Joyce Miller

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

The insurer terminated her income replacement benefits.

The applicant sought arbitration to determine her entitlement to post-104 week income replacement benefits.

The arbitrator found that although the applicant returned to work as a TTC fare collector and earned a comparable salary to her pre-accident employment, the new job did not reasonably reflect her pre-accident education, training, or experience.

The arbitrator concluded that the applicant met the post-104 week test and was entitled to ongoing income replacement benefits, less amounts earned.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for medical treatment, housekeeping, and the cost of an orthopaedic examination.

The insurer denied the claims based on an insurer's examination which concluded the applicant had sustained an uncomplicated soft tissue injury that did not require further treatment.

The arbitrator dismissed the application, finding the applicant failed to provide objective medical evidence or call treating practitioners to support his claims.

The arbitrator accepted the insurer's expert evidence and found the applicant's evidence regarding his living arrangements and housekeeping needs to be implausible and contradictory.

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

The insurer sent 28 notices stating that she did not qualify for non-earner benefits 'at this time'.

The insurer argued the applicant was barred from arbitration due to the two-year limitation period.

The arbitrator found that the insurer's notices were not clear and unequivocal denials, as they failed to provide a real basis for the refusal and the phrase 'at this time' created ambiguity.

Therefore, the limitation period had not begun to run, and the applicant was not precluded from proceeding to arbitration.

The applicant was involved in a motor vehicle accident in July 2007 but did not apply for statutory accident benefits until November 2008.

The insurer denied the claim for failing to comply with the time limits under section 32 of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant failed to provide a credible or reasonable explanation for the 16.5-month delay, noting numerous contradictions in his medical history and his initial report to the insurer that he suffered no injuries.

The application for accident benefits was dismissed.

Following the dismissal of the insurer's motion to stay the arbitration, the applicant sought her expenses for the motion and expenses 'thrown away' due to the delayed arbitration hearing.

The arbitrator found that the applicant was completely successful on the motion and that the delay was caused solely by the insurer's conduct.

The applicant was awarded her expenses in the amount of $6,034.20, inclusive of HST.

The applicant's counsel brought a motion to be removed as solicitors of record due to a breakdown in the solicitor-client relationship, citing substantial difficulties in communication and an inability to locate the applicant.

The respondent did not oppose the motion.

The arbitrator granted the motion, permitting Gluckstein & Associates LLP to withdraw as solicitors of record.

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

The insurer terminated the applicant's income replacement benefits and denied a treatment plan.

The applicant applied for mediation and subsequently arbitration.

The insurer raised a preliminary issue that the applications were filed beyond the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule.

The arbitrator found that the limitation period for the income replacement benefits commenced on the effective date of termination, not the date of the notice, making the application timely.

However, the application regarding the treatment plan was filed beyond the two-year limitation period and was therefore statute-barred.

Following a preliminary hearing where the applicant was found to be catastrophically impaired, the applicant sought arbitration expenses of $144,279.21.

The insurer disputed the amount, arguing the dockets were vague, excessive, and included non-compensable items.

The arbitrator agreed with the insurer's critique, noting the applicant's counsel unnecessarily lengthened the hearing by cross-examining the insurer's experts whose reports were already deficient, and provided superficial submissions.

Applying the principles of reasonableness and global assessment, the arbitrator fixed the applicant's expenses at $60,000 inclusive of taxes.

The applicant's counsel brought a motion to withdraw as solicitors of record due to a breakdown in the solicitor-client relationship.

The insurer took no position on the withdrawal but requested urgent notice regarding whether the upcoming hearing would proceed.

The applicant consented to the withdrawal.

The arbitrator granted the motion to withdraw without terms and adjourned the hearing on consent of the parties.

The applicant was injured in a hit-and-run motor vehicle accident and applied for statutory accident benefits from the Motor Vehicle Accident Claims Fund.

At the arbitration hearing, the applicant brought a motion to remove the Fund's counsel due to an alleged conflict of interest, which was dismissed.

In this subsequent decision on expenses, the Fund sought its costs for the motion.

The arbitrator found that the motion raised a novel issue regarding the Fund's practice of using the same counsel for tort and accident benefit claims without a 'Chinese Wall'.

Consequently, the arbitrator ordered that each party bear its own expenses.

The applicant's counsel brought a motion to be removed as solicitor of record due to a breakdown in the solicitor-client relationship.

The applicant did not attend the motion hearing despite being provided with proper notice.

The insurer did not object to the motion.

The arbitrator granted the motion, permitting the counsel to withdraw as solicitor of record pursuant to Rule 9.8 of the Dispute Resolution Practice Code.

The insurer brought a motion seeking an order to compel the insured to attend a section 44 insurer's examination, to stay the arbitration hearing, and to suspend interim income replacement benefits.

The insurer argued that the passage of the 104-week mark constituted a change in circumstances giving it a prima facie right to an assessment.

The Arbitrator dismissed the motion, finding that the insurer had ample notice of the post-104 week claim but unreasonably delayed its request for an examination until the eve of the resumed arbitration hearing, which prejudiced the insured.

The applicant's counsel brought a motion to withdraw as solicitor of record due to an irretrievable breakdown in the solicitor-client relationship.

The insurer did not object but requested that the withdrawal be subject to certain terms regarding notification of future representation, production of documents, and a revised timetable for a preliminary issue hearing.

The arbitrator granted the motion to withdraw and imposed the terms requested by the insurer.

The applicant brought a motion to remove the respondent's counsel and his law firm as solicitors of record due to an alleged conflict of interest.

The applicant argued that the same counsel could not represent the Motor Vehicle Accident Claims Fund in both the tort action and the statutory accident benefits claim.

The arbitrator dismissed the motion, finding no conflict of interest, as the counsel's only client was the Fund and there was no legal requirement for an insurer to retain separate solicitors for tort and accident benefits claims.

The applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment based on a Glasgow Coma Scale (GCS) score of 8.

The insurer denied the application, relying on an expert who opined that the score was invalid due to intubation and medications administered for surgery.

The arbitrator rejected the expert's opinion, finding that the expert ignored medical records showing the applicant was no longer intubated and that the medications would have cleared her system before the test.

The arbitrator concluded the GCS score was valid, accurate, and administered within a reasonable period of time, and therefore the applicant sustained a catastrophic impairment.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, claiming he was catastrophically impaired due to mental and behavioural disorders.

The insurer disputed the claim.

Following a lengthy arbitration hearing, the arbitrator found the applicant and his treating professionals to be highly credible, detailing a severe deterioration in his mental health, including major depression and suicidal ideation.

The arbitrator rejected the insurer's expert evidence as biased and superficial.

Applying the AMA Guides, the arbitrator concluded the applicant suffered marked impairments in multiple domains of functioning and was therefore catastrophically impaired pursuant to clause 2(1.2)(g) of the Schedule.

The applicant sought statutory accident benefits after slipping and falling on ice while traversing a snowbank immediately after parking and exiting her vehicle.

The insurer denied the claim, arguing the incident did not meet the definition of an 'accident' under section 2(1) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant was compelled to park at the access point due to the snowbank and was still in the process of disembarking when she fell.

The use or operation of the vehicle was a dominant feature and direct cause of her injuries.

The preliminary issue was resolved in favour of the applicant.

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

The insurer terminated weekly income replacement benefits.

An interim benefit order was previously made, but payments were suspended pending satisfaction of an overpayment.

The applicant requested the date the overpayment was satisfied and resumption of interim benefits.

The insurer's counsel did not respond to inquiries or make submissions opposing the request.

The arbitrator ordered the insurer to provide the date the overpayment was satisfied and to resume payment of interim income replacement benefits.

The applicant sought payment for an orthopaedic assessment, two chronic pain assessments, and housekeeping expenses following a motor vehicle accident.

The insurer argued that the orthopaedic assessment was not incurred, the chronic pain assessments were duplicative, and the housekeeping expenses had already been paid.

The arbitrator agreed with the insurer, finding that the orthopaedic assessment was not payable until incurred, the two chronic pain assessments were an unreasonable duplication of services, and the housekeeping expenses had been paid as evidenced by a cashed cheque.

The arbitration was dismissed.

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

After mediation failed, the applicant applied for arbitration but subsequently failed to attend two pre-hearings, a motion by his solicitors to be removed from the record, and the arbitration hearing itself.

The arbitrator found that the applicant had abandoned his claim and dismissed the arbitration without a hearing pursuant to Rule 68.1 of the Dispute Resolution Practice Code.

The insurer was awarded $1,000 in costs for its expenses.