Judith Killoran

The insurer brought a preliminary motion seeking an order to compel the applicant to produce her entire post-accident employment file.

The applicant had applied for statutory accident benefits following a motor vehicle accident but did not claim income replacement benefits, having returned to work three days after the accident.

The insurer argued the employment file was relevant to assessing her disability from activities of daily living.

The arbitrator dismissed the motion, finding that the request failed to meet the tests of relevance and reasonableness, as no income replacement benefits were claimed and there was already adequate medical documentation to address the entitlement questions.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the insurer, including income replacement benefits (IRBs) and medical benefits.

The insurer denied the benefits based on its assessors' reports, which concluded the applicant could return to his pre-accident employment as a heavy labourer.

The arbitrator found the applicant's evidence and his experts' reports more credible, noting the insurer's assessors lacked complete information and ignored the applicant's chronic pain.

The arbitrator held that the applicant met the test for IRBs both before and after the 104-week mark, as he suffered a complete inability to engage in suitable employment.

The requested medical benefits were also found to be reasonable and necessary.

However, the arbitrator dismissed the claim for a special award, finding the insurer did not act unreasonably in relying on its medical assessors, despite the flaws in their reports.

Following an arbitration decision regarding statutory accident benefits, both parties sought their expenses of the hearing.

The insurer argued it was entirely successful on the issues at arbitration and should be awarded expenses based on the result.

The applicant argued the insurer prolonged the proceedings by failing to respond to a treatment plan until the final day of the hearing and by ignoring a written offer to settle.

The arbitrator found that success is only one criterion to be weighed, and that the insurer's failure to comply with the Schedule and respond to the settlement offer prolonged the proceeding.

The arbitrator ordered that each party bear its own expenses.

The applicant sought statutory accident benefits following a 2004 motor vehicle accident.

The insurer raised a preliminary issue, arguing the application for arbitration was barred by the two-year limitation period under the Insurance Act.

The insurer claimed it had provided clear and unequivocal denials of income replacement and housekeeping benefits in 2005 via Explanation of Benefits (OCF-9) forms.

The arbitrator found no evidence that the applicant received the unsigned OCF-9 forms, which lacked proof of delivery.

Furthermore, the arbitrator held that even if received, the forms were vague, confusing, and requested further information, thus failing to constitute clear and unequivocal denials.

The insurer's limitation defence was dismissed, allowing the applicant to proceed to arbitration.

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

During the arbitration process, the insurer requested the production of the applicant's OHIP records and family doctor's clinical notes dating back to prior motor vehicle accidents alleged to have occurred in 2000, 2001, and 2002.

The applicant opposed the expanded production, arguing there was no reliable evidence of inconsistencies in his reporting.

The arbitrator found that references to earlier accidents in medical reports provided a foundation for the insurer's request, as the information was relevant to assessing causation and quantum.

The arbitrator ordered the applicant to produce the requested records dating back to 2000.

The applicant brought a motion for interim income replacement benefits pending the resolution of his dispute with the insurer over statutory accident benefits arising from a motor vehicle accident.

At the motion, the parties reached an agreement to reinstate the applicant's interim income replacement benefits at the rate of $400 per week, plus interest.

The arbitrator ordered the reinstatement of benefits on consent and adjourned the main hearing.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought payment for home accessibility reports prepared by Adapt-Able Design Group.

The insurer argued the reports were a rehabilitation benefit payable under section 15 of the Statutory Accident Benefits Schedule, which would erode the applicant's $1 million limit.

The applicant argued the reports were assessment expenses payable under section 24.

The arbitrator found that the reports were necessary to allow the applicant access to the benefit and assess the quantum, and were therefore properly compensated under section 24.

The insurer was also found to be estopped from arguing otherwise due to its prior approval of the assessment applications.

The applicant sought statutory accident benefits following a motor vehicle accident, including medical benefits, housekeeping expenses, and the cost of a functional abilities evaluation.

The insurer denied the claims, arguing that the applicant's ongoing impairments were caused by a subsequent workplace assault and robbery, not the motor vehicle accident.

The arbitrator dismissed the application, finding that the medical documentation contemporaneous with the workplace assault attributed the applicant's injuries to that event.

The arbitrator concluded that the disputed treatment plans and assessments were not reasonable or necessary, and the applicant failed to prove a substantial inability to perform pre-accident housekeeping tasks as a result of the motor vehicle accident.

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

The applicant had returned to work shortly after the accident but stopped working over a year later, citing medical advice.

The insurer denied benefits based on multiple assessments concluding the applicant was not substantially disabled.

The arbitrator dismissed the motion for interim benefits, finding that there were too many unanswered questions regarding causation, disability, and post-accident income, which required a full hearing to resolve.

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

The parties reached a settlement at a settlement conference.

The insurer forwarded a release that included a certificate to be signed by the applicant's lawyer, confirming the lawyer had explained the release to the applicant.

The applicant's lawyer refused to sign the certificate, citing solicitor-client privilege, and refused to witness the applicant's signature.

The insurer refused to pay the settlement funds without the witnessed release or lawyer's certificate.

The arbitrator held that the Settlement Regulation governs the requirements for a valid settlement and does not mandate a lawyer's certificate or witnessing of the signature.

The arbitrator ordered the insurer to pay the settlement funds and awarded a special award of $1,625, finding the insurer's withholding of funds based on an arbitrary, non-statutory requirement to be unreasonable to a flagrant degree.

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

The insurer sought to terminate benefits and scheduled a Designated Assessment Centre (DAC) evaluation, which the applicant did not attend due to pregnancy and travel difficulties.

The insurer terminated benefits and later argued the applicant's request for arbitration was barred by the two-year limitation period.

The arbitrator found that the insurer failed to provide a valid refusal notice in clear and straightforward language as required by the Schedule and the Supreme Court's decision in Smith.

Furthermore, the applicant had made herself reasonably available for a DAC assessment, but the insurer failed to accommodate her.

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

The applicants, an elderly couple who acted as foster parents, were injured in two motor vehicle accidents.

They applied for statutory accident benefits, including rehabilitation benefits for child care costs related to their foster children, and housekeeping benefits.

The insurer denied the claims, arguing that child care did not qualify as a rehabilitation expense and relying on surveillance and medical reports to dispute the housekeeping claims.

The arbitrator found that the child care expenses were reasonable and necessary to rehabilitate the applicants and allow them to reintegrate into their societal roles as foster parents.

The arbitrator also awarded the housekeeping benefits and ordered the insurer to pay a special award of $5,000 in total, finding that the insurer had unreasonably withheld payments, failed to communicate adequately, and treated the vulnerable applicants in a harsh and high-handed manner.

The applicant sought to withdraw her application for arbitration regarding statutory accident benefits.

The insurer refused to consent and requested an expense hearing.

The arbitrator found that the applicant's representative, her husband acting without compensation, had complied with the requirements of Rule 70 of the Dispute Resolution Practice Code and permitted the withdrawal.

The arbitrator declined to award expenses to either party under Rule 75, finding that no aspect of the proceeding was improper, vexatious, or unnecessary, and ordered the parties to bear their own expenses.

The insurer's counsel of record sought to be removed just days before the scheduled arbitration hearing, and the insurer's newly retained counsel requested an adjournment to prepare.

The claimant opposed the adjournment, citing prejudice, her advanced age, and costs already incurred.

The arbitrator granted the removal of counsel and the adjournment to ensure a full and fair hearing, but awarded the claimant $5,000 in expenses for costs thrown away due to the late adjournment request.

Following an arbitration hearing where the applicant was unsuccessful in claiming statutory accident benefits, the insurer sought its expenses of $13,330.90.

The arbitrator considered the criteria under the Expense Regulation, particularly whether a novel issue was raised.

Although the factual underpinnings of the novel issue were ultimately lacking, the arbitrator found that the applicant proceeded to arbitration primarily to resolve a novel issue regarding the calculation of income replacement benefits based on a full-time job and a job offer.

The arbitrator concluded that the proceeding was not frivolous or vexatious and declined to award expenses to the insurer.

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

The parties attended mediation and agreed to settle the claim for $10,000.

The applicant signed a release and a Settlement Disclosure Notice, but later rescinded the settlement, arguing the insurer failed to comply with the settlement regulation.

The arbitrator found that the Settlement Disclosure Notice was defective because it was not signed by the insurer and incorrectly stated the maximum available benefit without explaining the calculation for a self-employed person.

As the insurer failed to comply with the mandatory requirements of section 9.1 of Ontario Regulation 664, the applicant was entitled to rescind the settlement.

The arbitrator concluded the claim for income replacement benefits had not been settled.

Following a decision denying the applicant's claims for statutory accident benefits, the arbitrator considered the issue of expenses.

The insurer sought its expenses based on its complete success and negative credibility findings against the applicant.

The applicant argued that lack of success does not automatically result in an expense award and noted the novel issues regarding causation and disability involving three separate accidents.

The arbitrator found that while the insurer was successful and credibility was an issue, the novelty of the issues required a decision.

The arbitrator ordered each party to bear its own expenses.

The insurer brought a preliminary motion seeking an order for the production of various medical, employment, and financial records by a specific date, failing which the arbitration would be stayed.

The arbitrator found that the requested documents were relevant but were largely in the possession of third parties and not within the applicant's control.

The arbitrator declined to stay the proceedings, instead accepting the applicant's representative's undertaking to forward production request letters to the third parties, copied to the insurer, within 30 days.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including income replacement, medical, and housekeeping benefits.

The insurer denied the claims.

At arbitration, the arbitrator found the applicant's testimony regarding his employment and job offers to be inconsistent and not credible, dismissing the claim for income replacement benefits.

The housekeeping claim was dismissed as it fell outside the two-year limitation period and lacked credible evidence.

The medical benefits claim for a work hardening program was dismissed based on the persuasive testimony of the insurer's expert chiropractor, who concluded the treatment was not reasonable or necessary.

All claims were dismissed.

The applicant sought statutory accident benefits, including caregiver, housekeeping, and medical benefits, following a motor vehicle accident.

The insurer denied the claims, arguing the applicant's injuries, particularly to her wrist, were pre-existing from a prior accident.

The arbitrator dismissed the applicant's claims, finding insufficient evidence that the second accident caused or exacerbated her wrist problems, and preferring the independent medical assessments which concluded she was not disabled from caregiving or housekeeping.