Joyce Miller

The insurer brought a motion for a third party production order to obtain unredacted records from the Children's Aid Society regarding the applicant's children.

The motion was brought on the eve of the arbitration hearing without complying with the notice and service requirements of Rule 67 of the Dispute Resolution Practice Code.

The arbitrator dismissed the motion, finding it to be frivolous, vexatious, and an abuse of process, as the insurer failed to provide any valid basis or extraordinary circumstances for the late request.

The applicant was completely successful in an arbitration regarding statutory accident benefits.

She sought her expenses for the arbitration hearing.

The arbitrator found that the applicant was entitled to her expenses, noting that the hearing involved a novel issue and required interpretation for witnesses, which increased preparation time.

The arbitrator awarded the applicant $45,470.25 for legal fees and $11,853.65 for disbursements, for a total of $57,323.90 inclusive of GST.

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

The insurer terminated her income replacement and housekeeping benefits.

In a preliminary decision, the arbitrator found the insurer failed to properly terminate the benefits under section 37 of the Schedule and ordered payment until proper termination.

In this decision, the applicant sought a special award under subsection 282(10) of the Insurance Act, arguing the insurer unreasonably withheld benefits.

The arbitrator dismissed the claim for a special award, finding that the insurer's reliance on its medical evidence and its failure to comply with section 37 did not amount to unreasonable behaviour.

The applicant brought a motion arguing that the insurer waived its right to deny she was an 'insured person' under a policy of insurance because the insurer requested she attend a section 42 medical examination and provide a disability certificate.

The arbitrator dismissed the motion, finding that an insurer has the right to request a section 42 examination as long as a claim for benefits continues, even if the claim has been denied.

The insurer's compliance with the legislative intent of the Schedule could not be construed as a waiver of its right to maintain its position that the applicant was not involved in an 'accident'.

The applicant sought statutory accident benefits, alleging she was injured when her arm was caught in the doors of a TTC bus and she was dragged.

The insurer denied the claim on the basis that no such accident occurred.

The arbitrator found the applicant's uncorroborated evidence to be vague, contradictory, and implausible.

The arbitrator concluded that the applicant failed to prove on a balance of probabilities that she was injured as a result of an 'accident' as defined in section 2(1) of the Schedule.

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

The insurer denied two treatment plans and raised a preliminary issue regarding the applicant's failure to attend an insurer's examination.

The insurer later sought to withdraw the preliminary issue after learning the applicant had not received notice of the examination.

The applicant requested $500 in costs as a condition of the withdrawal.

The arbitrator found the insurer's initial request for a preliminary issue was not improper or vexatious, and permitted the insurer to withdraw the issue without terms.

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

The Insurer denied his claim for four treatment plans, and the Applicant applied for arbitration.

Prior to the pre-hearing, the Applicant indicated he no longer wished to proceed and his representative was removed from the record.

The Applicant failed to attend the pre-hearing.

The Insurer did not oppose the withdrawal and did not seek costs.

The Arbitrator deemed the Application for Arbitration withdrawn pursuant to Rule 70.2 of the Dispute Resolution Practice Code.

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

The insurer terminated her income replacement and housekeeping benefits after conducting section 42 insurer's examinations.

However, the insurer did not request a new, up-to-date disability certificate before scheduling these examinations, as required by section 37(1) of the Statutory Accident Benefits Schedule.

On a preliminary issue, the arbitrator found that the insurer failed to properly terminate the benefits because it relied on an outdated disability certificate.

Applying the principles from Smith v. Co-operators, the arbitrator held that the consequence of failing to properly terminate benefits is that the benefits remain payable until the insurer complies with the statutory termination procedures.

The insurer was ordered to pay the outstanding benefits with interest.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer denied.

The insurer raised a preliminary issue that the applicant's arbitration request was filed beyond the two-year limitation period.

On the morning of the preliminary issue hearing, the applicant's counsel requested an adjournment because the applicant had travelled to Germany and could not attend.

The insurer opposed the adjournment and moved to dismiss the arbitration.

The arbitrator granted the adjournment, noting it was the applicant's first request and her life was in transition, but ordered the hearing peremptory to the applicant and awarded $1,500 in costs to the insurer.

The motion to dismiss was denied as it would severely prejudice the applicant's rights without a hearing.

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

The insurer denied the claim on the basis of late notice.

The applicant applied for arbitration but failed to identify any substantive issues in dispute.

After multiple adjournments to allow the applicant to obtain legal representation, a preliminary issue hearing was scheduled.

The applicant failed to attend the hearing in person, citing car trouble, and subsequently stated over the phone that he wanted the proceeding concluded.

The arbitrator deemed the application for arbitration withdrawn pursuant to Rules 70.1(c) and 70.2 of the Dispute Resolution Practice Code.

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

The insurer denied the claim under section 59(1) of the Schedule, arguing the applicant was a Schedule 1 employee entitled to workers' compensation.

At the preliminary issue hearing, the insurer requested an adjournment to apply to WSIAT for a determination on the applicant's employment status.

The arbitrator denied the adjournment, finding no valid reason to stay the proceeding sine die when the insurer had ample notice to make the WSIAT application earlier.

Following the refusal, the parties consented to withdraw the preliminary issue.

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

The insurer later terminated these benefits, and the applicant applied for arbitration.

Prior to the preliminary issue hearing, the applicant settled her long-term disability claim, which would offset any potential income replacement benefits, and subsequently withdrew her arbitration.

The insurer sought $6,088.65 in expenses for its preparation for the preliminary issue hearing.

The arbitrator dismissed the insurer's claim for expenses, finding that the applicant had a valid reason for withdrawing and had provided timely notice to the insurer two months before the hearing.

The applicant sought statutory accident benefits after being struck in the head by a piece of fruit thrown by an 11-year-old boy from a passing school bus while she was stopped at a red light.

The insurer denied the claim on the basis that the incident was not an 'accident' under the Schedule.

The arbitrator applied the two-part test from Greenhalgh and found that while the applicant met the purpose test, she failed the causation test.

The arbitrator concluded that the dominant feature of the incident was the thrown fruit, constituting an assault, and the use or operation of the motor vehicle was merely the location of the incident.

The application was dismissed.

Following an arbitration where the applicant's claim for statutory accident benefits was dismissed, the insurer sought its expenses.

The arbitrator found that the applicant was completely unsuccessful and that the proceeding was vexatious and unnecessary, as objective evidence showed the alleged accident could never have occurred.

The applicant failed to provide submissions for the expense hearing.

The arbitrator awarded the insurer its expenses, assessing legal fees at $6,063.34 and disbursements at $5,570.01, after reducing the hours claimed by one of the insurer's counsel to reflect a reasonable global assessment.

The applicant was injured in a head-on motor vehicle collision and sought ongoing income replacement benefits after the insurer terminated them.

The insurer argued that the applicant's inability to work was due to her significant pre-accident medical history, including a prior accident and depression.

The arbitrator found the applicant credible and preferred the medical evidence demonstrating that the accident caused a disabling chronic pain syndrome.

The arbitrator concluded that the applicant met both the 104-week and post-104-week disability tests under the Statutory Accident Benefits Schedule, entitling her to ongoing income replacement benefits and interest, and dismissing the insurer's claim for repayment.

The applicant was injured in a motor vehicle accident and received income replacement benefits until they were terminated by the insurer.

The applicant brought a motion for interim income replacement benefits pending a full arbitration hearing.

The arbitrator found that the applicant presented a prima facie case for entitlement based on substantial medical evidence of ongoing disability, including chronic pain and psychological impairments, which outweighed the insurer's medical assessments.

The arbitrator also found the applicant demonstrated a compelling financial need.

The motion was granted, and the insurer was ordered to pay interim income replacement benefits of $311.40 per week from the date of termination until a final arbitration order is made.

Issues of special award, expenses, and interest were deferred to the hearing arbitrator.

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

After the insurer terminated her weekly income replacement benefits, the applicant applied for arbitration.

However, the applicant subsequently failed to attend a resumed pre-hearing, failed to provide requested productions, and failed to attend the arbitration hearing.

The insurer brought a motion to dismiss the application for arbitration due to abandonment and delay.

The arbitrator found that the applicant had abandoned her case and that the application was vexatious.

The application for arbitration was dismissed, and the applicant was ordered to pay $3,000 in expenses to the insurer.

The Applicant sought expenses following a preliminary issue hearing where it was determined she was injured in an 'accident' under the Statutory Accident Benefits Schedule.

The Insurer did not contest the disbursements but argued the claimed legal hours were excessive.

The Arbitrator agreed with the Insurer's submission of 18 hours, which the Applicant did not dispute, and awarded $1,396.08 in legal fees and $252.04 in disbursements.

The applicant sought statutory accident benefits, claiming she was injured as a passenger in a rear-end motor vehicle collision.

The insurer denied the claim on the basis that the applicant's involvement in the accident was not credible.

Relying on expert accident reconstruction evidence that demonstrated the damage to the vehicles was entirely inconsistent with the reported collision, the arbitrator found the applicant's version of events lacked credibility.

The arbitrator concluded the applicant failed to prove she was involved in an 'accident' under section 2(1) of the Schedule and dismissed the arbitration.

The parties sought their respective expenses following an arbitration decision that dismissed the applicant's claim for statutory accident benefits.

The insurer argued it was wholly successful and entitled to expenses.

The applicant argued the insurer's representative unnecessarily prolonged and obstructed the hearing.

The arbitrator found that the insurer's representative's conduct, including unnecessary preliminary objections and repetitive cross-examinations, unnecessarily prolonged a simple one-day hearing into three days.

Consequently, the insurer was denied its expenses.

The applicant was also denied his expenses because his underlying claim failed due to his lack of credibility and significant contradictions with his medical records.

Each party was ordered to bear its own expenses.