Lloyd (J.R.) Richards

Following an arbitration hearing where the self-represented applicant's claims for caregiver and non-earner benefits were dismissed, the insurer sought its expenses.

The arbitrator found that the insurer was completely successful and therefore entitled to its expenses.

Applying a broad strokes approach and considering the Legal Aid rate, the arbitrator awarded the insurer $5,656.80 in fees and $2,219.85 in disbursements, for a total of $7,906.65.

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

The insurer denied the benefits, arguing the treatments were not reasonable, necessary, or actually incurred.

The arbitrator dismissed the applicant's claims in their entirety, finding her testimony lacked credibility and was inconsistent with the clinical notes of her regular treating physicians.

The arbitrator drew adverse inferences from the applicant's failure to call treating practitioners or her son, who allegedly provided care, and concluded the claimed services were either not provided or not reasonably required.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner, attendant care, and housekeeping benefits, which the insurer denied.

The arbitrator found significant credibility issues with the applicant's evidence, noting surveillance footage that contradicted his claimed limitations and medical assessments indicating symptom magnification.

The arbitrator concluded that the applicant's ongoing issues were likely related to pre-existing degenerative conditions rather than the accident.

Consequently, the applicant failed to prove a complete inability to carry on a normal life or a reasonable necessity for the claimed attendant care and housekeeping services.

All claims for benefits, a special award, and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, housekeeping, and attendant care benefits, which the insurer had terminated.

The insurer argued the applicant had removed herself from the workforce prior to the accident due to pre-existing psychological issues.

The arbitrator applied the material contribution test and found that the accident materially contributed to the applicant's pain disorder and exacerbated her depression and anxiety, resulting in a complete inability to engage in employment.

The arbitrator awarded ongoing income replacement benefits and partial housekeeping benefits, but denied attendant care benefits and a special award, finding the insurer's reliance on its medical assessments was not unreasonable.

The applicant was injured in a motor vehicle accident and applied for income replacement benefits from his automobile insurer.

He was also receiving $2,000 per month in disability benefits from a Manulife personal accident disability insurance policy.

The insurer argued these benefits were deductible as payments for loss of income under an income continuation benefit plan pursuant to the Statutory Accident Benefits Schedule.

The arbitrator found that the Manulife policy required the applicant to be employed at its inception and that the maximum benefit was calculated with reference to his income from employment.

Consequently, the Manulife benefits constituted payments under an income continuation benefit plan and were deductible from the applicant's income replacement benefits.

The applicant was injured in a motor vehicle accident and received caregiver benefits for over five years before the insurer terminated them.

She sought a continuation of the caregiver benefit and a non-earner benefit, claiming physical and psychological impairments prevented her from caring for her children and engaging in pre-accident activities.

The Arbitrator found that while the accident materially contributed to her psychological impairments, she exaggerated her physical complaints.

The Arbitrator concluded the applicant did not suffer a complete inability to carry on a normal life, as she was capable of engaging in activities with her children and her condition had improved enough for her supportive counseling file to be closed.

The claims for caregiver benefits, non-earner benefits, and interest were dismissed.

The applicant sought payment of $16,896.64 for a catastrophic impairment rebuttal report submitted to the insurer after the 80-business-day limitation period under the Statutory Accident Benefits Schedule.

The arbitrator found that the insurer had provided a valid determination and complete report, triggering the timeline.

However, the applicant had a reasonable excuse for the delay because her chosen occupational therapist was unavailable due to family issues, and the insurer suffered no prejudice.

The insurer was ordered to pay the full cost of the rebuttal report, plus interest.

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

The insurer terminated benefits, arguing the applicant could return to work and perform housekeeping.

The arbitrator found that the applicant suffered from chronic pain and psychological impairments caused by the accident, rendering her substantially and completely unable to engage in her pre-accident employment as a personal support worker or any suitable alternative employment.

The arbitrator awarded ongoing income replacement benefits, partial housekeeping benefits, and specific medical benefits, while dismissing other claims for lack of evidence.

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

The applicant applied for arbitration but failed to attend the hearing.

The applicant's representative was permitted to withdraw due to a breakdown in the relationship.

As the applicant did not appear to present evidence, she failed to meet her burden of proof, and her claims were dismissed.

The insurer was awarded $1,000 in expenses.

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

After the insurer terminated benefits, the applicant sought arbitration but repeatedly failed to comply with production orders and did not attend pre-hearings.

The applicant's representatives withdrew due to an inability to obtain instructions.

When the applicant failed to appear at the scheduled hearing, the arbitrator proceeded in his absence.

The claims were dismissed as the applicant failed to meet the burden of proof, and the applicant was ordered to pay the insurer's arbitration expenses of $1,682.25.

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

After failing to comply with production orders and terminating her legal counsel, the applicant failed to appear at the resumed pre-hearing and the scheduled arbitration hearing.

The arbitrator dismissed the applicant's claims as she failed to meet her burden of proof.

The insurer abandoned its claim for repayment of benefits without prejudice.

No expenses were awarded.

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

The insurer denied the claim, arguing the applicant was precluded under s. 59(1) of the Statutory Accident Benefits Schedule because he was entitled to workers' compensation benefits.

The applicant argued the insurer was estopped from relying on s. 59 because it initially denied benefits on the basis of a suspended licence, prompting him to apply for WSIB benefits.

The arbitrator found the insurer was not estopped, as it had not misrepresented its position and the applicant did not rely on it to his detriment.

The arbitrator also found the applicant did not fall under the s. 59(2) exception, as he failed to prove his tort action was not commenced primarily for the purpose of claiming accident benefits.

The applicant was therefore precluded from receiving accident benefits.

The insurer sought its expenses of $4,351.51 for a preliminary issue arbitration hearing after successfully appealing the initial decision.

The original arbitration decision allowed a third-party insurer to proceed with a claim in the applicant's name, but this was overturned on appeal.

The arbitrator found that the issue in dispute was novel and that the third-party insurer was entirely successful at the original hearing.

The arbitrator concluded that the insurer's subsequent success on appeal did not negate the third-party insurer's success at the preliminary hearing, and ordered each party to bear their own expenses.

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

The Insurer denied benefits on the basis that her policy had been cancelled for non-payment of premiums prior to the accident, and she knew or ought to have known she was driving without insurance.

The Arbitrator found that the Applicant, who had been away from home caring for her mother and touring with her children, did not receive the registered mail notice of cancellation.

The Arbitrator concluded that the Applicant did not know, and a reasonable person in her circumstances ought not to have known, that the policy was cancelled.

Therefore, she was not precluded from receiving benefits under section 30 of the Schedule.

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

The insurer terminated certain benefits, and the applicant applied for arbitration.

The applicant subsequently withdrew her application to pursue a market conduct complaint, and later refiled after the complaint was dismissed.

The insurer argued the refiled claims were barred by the two-year limitation period under s. 281(5) of the Insurance Act.

In this preliminary issue hearing, the arbitrator found the withdrawal and refiling was an abuse of process but permitted the refiling to avoid prejudice.

The arbitrator then analyzed each claim, finding that the limitation period barred several claims where the insurer had provided a valid, unequivocal refusal more than two years prior.

Claims without a valid refusal or where the insurer's conduct suggested ongoing consideration were permitted to proceed.

The arbitrator also dismissed the applicant's request to set aside a prior settlement agreement.

The insurer requested an expense hearing after the applicant's arbitration for statutory accident benefits was dismissed as frivolous and vexatious due to his failure to participate.

The applicant did not attend the expense hearing.

The arbitrator awarded the insurer $1,144.63 in expenses, finding that the applicant's conduct unnecessarily prolonged the proceedings.

The insurer's request for the applicant to pay the $3,000 arbitration filing fee was denied for lack of jurisdiction.

The applicant sought statutory accident benefits for housekeeping and home maintenance services, as well as the cost of an assessment, following a motor vehicle accident.

The arbitrator found the applicant's evidence regarding his pre- and post-accident housekeeping activities to be unreliable, inconsistent, and exaggerated.

The arbitrator concluded that the applicant did not suffer a substantial inability to perform his housekeeping tasks and that the claimed expenses were not reasonable or necessary.

The request for the cost of the assessment was also denied as it amounted to a duplication of services.

The application was dismissed.

The applicant was struck by a pickup truck while riding his bicycle, sustaining severe injuries to his left heel and ankle.

He applied for a determination of catastrophic impairment, which the insurer denied.

At arbitration, the arbitrator preferred the evidence of the applicant's experts, finding that his need for two crutches and a short leg brace resulted in a 55% Whole Person Impairment under the AMA Guides.

Furthermore, the arbitrator accepted that the applicant's chronic pain and depression resulted in a Class 4 marked impairment in at least one area of functioning.

The arbitrator concluded that the applicant sustained a catastrophic impairment under both paragraphs 2(1.2)(f) and (g) of the Schedule.

The applicant, a school bus driver, was injured when her bus rolled forward and struck other vehicles.

She applied for statutory accident benefits but did not pursue a WSIB claim.

Two years later, after the insurer raised a defence under s. 59(1) of the SABS, she commenced a tort action against the bus manufacturer.

The arbitrator found that the applicant's delay in bringing the tort action and her failure to prosecute it demonstrated that her election to sue was made primarily for the purpose of claiming accident benefits.

Therefore, under s. 59(2) of the SABS, she was precluded from receiving statutory accident benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement, medical, and housekeeping benefits, as well as a special award.

The applicant failed to attend the pre-hearing and the arbitration hearing.

As the applicant did not appear to present evidence and meet the burden of proof, the arbitrator dismissed all claims.

The applicant was ordered to pay the insurer's reasonable arbitration expenses, fixed at $1,669.46.