Joyce Miller

The applicant was walking across a street when she heard a fire truck siren and saw the vehicle approaching.

Frightened, she quickened her pace to get out of the way and fell, sustaining serious injuries.

She applied for statutory accident benefits, which the insurer denied on the basis that she was not injured in an 'accident' as defined in section 2(1) of the Schedule.

On a preliminary issue hearing, the Arbitrator found that the use and operation of the fire truck was the dominant feature in the incident and the direct cause of the applicant's injuries.

The Arbitrator concluded that the applicant was injured as a result of an accident and is entitled to proceed with her claim for benefits.

Following a successful motion where the applicant was denied interim benefits, the insurer sought its expenses for the motion.

The arbitrator rejected the applicant's request to reserve expenses to the full hearing, finding it appropriate to determine them as the arbitrator who heard the preliminary issue.

Applying the criteria under O. Reg. 664, the arbitrator found the insurer was completely successful and entitled to expenses.

However, the arbitrator reduced the claimed preparation time due to duplication and the straightforward nature of the motion, awarding the insurer $1,046.44 in total expenses.

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

A dispute arose over the calculation of her income replacement benefit when she returned to work on modified duties.

The applicant argued that her post-accident income should be deducted from her calculated base benefit of $532, while the insurer argued it should be deducted from the maximum payable benefit of $400.

The arbitrator found the legislation unambiguous and held that post-accident income must be deducted from the maximum payable benefit of $400, not the base calculated amount.

The applicant was successful in a preliminary issue hearing determining he was involved in an accident.

He subsequently sought his expenses.

The insurer requested an adjournment of the expense hearing to bring a motion for the arbitrator's recusal based on alleged bias.

The arbitrator denied the adjournment, finding the bias motion was brought over a year after the alleged events and without proper notice.

The arbitrator awarded the applicant his legal fees and disbursements for the preliminary issue hearing, as well as costs for the unnecessary expense hearing and frivolous bias motion.

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

The insurer denied claims for medical and rehabilitation benefits, housekeeping benefits, and assessment costs.

The arbitrator dismissed the applicant's claims, finding her evidence regarding the necessity of treatments and assessments lacked credibility and was contradicted by independent DAC assessments.

The arbitrator also ordered the applicant to repay the insurer for a missed DAC appointment, rejecting her explanation that she did not open her mail.

The applicant sought arbitration after the insurer denied his claim for medical benefits for treatment plans totaling $2,589 following a motor vehicle accident.

The arbitrator found the applicant lacked credibility, noting significant inconsistencies between his testimony of debilitating pain and the clinical notes of his long-time family doctor, which made no mention of the accident or musculoskeletal complaints.

The arbitrator gave no weight to the evidence of the applicant's chiropractors, as one failed to provide clinical notes or a reasonable explanation for his conclusions, and the other merely repeated progress reports without examining the applicant.

The arbitration was dismissed, and the claims for medical benefits and a special award were denied.

The applicant sought interim income replacement benefits following a motor vehicle accident.

The insurer denied the claim, alleging it was out of time.

The applicant brought a motion for interim benefits, claiming urgent financial need and a deterioration in her physical condition.

The arbitrator dismissed the motion, finding that the applicant failed to establish a prima facie case of entitlement, as the medical evidence largely indicated she was able to perform her essential tasks of employment.

Furthermore, the applicant failed to provide sufficient evidence to prove financial urgency.

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

The insurer terminated her income replacement benefits after 16 weeks, arguing her injuries were limited to a WAD II neck injury.

The arbitrator found that the applicant suffered from a psychological impairment and chronic pain syndrome directly resulting from the accident, entitling her to ongoing income replacement benefits, housekeeping expenses, and the cost of a psychological assessment.

The arbitrator also awarded a special award against the insurer, finding it acted unreasonably by maintaining a closed mind and ignoring cogent medical evidence, including its own insurer's examination, that supported the applicant's claim.

The insurer applied to vary an arbitration order that awarded the insured 24-hour attendant care benefits, alleging a material change in circumstances based on surveillance evidence.

The insurer then sought to compel the insured to attend an Insurer's Examination under section 42 of the Statutory Accident Benefits Schedule prior to the variation hearing.

The Arbitrator held that the insured was not required to attend the examination, reasoning that an insurer must have sufficient evidence to support its claim before delivering an Application for Variation, rather than seeking to obtain such evidence after the application has been accepted.

The applicant's arbitration for statutory accident benefits was previously dismissed as frivolous and vexatious after he failed to attend the hearing.

The insurer subsequently sought its expenses under section 282(11) of the Insurance Act.

The arbitrator found that the insurer was completely successful in its application for dismissal and awarded $1,782.83 for legal fees and disbursements.

The arbitrator declined to award the $3,000 filing fee, noting that legislative amendments revoked the jurisdiction to order repayment of the assessment fee.

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

After mediation failed, he applied for arbitration.

The applicant subsequently failed to attend two pre-hearings and a motion hearing, and failed to provide instructions to his counsel.

The applicant's counsel brought a motion to be removed from the record, and the insurer brought a motion to dismiss the arbitration as frivolous and vexatious.

The arbitrator granted counsel's motion to withdraw due to a breakdown in the solicitor-client relationship.

The arbitrator also dismissed the arbitration, finding that the applicant's complete failure to participate rendered the proceeding vexatious.

The applicant was ordered to pay $1,000 in costs to the insurer.

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

After mediation failed, she applied for arbitration.

The applicant subsequently failed to attend a pre-hearing or provide instructions to her counsel.

Her counsel brought a motion to be removed from the record, and the insurer brought a motion to dismiss the arbitration as frivolous and vexatious.

The applicant failed to attend the motion hearing despite receiving notice.

The arbitrator granted counsel's motion to withdraw and dismissed the arbitration, finding that the applicant's complete failure to participate rendered the proceeding vexatious.

The applicant was ordered to pay $1,000 in costs.

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

After mediation failed, the applicant applied for arbitration but subsequently failed to attend two pre-hearings and a motion hearing.

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

The insurer brought a motion to dismiss the arbitration as frivolous and vexatious.

The arbitrator granted the insurer's motion, finding that while the application may have initially had merit, the applicant's complete failure to participate rendered the proceeding vexatious.

The arbitration was dismissed and costs of $1,000 were awarded to the insurer.

The applicant claimed statutory accident benefits after allegedly being injured while a passenger on a TTC bus that was struck from behind by a car.

The insurer denied the claim on the basis that the applicant could not prove he was a passenger on the bus at the time of the accident.

Following a hearing on this preliminary issue, the arbitrator found the applicant and his witness to be credible, noting their evidence was consistent with the bus driver's testimony and occurrence report.

The arbitrator concluded on a balance of probabilities that the applicant was a passenger on the bus and was involved in an accident as defined in the Schedule.

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

After the insurer terminated benefits, the applicant applied for arbitration.

The applicant failed to communicate with his counsel, respond to production requests, or attend the pre-hearing, leading his counsel to withdraw.

The insurer brought a preliminary issue hearing to dismiss the arbitration as frivolous and vexatious.

The applicant failed to attend the hearing despite receiving proper notice.

The arbitrator found the applicant completely failed in his obligations to support his claim and dismissed the arbitration as frivolous and vexatious.

The applicant was injured when he tripped on a raised hump of asphalt in the roadway after disembarking from a TTC bus that had stopped on the roadway instead of the bus bay.

The insurer denied his claim for statutory accident benefits, arguing the incident was not an 'accident' under section 2(1) of the Schedule.

The arbitrator found that the use and operation of the bus was the dominant feature in the incident and a direct cause of the applicant's injuries, as he was compelled to exit onto the dark roadway and was still in the process of disembarking when he fell.

The arbitrator concluded the applicant was injured as a result of an accident.

The applicant was injured when he tripped over a raised hump of asphalt in the roadway after disembarking from a bus that had stopped in a traffic lane rather than at the designated bus stop.

The insurer denied his claim for statutory accident benefits, arguing the incident was not an 'accident' under section 2(1) of the Schedule.

The arbitrator found that the use and operation of the bus was the dominant feature in the incident and a direct cause of the injuries, as the applicant was compelled to exit onto the roadway and was still in the process of disembarking when he fell.

The arbitrator concluded the applicant was injured as a result of an accident.

The applicant's counsel brought a motion to be removed as solicitors of record for the applicant in an upcoming arbitration.

Counsel submitted that they had lost contact with the applicant despite multiple attempts to reach him at his last known address and telephone numbers, including a number in New Jersey.

The insurer did not object to the withdrawal but requested a peremptory notice of hearing.

The arbitrator found a breakdown in the solicitor-client relationship and permitted the firm to withdraw without terms.

The request for a peremptory notice was denied as unnecessary.

The applicant sought an assessment of expenses following a successful arbitration for statutory accident benefits and a subsequent appeal.

The insurer argued the request was out of time under Rule 79.1 of the Dispute Resolution Practice Code.

The arbitrator exercised discretion under Rule 81.1 to set aside the 30-day time limit, finding it reasonable that the applicant waited until the appeal was resolved.

The arbitrator awarded the applicant his expenses, including an hourly rate of $150 for his counsel and $45 for a highly experienced law clerk who also acted as an interpreter.

Total expenses of over $51,000 were awarded, including disbursements and the costs of the assessment hearing.

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

The insurer suspended his income replacement benefits after an insurer's psychological assessment was terminated prematurely.

The insurer argued the applicant abruptly left, while the applicant claimed the assessor was harsh and unaccommodating.

The arbitrator found that the assessor created an insensitive and critical atmosphere, which precipitated the termination of the assessment.

The arbitrator concluded that the assessment was not a reasonable examination to which the applicant should be required to submit, and that he had a reasonable excuse for refusing further assessment with that specific doctor.

The suspension of benefits was lifted, and the applicant was permitted to proceed to arbitration.