Kimberly Parish

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

The respondent denied funding for physiotherapy and psychological treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The Tribunal found that the applicant did not suffer from a psychological impairment or chronic pain syndrome as a result of the accident that would warrant removal from the MIG.

The applicant's appeal was dismissed.

Following an arbitration decision denying the applicant's claim for the cost of catastrophic impairment assessments, the insurer requested an expense hearing.

The insurer argued the applicant's pursuit of the claim was frivolous and unnecessarily prolonged the hearing with arguments about vested interests.

The arbitrator found the applicant was entitled to pursue her claim but agreed that her counsel's arguments regarding vested interests unnecessarily prolonged the hearing.

The arbitrator awarded the insurer $4,000 in expenses, finding its claimed amount of $8,283.22 to be excessive given the $11,599.99 amount in dispute.

Following a preliminary issue hearing where it was determined that the applicant was not involved in an 'accident' within the meaning of the Schedule, the successful insurer sought its expenses of the arbitration.

The insurer claimed $24,182.62 in costs.

The arbitrator considered the criteria under section 282(11) of the Insurance Act and the Dispute Resolution Practice Code.

Noting that the applicant was an ODSP recipient and that the insurer's claimed hours were excessive given the nature of the preliminary issue, the arbitrator reduced the legal fees to a 2:1 ratio based on the Legal Aid Tariff.

The applicant was ordered to pay $3,028.22 in expenses.

Following an arbitration where the insurer successfully defended against the applicant's claim for income replacement benefits, the insurer sought its expenses against the applicant and/or her litigation guardian.

The arbitrator dismissed the insurer's claim for expenses.

The arbitrator found no authority to assess expenses against the litigation guardian and noted that the litigation guardian did not act in a frivolous or vexatious manner.

Furthermore, the arbitrator declined to award costs against the applicant, a vulnerable person with severe psychiatric issues, finding that doing so could have a detrimental effect on vulnerable persons attempting to access accident benefits.

The insurer was entirely successful at the arbitration hearing regarding the applicant's claim for accident benefits.

The insurer subsequently sought its expenses for the arbitration.

The arbitrator considered the criteria under the Expense Regulation, noting the insurer's 100% success and an unaccepted Rule 76 offer to settle.

The arbitrator rejected the applicant's argument that his limited financial means due to incarceration should preclude an expense award, as ability to pay is not a listed criterion.

The arbitrator reduced the insurer's claimed legal fees and disbursements, awarding a total of $4,851.23 in expenses payable by the applicant.

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

After her legal counsel was removed, the applicant failed to attend the scheduled arbitration hearing.

The insurer brought an oral motion to dismiss the application.

The arbitrator dismissed the application for arbitration due to the applicant's failure to attend and present evidence, concluding she had abandoned her claim.

The insurer was awarded $2,000 in expenses for unnecessary time and money spent defending the claim.

The applicant was injured in a motor vehicle accident and sought accident benefits from the insurer, including the cost of a worksite assessment.

The insurer denied the assessment and took the position that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The arbitrator found that the worksite assessment was not reasonable and necessary, as the applicant had only missed one day of work and had not claimed income replacement benefits.

Furthermore, the arbitrator concluded that the applicant failed to provide sufficient objective medical evidence to establish that his injuries, including alleged chronic pain and a subsequent left knee impairment, fell outside the MIG.

The applicant's claims were dismissed.

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

After his legal counsel was removed from the record, the applicant failed to attend the scheduled arbitration hearing or file any documentation.

The insurer brought an oral motion to dismiss the application.

The arbitrator dismissed the application for arbitration due to the applicant's failure to appear and awarded $2,000 in expenses to the insurer.

The insurer sought its expenses following a preliminary issue hearing where the arbitrator found that no 'accident' had occurred and dismissed the applicant's claim for statutory accident benefits.

The applicant's paralegal sought to be removed from the record due to a breakdown in the solicitor-client relationship, but the arbitrator denied the request to prevent prejudice to the applicant.

The arbitrator found that the applicant's claim was frivolous and his testimony fabricated, causing the insurer to incur unnecessary costs.

The arbitrator ordered the applicant to pay the insurer's expenses fixed at $8,419.18.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the insurer, including attendant care benefits, medical benefits for an eye exam, and replacement costs for damaged clothing and prescription sunglasses.

The insurer denied the benefits.

The arbitrator found the applicant was entitled to attendant care benefits at the rate determined by the initial assessment, as the service provider had sustained an economic loss.

The arbitrator also awarded the costs of the eye exam and prescription sunglasses, but denied the clothing claims due to a lack of receipts.

Furthermore, the arbitrator ordered the insurer to pay a special award of 50% of the owing benefits, finding that the insurer had unreasonably withheld payment contrary to the Schedule and ignored evidence of the service provider's economic loss.

The applicant claimed he was injured in a motor vehicle accident while riding his bicycle and sought statutory accident benefits.

The insurer denied the claim, arguing the injuries resulted from a physical altercation with the driver of an SUV, not from the use or operation of an automobile.

The arbitrator found the applicant's testimony inconsistent with the police and emergency room reports, which indicated no physical contact between the SUV and the bicycle.

The arbitrator concluded that the physical altercation was an intervening act that broke the chain of causation, meaning the injuries were not directly caused by the use or operation of a motor vehicle.

The application was dismissed as there was no 'accident' within the meaning of the Schedule.

The applicant was injured in a motor vehicle accident and received Income Replacement Benefits (IRBs) from the insurer.

The insurer subsequently terminated the IRBs and sought repayment of $28,078.96, alleging the applicant materially misrepresented her pre-accident employment and income.

The applicant disputed the repayment and sought outstanding IRBs of $9,413.00 for the period following the termination.

The arbitrator found that the insurer failed to prove on a balance of probabilities that the applicant committed wilful misrepresentation or fraud, as the applicant provided credible explanations for inconsistencies in her employment and travel records.

However, the arbitrator also found that the applicant failed to prove entitlement to ongoing IRBs, relying on Insurer Examination assessments concluding she did not suffer a substantial inability to perform her pre-accident employment tasks.

Both the insurer's claim for repayment and the applicant's claim for ongoing IRBs were dismissed.

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

At the scheduled arbitration hearing, the applicant failed to attend.

The applicant's legal representative brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, which was granted.

The insurer brought an oral motion to dismiss the application for arbitration due to the applicant's non-attendance.

The arbitrator dismissed the application and awarded costs of $6,221.42 to the insurer, noting the applicant's failure to attend insurer's examinations, failure to provide income documentation, and failure to attend the hearing.

The applicants sought accident benefits following a motor vehicle accident.

At the scheduled arbitration hearing, the applicants failed to attend.

Their counsel appeared and successfully requested to be removed from the record due to a breakdown in the solicitor-client relationship.

The insurer brought an oral motion to dismiss the applications for arbitration due to the applicants' non-attendance.

The arbitrator granted the motion, dismissing the applications and ordering the applicants to pay the insurer's arbitration expenses in the amount of $9,500 plus HST.

The applicant's claim for accident benefits was dismissed after she failed to participate in the arbitration process.

The insurer subsequently requested an expense hearing, seeking $6,669.17 in costs.

The arbitrator found that the insurer was the successful party and that the applicant's failure to attend prolonged the process unnecessarily.

However, the arbitrator found the insurer's bill of costs excessive, noting that the insurer had been advised not to prepare for a contested hearing.

The arbitrator awarded the insurer $1,000 in expenses.

The applicant was injured in a motor vehicle accident and sought Income Replacement Benefits (IRBs) from the insurer.

The applicant received Short-Term Disability, Long-Term Disability, and CPP disability benefits.

The issue was whether the insurer could deduct the gross or net amounts of these collateral benefits from the IRB payable.

The arbitrator held that the clear wording of section 4(1)(a) of the Statutory Accident Benefits Schedule refers to 'gross weekly payment for loss of income'.

Unlike the previous regime, the current Schedule does not contain provisions for calculating after-tax amounts.

Therefore, the insurer is entitled to deduct the gross amounts of the collateral benefits from the IRB.

The applicant was injured in a motor vehicle accident and sought accident benefits, including non-earner benefits and medical benefits for physiotherapy and a psychological assessment.

The insurer denied the claims.

At arbitration, the arbitrator dismissed the claim for non-earner benefits because the applicant failed to submit a completed disability certificate within 104 weeks of the accident, statutorily barring the claim, and otherwise failed to provide sufficient evidence of entitlement.

The claims for medical benefits were also dismissed as the treatment plans were unsigned, not proven to be reasonable and necessary, and could not be causally linked to the subject accident due to an intervening second accident.

The applicant sought statutory accident benefits following an alleged motor vehicle accident where he claimed he was struck by a vehicle while riding his bicycle.

The insurer denied the claim on the basis that no accident occurred.

The arbitrator found the applicant's testimony to be inconsistent and unreliable, noting contradictions regarding the mechanics of the collision and the lack of documented injuries in his medical records.

The arbitrator concluded that the applicant failed to prove on a balance of probabilities that an accident occurred within the meaning of s. 3(1) of the Schedule, and dismissed the application.

The applicant sought to withdraw her Application for Arbitration regarding statutory accident benefits after failing to attend an Insurer's Examination.

The insurer opposed the withdrawal, arguing the applicant should be statutorily barred from proceeding to arbitration or the Licence Appeal Tribunal.

The arbitrator permitted the withdrawal of the application on a without costs basis pursuant to Rule 70 of the Dispute Resolution Practice Code, finding no cogent evidence to deny the request made at the pre-hearing stage.

As the application was withdrawn, the issue of whether the applicant was precluded from proceeding to arbitration was moot.

No expenses were awarded.

The applicant, who was in a coma following a motor vehicle accident, applied for statutory accident benefits through his litigation guardian.

The insurer argued that the issues in dispute had been previously settled by the applicant's former legal counsel.

The arbitrator found that no binding settlement had been reached, as the applicant was a person under a disability and no settlement documents had been signed or approved by the court as required by Rule 7.08 of the Rules of Civil Procedure.