Judith Killoran

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

The insurer brought a preliminary issue arguing the applicant was barred from proceeding to arbitration under section 32 of the Statutory Accident Benefits Schedule because she did not submit her expense forms until nearly a year after receiving the application package.

The arbitrator found that the applicant had provided sufficient information to notify the insurer of her claims in a timely fashion.

Furthermore, the insurer failed to inform the applicant of the consequences of failing to provide the requested information, precluding it from relying on the time limit to defeat her claims.

The preliminary issue was resolved in favour of the applicant.

The applicant was injured in a motor vehicle accident and received caregiver benefits, which the insurer terminated after 104 weeks.

The applicant attended a scheduled DAC assessment but insisted on videotaping it.

The DAC refused to proceed and charged a cancellation fee.

The insurer argued the applicant failed to make himself reasonably available for the assessment under section 50 of the Schedule and sought reimbursement of the fee.

The arbitrator found that the applicant made himself reasonably available by attending the assessment, and it was the DAC that refused to proceed without providing reasons.

The applicant was permitted to proceed to arbitration and was not required to pay the cancellation fee.

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

The Insurer terminated benefits, initially alleging the Applicant was charged with a criminal offence, and later alleging he was not a passenger in the vehicle.

The Insurer also scheduled multiple insurer's examinations which the Applicant did not attend.

On preliminary issues, the Arbitrator found credible evidence that the Applicant was a passenger in the vehicle.

The Arbitrator also held that the Applicant was not precluded from proceeding to arbitration, as the insurer's examinations were not reasonably necessary given the lack of corresponding benefit claims and the Insurer's unjustified adversarial conduct.

The applicant, who was injured in a motor vehicle accident, applied for statutory accident benefits from the insurer.

During a pre-hearing discussion, the applicant sought to add several issues to the arbitration hearing, including claims for medical and rehabilitation expenses and a special award.

The arbitrator ordered the insurer to respond to seven additional issues previously identified and ordered the applicant to provide particulars for the special award claim.

The arbitrator declined to add two newly raised issues to the hearing because they had not yet been mediated, doing so without prejudice to the applicant's right to mediate them.

The applicant brought a motion to adjourn the arbitration hearing regarding statutory accident benefits because her family physician, an important witness, was out of the country.

The insurer consented to the adjournment because it required the physician's presence for cross-examination and a transcription of his illegible records.

The arbitrator granted the adjournment on consent and rescheduled the hearing.

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

The parties proceeded to a preliminary issues hearing regarding the applicant's entitlement to a Loss of Earning Capacity Benefit (LECB).

At the hearing, the parties agreed that the applicant was entitled to an offer of an LECB effective April 30, 2003.

The arbitrator recorded the parties' procedural agreements on outstanding issues, including scheduling a residual earning capacity assessment and producing income loss calculations, and adjourned the main hearing.

The applicant was injured when the TTC bus she was riding stopped suddenly.

She claimed ongoing income replacement benefits, medical benefits for physiotherapy and massage, and rehabilitation benefits for increased auto insurance premiums.

The insurer argued the claim was time-barred.

The arbitrator found the claim was not time-barred because the insurer's termination letters did not constitute a valid refusal under the Smith v. Co-operators standard.

However, on the merits, the arbitrator dismissed all claims.

Medical evidence, including from the applicant's own treating practitioners, indicated her ongoing symptoms were related to pre-existing chronic conditions rather than the accident, and she did not suffer a substantial inability to perform the essential tasks of her employment.

The applicant was injured while fleeing a multi-vehicle collision as a pedestrian.

She applied for statutory accident benefits from Royal, claiming she was an insured person under her son's automobile insurance policy.

Royal responded as the first insurer but denied she was an insured person.

The arbitrator found that the applicant was not listed on the policy and rejected her claim that there was a binding oral contract to include her, applying the parol evidence rule.

The arbitrator concluded the applicant was not an 'insured person' under the policy and not entitled to seek further accident benefits from Royal.

The applicant was injured in a motor vehicle accident and sought payment from her insurer for a catastrophic impairment assessment report and a psycho-vocational assessment.

The insurer denied payment, arguing the reports were not reasonable or necessary.

The arbitrator found that both assessments were reasonable and necessary under section 24 of the Statutory Accident Benefits Schedule.

The catastrophic impairment report was required to complete the application for determination of catastrophic impairment, and the psycho-vocational report was necessary to facilitate the applicant's reintegration into the labour market.

The insurer was ordered to pay the costs of both reports.

The applicant was injured while attempting to avoid a collision as a pedestrian and applied for statutory accident benefits from the insurer.

The parties proceeded to arbitration on three preliminary issues.

After hearing evidence on the first preliminary issue, the arbitrator declined to issue a decision immediately, finding it necessary in the interests of fairness and efficiency to reserve the decision until the hearing concluded with respect to all three preliminary issues.

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

In this subsequent hearing on expenses, the insurer sought its costs of the arbitration, arguing the applicant's claims were unfounded and his conduct prolonged the proceeding.

The arbitrator found that while the applicant lacked evidence and had problematic conduct, his claims were not entirely without merit and the difficulties were largely attributable to his lack of legal representation at the main hearing.

The arbitrator declined to award expenses to the insurer and ordered each party to bear their own expenses.

The applicant, a Colorado resident, was injured in a motor vehicle accident in New York State while a passenger in an Ontario-insured vehicle.

He received New York no-fault benefits but sought Ontario statutory accident benefits from the insurer, State Farm.

The applicant argued that the Power of Attorney and Undertaking (PAU) filed by State Farm required it to pay Ontario benefits.

The arbitrator held that the PAU must be read as a whole and only applies to accidents occurring within a province or territory of Canada.

Since the accident occurred in New York, the PAU did not entitle the applicant to Ontario statutory accident benefits.

In a dispute over statutory accident benefits, the insurer requested production of the transcript of the applicant's examination for discovery from a related tort action.

The arbitrator denied the request, noting that the dispute resolution system at FSCO does not include examinations for discovery.

Allowing the insurer to obtain the transcript would give it an unfair advantage and distort the FSCO process, allowing the insurer to do indirectly what the legislature chose not to allow directly.

Following an arbitration hearing where all of the applicant's claims for statutory accident benefits were dismissed, the arbitrator considered the issue of expenses.

The insurer argued that the applicant's conduct prolonged the proceeding and that his claims were unfounded.

The applicant argued that his inaccurate history was due to his medical condition, not deception, and relied on the principle of facilitating access to the dispute resolution system.

The arbitrator found that while the applicant's conduct was unreasonable at times and prolonged the proceeding, it was not so unacceptable as to warrant an award of expenses against him.

Both parties were ordered to bear their own expenses.

The applicant was injured when he slipped and fell on ice at a gas station after filling his car's tire with air.

He applied for statutory accident benefits, which the insurer denied on the basis that the incident was not an 'accident' under the Schedule.

The arbitrator found that the applicant was engaged in the ordinary activity of maintaining his vehicle, and the icy pavement was a subsequent contributing cause that did not break the chain of causation.

The arbitrator concluded that the use or operation of the automobile was the dominant feature of the incident, and therefore it met the definition of an 'accident'.

The insurer brought a motion for an order permitting its medical expert to conduct an examination of the insured pursuant to section 42 of the Statutory Accident Benefits Schedule.

The insured, an 83-year-old man who suffered a catastrophic impairment in a motor vehicle accident, sought funding for home modifications to return home from a nursing home.

The medical/rehabilitation Designated Assessment Centre had failed to address the reasonableness and necessity of the treatment plans, instead improperly revisiting causation.

The arbitrator found that, given the DAC's failure to assess the treatment plans and the lack of a recent physical examination, the insurer's request for an examination was reasonable and necessary.

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

The parties reached an oral settlement agreement, and the insurer forwarded the settlement documents and a release.

The applicant reconsidered and did not sign the release.

The insurer argued the claim was settled on a full and final basis.

The arbitrator found that the settlement was enforceable because the insurer complied with the Settlement Regulation by forwarding the disclosure and release, and the applicant failed to deliver a written notice of rescission within the two-day cooling-off period.

The applicant was precluded from proceeding to arbitration.

The applicant and her counsel failed to attend a scheduled resumption of a pre-hearing discussion regarding statutory accident benefits.

The applicant's counsel had decided attendance was unnecessary but failed to notify the Commission or the insurer's counsel, resulting in wasted preparation time.

The arbitrator found this conduct tended to prolong, obstruct, or hinder the proceeding under s. 12(2) of O. Reg. 664.

The applicant was ordered to pay $300 to the insurer forthwith for costs thrown away.

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

She failed to attend the arbitration hearing or file any evidence to support her claims.

The arbitrator reviewed the insurer's medical and functional assessments, which concluded the applicant could perform her pre-accident activities.

The arbitrator dismissed all claims for benefits and ordered the applicant to pay the insurer's arbitration expenses, though declined to find the proceeding was frivolous or vexatious from the outset.

The applicant was injured in a motor vehicle accident and sought income replacement benefits, housekeeping expenses, and the cost of a gym membership.

The arbitrator found that the medical evidence did not support a substantial inability to perform the essential tasks of his employment during the claimed period.

The claims for housekeeping and the gym membership were also dismissed due to lack of credible evidence and medical necessity.

The applicant was ordered to repay the insurer for an overpayment of benefits received while he was also receiving long-term disability benefits.