Judith Killoran

The applicant was injured in a motor vehicle accident and applied for a catastrophic impairment designation under the Statutory Accident Benefits Schedule.

The insurer argued the applicant required a below-knee amputation and assessed her as an amputee, resulting in a 35% Whole Person Impairment (WPI) rating.

The applicant's assessors found her to be wheelchair dependent, resulting in an 80% WPI rating under the Gait Derangement Table, and also found significant psychological impairments.

The Arbitrator preferred the applicant's assessors, finding that the insurer's assessors failed to evaluate the applicant as she presented herself.

The Arbitrator concluded the applicant was wheelchair dependent and met the definition of catastrophic impairment.

The applicant was involved in a motor vehicle accident and her application for statutory accident benefits was dismissed in a prior decision, with the insurer entitled to its expenses.

The insurer claimed $7,591.67 in expenses.

The self-represented applicant submitted she lacked familiarity with the process and could not afford the claimed amount.

The arbitrator fixed the expenses payable by the applicant to the insurer at $1,500 inclusive of disbursements and HST.

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

After failing to attend two scheduled pre-hearings and a motion hearing without explanation, the Insurer brought a motion to dismiss the application.

The arbitrator dismissed the Application for Arbitration due to the Applicant's failure to participate in the dispute resolution process and failure to provide evidence supporting his claims.

The Applicant was ordered to pay the Insurer's expenses fixed at $1,500.

The applicant's representative brought a motion to withdraw as counsel of record in a statutory accident benefits dispute, citing a breakdown of communication.

The arbitrator found that the representative complied with the notice requirements under Rule 9.7 of the Dispute Resolution Practice Code.

The motion was granted and the representative and his firm were removed from the record.

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

The matter proceeded to an arbitration hearing.

The applicant's representative successfully moved to be removed from the record.

The applicant failed to attend the hearing.

The insurer brought a motion to dismiss the application.

The arbitrator dismissed the application for arbitration due to the applicant's failure to appear and discharge her burden of proof.

The insurer was awarded its expenses of the arbitration, with the quantum to be determined at a subsequent assessment hearing.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for medical treatment and examinations related to chronic pain.

The insurer denied the treatment plans, arguing the injuries were minor soft tissue injuries that did not justify further treatment two years post-accident.

The arbitrator found the applicant credible and accepted expert evidence that she suffered from a chronic pain disorder.

The arbitrator concluded the treatment at the Rehab Centre was reasonable and necessary to manage pain, improve function, and allow the applicant to continue working.

The applicant was awarded $11,695 for medical benefits, $1,462.44 for examinations, and interest on overdue payments.

The applicant was injured in a motor vehicle accident when he was struck by a minivan while examining his truck on the side of the road.

He applied for statutory accident benefits, claiming he sustained a catastrophic impairment.

The insurer denied the claim, arguing that the applicant's impairments were unrateable due to inconsistent test results and symptom magnification.

The arbitrator preferred the evidence of the applicant's experts, finding that the use of the Gait Derangement Table was appropriate for rating his physical impairments and that his psychological impairments were marked despite invalid psychometric testing.

The arbitrator concluded that the applicant met the definition of catastrophic impairment under both the 55% whole person impairment threshold and the marked mental or behavioural disorder threshold.

The Applicant sought expenses for an arbitration hearing that concluded in 2008 when the Insurer conceded the issue of catastrophic impairment.

The Insurer argued the Applicant was not entitled to expenses due to a 4.5-year delay in submitting a Bill of Costs, relying on Rule 79.1 of the Dispute Resolution Practice Code and the principle of finality.

The Arbitrator found that Rule 79.1 did not apply because no final arbitration order had been issued.

Given the ongoing dealings between the parties over the years, the delay did not deprive the Applicant of her entitlement under s. 282(11) of the Insurance Act.

The Arbitrator awarded the Applicant $30,972.81 in expenses.

The applicant, a five-year-old pedestrian, was struck by a vehicle and sustained severe injuries, including a Glasgow Coma Scale (GCS) score of 9 recorded by paramedics shortly after the accident.

The insurer argued the low GCS score was caused by hemodynamic instability due to blood loss rather than a brain impairment.

The arbitrator found that the applicant suffered a brain impairment as a result of the accident, as the massive blood loss deprived the brain of oxygen, impairing its function and resulting in the GCS score of 9.

The arbitrator concluded the applicant met the definition of catastrophic impairment under subsection 2(1.1)(e)(i) of the Statutory Accident Benefits Schedule.

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

After failing to attend two pre-hearing discussions and the scheduled arbitration hearing, the insurer requested that the application be dismissed.

The arbitrator found that the applicant had declined to participate in the dispute resolution process and dismissed the application.

The applicant was ordered to pay $1,000 in expenses to the insurer for its attendance at the proceedings.

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

At the outset of the arbitration hearing, the parties requested an adjournment to allow for global mediation, which was granted.

The arbitrator also ruled on preliminary issues regarding witness availability and document production.

The insurer was ordered to make its physiatrist and claims specialist available for cross-examination, and to produce its complete file up to the date of mediation, subject to claims of privilege.

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

She initially sent her application to the wrong insurer, resulting in a delay in notifying the respondent insurer.

The respondent denied benefits, citing the delay and a lack of information.

The arbitrator found that the applicant had a reasonable explanation for the delay and that the respondent had failed egregiously in its responsibilities by not expeditiously obtaining her file from the other insurer.

The arbitrator awarded the applicant housekeeping benefits for 104 weeks, caregiver benefits for 52 weeks, and a medical benefit for chiropractic treatment.

Additionally, the arbitrator ordered the respondent to pay a special award of $5,000 because it had unreasonably withheld the payment of benefits.

The insurer sought its expenses following a successful defence against the applicant's claims for statutory accident benefits.

The applicant did not attend the expense hearing.

The arbitrator found the insurer was entitled to expenses because it was completely successful, had made written offers to settle, and the applicant's conduct had hindered and prolonged the proceedings.

The insurer claimed over $47,000 in legal fees and disbursements, but the arbitrator fixed the expenses at $14,000, noting the matter did not involve complex or novel issues and declining to compensate for the participation of multiple lawyers and staff.

The applicant, who was confined to a wheelchair following a motor vehicle accident, sought interim attendant care, caregiving, and housekeeping benefits after the insurer terminated them at the 104-week mark.

The insurer relied on a surveillance video and medical assessments suggesting the applicant was malingering.

The arbitrator found the surveillance video to be of questionable probative value and tainted the insurer's medical evidence.

Applying the prima facie and urgency/necessity tests, the arbitrator granted the interim benefits, noting the extraordinary hardship on the applicant's family who were providing his care.

The Applicant sought an adjournment of an arbitration hearing regarding statutory accident benefits, which the Insurer initially opposed but later conceded.

The Arbitrator granted the adjournment to allow the catastrophic impairment issue to be heard together with other issues.

On a preliminary issue regarding the quantum of income replacement benefits, the Arbitrator ruled that the Canada Pension Plan (CPP) child's benefit is not a 'disability pension benefit' under subsection 2(9) of the Schedule and therefore cannot be deducted from the Applicant's income replacement benefits.

The Arbitrator awarded the Applicant $11,960 in expenses due to the Insurer's failure to consent to the adjournment earlier.

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

The insurer denied the claims, relying on surveillance evidence showing the applicant working at her family's dry cleaning business and performing physical tasks without apparent difficulty.

The arbitrator found the applicant and her husband lacked credibility, noting numerous contradictions in their testimony.

The arbitrator preferred the medical evidence of the insurer's experts, who concluded the applicant could perform her pre-accident work and housekeeping tasks, over the applicant's experts, who were unaware she had returned to work.

The application for benefits, interest, and a special award was dismissed.

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

At the hearing, a new issue arose regarding the quantum of income replacement benefits, as recent productions indicated the applicant had received collateral benefits.

Neither party could quantify the amount in dispute without further information from the collateral benefits carrier.

The arbitrator adjourned the hearing to allow the parties to obtain the necessary information, schedule a longer hearing, and address evidentiary issues.

The applicant applied for statutory accident benefits following a motor vehicle accident but failed to participate in the arbitration process or communicate with his counsel, who subsequently withdrew.

The insurer brought a motion to dismiss the application as frivolous or vexatious under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator declined to find the claim frivolous or vexatious but deemed the application withdrawn under Rule 70 due to the applicant's abandonment of the proceeding.

The applicant was ordered to pay the insurer's expenses of $1,712.63.

Following a successful claim for statutory accident benefits, the applicant sought expenses for the arbitration and expense hearings.

The insurer conceded entitlement but disputed the quantum of hours claimed and the applicability of HST to certain disbursements.

The Arbitrator reduced the billable hours using a 3:1 ratio for the hearing length, awarding 98 hours at $150 per hour.

The Arbitrator also found that HST was applicable to the disbursements for expert reports, as they were not incurred as an agent.

Total expenses of $26,669.63 were awarded to the applicant.

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

The insurer terminated the caregiver benefits at the two-year mark without requesting a new disability certificate, contrary to section 37 of the Statutory Accident Benefits Schedule.

The insurer also failed to advise the applicant of her potential entitlement to non-earner benefits.

On a preliminary issue hearing, the arbitrator found that the insurer failed to comply with the Schedule.

Applying the principles from Yogesvaran, the arbitrator ordered the insurer to pay interim caregiver and non-earner benefits pending a full arbitration hearing on final entitlement.

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