Jeffrey Shapiro

Aviva sought repayment of $14,514 in Income Replacement Benefits (IRB) and $5,537 in insurer examination expenses from the respondent, whose auto policy was voided for failing to disclose that his partner, who had a poor driving record, had moved in with him.

The Tribunal found that the respondent intentionally failed to notify Aviva of a material change in risk, entitling Aviva to repayment of the IRB under s. 52(1)(b) of the Statutory Accident Benefits Schedule.

However, the Tribunal dismissed Aviva's claim for reimbursement of insurer examination expenses, finding no statutory basis for such recovery.

No costs were awarded.

The applicant was injured in a motor vehicle accident while in the course of her employment.

She initially received WSIB benefits but later de-elected to pursue a tort action and statutory accident benefits.

The insurer denied her accident benefits claim, arguing under s. 61 of the Schedule that her re-election was primarily for the purpose of claiming accident benefits.

The Tribunal found that the applicant's election was equally made to pursue a tort claim and accident benefits, and thus not primarily for claiming accident benefits.

The applicant was permitted to proceed with her claim for accident benefits.

The applicant was injured in a motor vehicle accident and sought payment for five chiropractic treatment plans outside the Minor Injury Guideline (MIG) limit.

The applicant argued that a compression fracture discovered two years post-accident removed him from the MIG.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the compression fracture was caused by the accident, relying on the timeline and independent medical examinations.

Consequently, the applicant's injuries remained subject to the MIG limit, and the claims for additional treatment plans and interest were dismissed.

The applicant appealed the insurer's denial of statutory accident benefits but withdrew the appeal during a case conference after the insurer alleged he had concealed a prior workplace injury.

The insurer subsequently brought a motion for costs under Rule 19, arguing the applicant's conduct amounted to bad faith.

The adjudicator dismissed the motion, finding the evidence did not establish that the applicant had sustained a significant workplace injury or that he had intentionally lied or acted in bad faith during the proceeding.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the $3,500 Minor Injury Guideline (MIG) limit.

The adjudicator found that while the applicant's physical injuries were predominantly soft-tissue and she did not suffer a diagnosable psychological impairment, she was nevertheless removed from the MIG limit because the insurer's notice failed to explicitly state its belief that the MIG applied, breaching section 38(9) of the Schedule.

Consequently, the applicant was awarded the outstanding balance of an incurred chiropractic plan and reimbursement for prescription expenses.

However, claims for a psychological assessment and a further chiropractic plan were dismissed as not reasonable and necessary.

The applicant sought various statutory accident benefits following a motor vehicle accident, including ongoing income replacement benefits, removal from the Minor Injury Guideline (MIG), and funding for treatment plans.

The adjudicator found significant credibility issues with the applicant's evidence, including inconsistencies regarding his post-accident employment and medical history.

The claim for ongoing income replacement benefits was dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment.

However, the adjudicator found that the insurer failed to comply with the procedural requirements of section 38 of the Schedule when responding to a chiropractic treatment plan.

As a result, the insurer was prohibited from taking the position that the MIG applied, and the chiropractic treatment plan was approved.

The remaining claims for prescriptions, a psychological assessment, and costs were dismissed.

The applicant sought Attendant Care Benefits (ACB) following a 2014 motor vehicle accident.

The insurer denied the claim, arguing the need for ACB arose from a subsequent, unrelated fall in 2015 where the applicant injured her knee while chasing her daughter.

The Tribunal found that the applicant failed to establish causation between the 2014 accident and the 2015 knee injury.

Furthermore, the Tribunal held that the applicant was not entitled to retroactive ACB because there was no urgency or impracticability preventing the timely submission of a Form-1.

The application for ACB was dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The insurer stopped paying IRBs and requested the applicant's income tax returns to verify his pre-accident income, which the applicant failed to produce.

At a Preliminary Issue Hearing held in writing, the arbitrator found that under section 4(5) of the Schedule, unreported income cannot be used to calculate IRBs, resulting in a quantum of zero.

The arbitrator concluded that maintaining the claim to the eve of the hearing without the required tax documents bordered on an abuse of process and dismissed the claim for IRBs.

Following a preliminary issue hearing where the insurer successfully argued that the applicant's claim for statutory accident benefits was barred by s. 268(1.1) of the Insurance Act, the parties made written submissions on expenses.

The insurer sought its legal expenses of $6,939.02, arguing it was wholly successful and had made a Rule 76 offer to settle.

The arbitrator found that the offer to settle was not a firm, binding offer and that the preliminary issue involved a novel interpretation of s. 268(1.1) with no direct precedent.

Balancing the insurer's success against the novelty of the issue and the modest amount in dispute, the arbitrator ordered that each party bear its own expenses.

The applicant, an 88-year-old pedestrian, was struck by a pole knocked over by a truck insured by the respondent.

She sought interim medical, rehabilitation, and attendant care benefits pending a full arbitration hearing to determine if she is catastrophically impaired.

The applicant had exhausted her non-catastrophic limits and required 24-hour care.

The arbitrator found that the applicant established a prima facie case for catastrophic impairment, noting that the insurer's own neurologist found severe cognitive impairment secondary to the accident, which was improperly omitted from the insurer's multidisciplinary whole person impairment rating.

Considering the applicant's financial hardship, the risk of irreparable harm, the low risk of prejudice to the insurer (who was also the tort insurer), and the delay in scheduling the hearing, the arbitrator granted interim benefits of up to $3,000 per month.

The applicant sought accident benefits following a motor vehicle accident but passed away after filing the application for arbitration.

His family did not open an estate or provide instructions to his legal representative.

The representative moved to be removed from the record, and the insurer moved to dismiss the application.

The arbitrator granted the representative's removal and deemed the application constructively withdrawn under Rule 70 of the Dispute Resolution Practice Code due to the family's non-participation, rather than dismissing it as frivolous or vexatious.

No costs were awarded.

The applicant was a passenger on a public transit bus that made a sudden stop to avoid a collision with another vehicle.

The bus did not collide with any object.

The applicant claimed statutory accident benefits from the insurer of the other vehicle.

The insurer denied the claim, arguing that s. 268(1.1) of the Insurance Act bars accident benefits for occupants of a public transit vehicle involved in a no-collision incident.

The arbitrator agreed, finding that the provision acts as a complete bar to statutory accident benefits from any source for such passengers.

The application for arbitration was barred.

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

After her counsel was removed from the record, the applicant failed to attend a pre-hearing discussion and the scheduled arbitration hearing, despite receiving notice.

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

The applicant was ordered to pay $500 in expenses to the insurer.

The Applicant sought to withdraw his Application for Arbitration for accident benefits after failing to comply with undertakings and orders to produce financial documents.

The Insurer opposed a withdrawal without costs and sought its expenses.

The Arbitrator granted the withdrawal pursuant to Rule 70.3 of the Dispute Resolution Practice Code and ordered the Applicant to pay $2,000 in expenses to the Insurer, noting the Applicant's conduct prolonged the proceeding but acknowledging the withdrawal was requested prior to the hearing.

The applicants sought statutory accident benefits following a 2007 motor vehicle accident.

After filing the applications for arbitration, the applicants' legal representative lost contact with them, and they failed to appear at scheduled pre-hearings or provide productions.

The representative moved to be removed from the record, and the insurer moved to dismiss the applications and sought costs against both the applicants and their representative.

The arbitrator granted the representative's motion to be removed due to a breakdown in the solicitor-client relationship.

The applications were dismissed as frivolous or vexatious under Rule 68 of the Dispute Resolution Practice Code due to the applicants' failure to participate.

The arbitrator awarded the insurer $500 in expenses against each applicant but declined to award costs against the representative, finding insufficient evidence on the record to conclude that the claims were entirely time-barred when filed.

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

After the applicant failed to attend a pre-hearing discussion and his counsel lost contact with him, counsel successfully moved to withdraw.

The insurer subsequently moved to dismiss the application for arbitration.

The arbitrator granted the motion to dismiss under Rule 68 of the Dispute Resolution Practice Code, finding the application frivolous, vexatious, or commenced in bad faith due to the applicant's failure to participate.

The insurer was awarded $750 in expenses.