Joyce Miller

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

The applicant failed to attend the arbitration hearing or provide any evidence to support her claim.

As the onus is on the applicant to prove entitlement to benefits, the arbitrator dismissed the claim.

The arbitrator ordered the applicant to pay $1,500 in expenses to the insurer, finding that commencing a proceeding and failing to pursue it caused unnecessary expenses.

The insurer requested a preliminary issue hearing to stay the applicant's arbitration until she attended an insurer's examination under section 42 of the Statutory Accident Benefits Schedule.

The applicant's income replacement benefits had been terminated in April 2004.

Despite numerous requests for reinstatement supported by medical evidence of a worsening condition and subsequent surgery, the insurer did not request an examination until three months before the scheduled arbitration.

The arbitrator found that the insurer's request was not reasonably necessary to adjust the file, but rather an attempt to bolster its case for the upcoming arbitration.

The insurer's request was dismissed, and the arbitration was ordered to proceed as scheduled.

The insurer sought an assessment of its expenses and an order specifying the interest rate and start date for a repayment order of $33,997.72 made in a previous arbitration decision.

The arbitrator found that the insurer was not entitled to an assessment of its expenses because it failed to follow the rules in the Dispute Resolution Practice Code, specifically by waiting 19 months to enforce the order and failing to serve the applicant with an itemized bill of costs.

The arbitrator declined to exercise discretion to excuse the delay.

Regarding interest, the arbitrator ordered the applicant to pay interest on the $33,997.72 repayment amount at the bank rate of 4.75% per annum from October 4, 1999, as the applicant had notice of the overpayment and failed to repay it in a timely manner.

The insurer sought an assessment of its arbitration expenses following a decision that dismissed the applicant's claim for statutory accident benefits and awarded the insurer its reasonable expenses.

The applicant did not pay the itemized Bill of Costs and failed to appear or provide written submissions for the assessment hearing, despite receiving proper notice.

The arbitrator reviewed the insurer's Bill of Costs and found the claimed legal fees and disbursements to be reasonable in relation to the length and complexity of the arbitration.

The applicant was ordered to pay the insurer $7,005.56, inclusive of GST.

Counsel for the applicant brought a motion to withdraw as counsel of record for an assessment of expenses proceeding following an arbitration decision.

Counsel submitted that there had been a breakdown in the solicitor-client relationship and that he had lost contact with the applicant.

The insurer did not object to the motion.

The arbitrator found that the solicitor-client relationship had broken down and granted the motion, permitting counsel to withdraw without terms.

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

The applicant failed to attend the arbitration hearing or provide notice of her absence.

As the onus is on the applicant to prove entitlement to benefits and no evidence was provided, the arbitrator dismissed the claims.

The applicant was ordered to pay the insurer's arbitration expenses due to causing unnecessary costs by failing to provide notice of her non-participation.

The insurer brought a motion to adjourn an upcoming arbitration hearing so that the insured could attend an Examination Under Oath regarding her delayed application for statutory accident benefits.

The arbitrator denied the adjournment request, finding that the insurer's request was made too close to the hearing date despite having ample prior opportunity.

Furthermore, the arbitrator held that there is no jurisdiction to adjourn an arbitration hearing as a remedy for an insured's failure to attend an Examination Under Oath, as the Statutory Accident Benefits Schedule provides an express remedy of benefit suspension.

The issue of expenses was deferred to the hearing arbitrator.

The insurer brought a motion to stay the arbitration hearing on the basis that the claimant refused to attend an insurer's medical examination (IME) with a neuro-psychiatrist.

The claimant argued the request was neither reasonable nor timely, as it was made close to the hearing date and the insurer already had numerous assessments in its favour.

The arbitrator found that the insurer's request was not reasonably necessary, noting that the insurer had ample time to request the IME earlier and that the chosen doctor had already concluded from a paper review that the claimant's injuries were not accident-related.

The motion was dismissed and the arbitration was ordered to proceed.

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

The insurer denied a treatment plan for massage therapy based on a negative Designated Assessment Centre (DAC) report.

In a previous arbitration decision, the arbitrator found the treatment plan was reasonable and necessary, and awarded the medical benefit.

The current issue was when interest on the overdue payment started to run.

The insurer argued that based on previous appeal decisions, interest should not run until the date of the arbitration decision because of the negative DAC report.

The arbitrator distinguished the appeal decisions, finding that the DAC report was flawed and the insurer had ample evidence to support the claim.

The arbitrator held that the interest provisions are compensatory and remedial, and that interest started to run 14 days after the treatment plan was submitted to the insurer.

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

The applicant failed to attend the scheduled hearing and provided no evidence to support her claim.

The arbitrator proceeded in her absence pursuant to the Statutory Powers Procedure Act and dismissed the arbitration without costs.

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

At a pre-hearing discussion, the insurer refused to engage in settlement talks unless the applicant also discussed an unmediated claim from a second accident.

The arbitrator found the insurer's conduct inappropriate and ordered the insurer to pay $150 in costs for wasting the applicant's time.

Additionally, the arbitrator ordered the insurer to provide cogent reasons why a preliminary issue hearing regarding the applicant's alleged failure to attend medical examinations should proceed, given documentary evidence suggesting she had attended.

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

The insurer denied medical rehabilitation and housekeeping expenses beyond 104 weeks and denied indexation of income replacement benefits.

On a preliminary issue, the arbitrator found that while the insurer failed to offer the optional indexation benefit when the applicant chose the transitional coverage option, the arbitrator lacked jurisdiction to order a remedy.

However, the arbitrator held that temporal limits do not apply to the transitional provisions under subsection 70(3) of the Schedule, entitling the applicant to claim supplementary medical and rehabilitation benefits beyond 104 weeks.

The Applicants were injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied several claims.

The insurer brought a preliminary issue motion arguing that the FSCO Arbitration Unit lacked jurisdiction because the Applicants applied for mediation before the insurer had denied the claims, in breach of Rule 12.1 of the Dispute Resolution Practice Code.

The Arbitrator dismissed the motion, finding that while the Applicants breached the procedural rule, the statutory preconditions under section 50 of the Schedule and section 281(2) of the Insurance Act were met by the time the mediation actually occurred.

The Applicants were permitted to proceed to arbitration.

The applicant applied for statutory accident benefits after slipping and falling on a snow and ice-covered pedestrian island.

She claimed she was forced onto the island to avoid an oncoming bus that was blocking her path.

The insurer denied the claim, arguing the fall was caused by the snow and ice, not the use or operation of a motor vehicle.

The arbitrator found that the bus rolling towards the applicant was the dominant feature of the incident and directly caused her to step onto the island, resulting in her fall.

The arbitrator concluded the applicant was injured as a result of an 'accident' under subsection 2(1) of the Schedule.

The applicant was catastrophically injured in a motor vehicle accident and received income replacement benefits.

The insurer terminated these benefits based on outdated and superficial medical reports, ignoring cogent evidence of the applicant's severe cognitive and behavioural impairments.

Following an arbitration decision reinstating the benefits, a hearing was held to determine entitlement to a special award.

The arbitrator found that the insurer acted unreasonably in terminating and continuing to withhold the benefits, particularly by relying on a flawed Disability Assessment Centre (DAC) report and ignoring reports from the applicant's treating specialists.

A special award of $12,500, inclusive of interest, was granted pursuant to subsection 282(10) of the Insurance Act.

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

The applicant sought payment of $2,500 for a physiatrist's assessment under section 24 of the Statutory Accident Benefits Schedule.

The insurer denied the claim, arguing the assessment was not incurred for the purpose of the Schedule.

The arbitrator found that at the time the report was requested, the insurer was paying income replacement benefits and no benefits were in dispute.

The report was requested by the applicant's counsel for a medical-legal opinion on employability.

The arbitrator concluded the assessment was not a reasonable expense incurred for the purpose of the Schedule and dismissed the arbitration.

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

After the applicant's counsel was removed from the record and the applicant indicated he would not attend the arbitration, the insurer brought a motion to dismiss the arbitration without a hearing under Rules 34.1(e) and 65.7 of the Dispute Resolution Practice Code.

The arbitrator dismissed the motion, applying the implied exclusion rule of statutory interpretation to find that because Rule 68 specifically provides for dismissal without a hearing and its strict timelines were not met, Rules 34.1(e) and 65.7 could not be used to bypass those requirements.

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

The insurer denied the claims, and the matter proceeded to arbitration.

The applicant failed to attend the pre-hearing, settlement discussion, and the scheduled arbitration hearing without providing notice.

The arbitrator dismissed the application due to the applicant's failure to prove his claim.

Finding the applicant's conduct to be an abuse of process, the arbitrator ordered the applicant to pay the insurer's arbitration expenses in the amount of $1,727.83.

The applicant was injured in a motor vehicle accident and sought payment for two treatment plans for massage therapy to treat chronic pain.

The insurer denied the claims, relying on various medical and DAC reports.

The arbitrator found the applicant's testimony credible that massage therapy provided temporary pain relief, which in turn allowed her to engage in active exercise to improve her strength and endurance.

The arbitrator gave little weight to the insurer's medical reports, noting they either did not address massage therapy or lacked sufficient reasoning.

The arbitrator concluded that the massage therapy was a reasonable and necessary medical benefit under section 14 of the Statutory Accident Benefits Schedule and ordered the insurer to pay the claimed amount of $5,190 plus interest.

The insurer sought an assessment of its expenses following a successful arbitration where the insured was found liable to pay the insurer's expenses under section 282(11) of the Insurance Act.

The arbitrator awarded the insurer its legal fees at the Legal Aid rate rather than the requested $150 per hour, noting the higher rate is only available to insured persons.

The arbitrator denied the insurer's claims for the costs of medical expert reports, finding they were obtained as insurer's medicals under section 42(1) of the Schedule rather than as expert reports for arbitration.

Claims for surveillance expenses and standby investigators were also denied for lack of statutory authority.

The insurer was awarded a total of $8,589.46 for legal fees and $1,461.09 for disbursements, plus GST.