However, recognizing that the applicant was unsuccessful on several other claims that consumed hearing time, the arbitrator reduced the recoverable counsel fees by 30% and disbursements by 10%.

The applicant was awarded total expenses of $35,084.75, including the costs of the expense hearing.

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

After disputes arose, he applied for arbitration but subsequently lost contact with his counsel and failed to attend two pre-hearings and the arbitration hearing.

The arbitrator dismissed the application for arbitration due to the applicant's failure to attend and failure to provide evidence to support his claims.

The insurer was awarded $1,600 in expenses.

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

The insurer refused to pay further benefits, arguing the applicant's election to opt out of WSIB benefits was made primarily to obtain statutory accident benefits.

A preliminary issue hearing was scheduled to determine the validity of the election.

The applicant failed to appear at the hearing despite proper notice.

As the applicant bore the onus of proving the validity of his election and failed to do so, the application for arbitration was dismissed.

The applicant was ordered to pay the insurer's expenses of $5,254.77.

The applicants sought statutory accident benefits following a motor vehicle collision.

The insurer denied the claims, alleging that the collision was staged and that the applicants wilfully misrepresented material facts.

At a preliminary issue hearing, the arbitrator considered evidence from the police officer, the occupants of the other vehicle, and accident reconstruction engineers.

The arbitrator rejected the insurer's theory that the collision was staged, finding no evidence of a conspiracy between the drivers and noting that the occupants of the other vehicle did not know the applicants.

The arbitrator concluded that the applicants were involved in an 'incident' within the meaning of section 2(1) of the Schedule and did not wilfully misrepresent material facts.

The issue of impairments was reserved for the main arbitration hearing.

The applicant was injured in a motor vehicle accident and claimed she sustained a catastrophic impairment due to a mental or behavioural disorder.

The insurer argued the accident was minor and her impairments were pre-existing or caused by unrelated post-accident stressors.

Applying the three-stage process from Pastore, the arbitrator found that the accident materially contributed to the applicant's diagnosed mental and behavioural disorders, including major depressive disorder and pain disorder.

The arbitrator preferred the evidence of the applicant's experts and the insurer's occupational therapist over the insurer's psychiatrist, concluding the applicant suffered a marked impairment in the sphere of deterioration or decompensation in work or worklike settings.

The applicant was deemed catastrophically impaired.

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

After his counsel was removed from the record, the applicant failed to provide written submissions or attend the scheduled arbitration hearing.

The arbitrator proceeded in the applicant's absence pursuant to Rule 37 of the Dispute Resolution Practice Code.

As the applicant presented no evidence to support his claims, the arbitration was dismissed.

The insurer was awarded its expenses of the arbitration in the amount of $1,114.67.

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

After her solicitors were removed from the record due to a breakdown in the solicitor-client relationship, the applicant failed to attend the scheduled hearing despite proper notice.

The arbitrator dismissed the application for arbitration due to the applicant's failure to present evidence and ordered her to pay the insurer's expenses in the amount of $1,289.53, calculated using the applicable Legal Aid Services Act rates.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including income replacement, attendant care, housekeeping, and medical benefits.

The arbitrator found that the applicant's left knee impairment was caused by the accident, despite pre-existing arthritis, and that his ongoing impairments rendered him completely unable to engage in any suitable employment, entitling him to ongoing income replacement benefits.

Claims for attendant care and medical benefits were dismissed as the applicant was independent in self-care and the proposed treatments were not reasonable and necessary.

Housekeeping benefits were granted in part.

The arbitrator also awarded interest at the rate of 2% per month under the Old SABS, finding that the transitional provisions of the New SABS did not erode the right to the old interest rate for benefits that became overdue.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs).

The insurer sent an Explanation of Benefits terminating the IRBs after the applicant returned to work.

More than two years later, the applicant sought reinstatement of IRBs after stopping work again.

The insurer argued the claim was statute-barred by the two-year limitation period.

The arbitrator found that the Explanation of Benefits was not a clear and unequivocal refusal because it contradictorily stated the applicant was both eligible and not eligible for IRBs.

Consequently, the limitation period was not triggered, and the applicant was not precluded from proceeding to arbitration.

Following the dismissal of the applicant's claim for statutory accident benefits, the insurer sought its expenses of the arbitration.

The arbitrator found that the insurer was completely successful and therefore entitled to its expenses, noting that there is no discretion to consider the applicant's inability to pay or dire financial circumstances.

The arbitrator reduced the claimed amount of $8,823.47 to $6,435.58, making deductions for hearing time wasted waiting for a court reporter, time spent on resolved issues, excessive law clerk rates, and excessive time claimed for a phase 1 report.

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

A dispute arose, and the applicant filed an Application for Mediation.

Due to a backlog at the Financial Services Commission of Ontario, a mediator was not appointed within the prescribed 60-day period.

The applicant subsequently filed an Application for Arbitration, arguing that mediation was deemed to have failed.

The insurer argued the application was premature because the 60-day period only begins when a mediator is appointed.

The Arbitrator held that an application is 'filed' when delivered to the Commission, and therefore mediation was deemed to have failed before the arbitration commenced.

The insurer brought a motion to compel the insured to attend orthopaedic and psychological assessments to determine ongoing entitlement to income replacement benefits after the 104-week mark.

The insured opposed, arguing the assessments were merely to bolster the insurer's case at arbitration.

The arbitrator found that the change in the entitlement test post-104 weeks constituted a change in circumstances, giving the insurer a prima facie right to the assessments.

The motion was granted, and the arbitration was ordered stayed if the insured failed to attend the scheduled assessments.

The insurer brought a motion to require the insured to attend an in-home assessment, a psychological assessment, and an orthopaedic assessment pursuant to section 42 of the Statutory Accident Benefits Schedule, and to stay the arbitration pending her attendance.

The insured had previously failed to attend the insurer's scheduled assessments, claiming they conflicted with her own.

The arbitrator found that the insured had conceded the assessments were reasonable and necessary by agreeing to attend them at a pre-hearing, and that allowing her to reverse this position would be procedurally unfair.

The arbitrator ordered the insured to attend the assessments and stayed the arbitration pending her attendance.

The applicant was injured in a motor vehicle accident and applied for a non-earner benefit but failed to submit a Disability Certificate for over a year.

The insurer denied benefits for the period prior to the submission of the certificate.

The arbitrator found that the applicant's drug addiction and mental illness, which severely impaired her motivation and ability to function, provided a reasonable explanation for the delay under section 31 of the Statutory Accident Benefits Schedule.

The applicant was therefore not precluded from claiming the benefit for the disputed period.