Maggy Murray

The Applicant was injured in a motor vehicle accident and sought payment for nine treatment plans totaling $12,085.66 from Osler Rehabilitation Centre.

The Insurer denied the claims.

At arbitration, the Arbitrator found the Applicant failed to meet her burden of proof that the medical benefits claimed were reasonable and necessary.

The Arbitrator concluded that the invoices and treatment plans from the rehabilitation centre were highly unreliable, containing numerous inconsistencies regarding the type, frequency, and providers of the treatment allegedly received.

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

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

The insurer subsequently requested an examination under oath, which the applicant attended but refused to answer questions regarding those specific benefits.

The insurer then terminated the benefits.

In this preliminary issue hearing, the arbitrator held that the insurer was precluded from conducting the examination under oath regarding those benefits because it failed to request the examination within 10 business days of receiving the application and disability certificate, as required by s. 36(4)(c) of the Statutory Accident Benefits Schedule.

Consequently, the insurer was not entitled to suspend the benefits under s. 33(6).

The applicant was awarded expenses for the hearing.

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

The insurer denied two treatment plans and argued that the applicant was precluded from proceeding to arbitration because he failed to commence proceedings within the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule and section 281.1 of the Insurance Act.

The arbitrator found that the applicant had filed for mediation within two years of the insurer's refusals and subsequently filed for arbitration within 90 days of the mediator's reports.

Therefore, the limitation periods had not expired, and the applicant was permitted to proceed to arbitration on both treatment plans.

The Applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment.

The parties agreed on a 34% physical whole person impairment but disputed the mental and behavioural impairment rating.

The arbitrator preferred the evidence of the Applicant's psychological expert, finding that the Applicant suffered a marked impairment in adaptation to work environments due to severe panic disorder and agoraphobia.

The arbitrator concluded that the Applicant sustained a catastrophic impairment under both clause 2(1.2)(g) (marked mental impairment) and clause 2(1.2)(f) (combined physical and mental impairment of 60%).

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

The insurer denied non-earner and housekeeping benefits, but subsequently sent a letter indicating it was reviewing the applicant's entitlement, which the arbitrator found rendered the initial refusal invalid and estopped the insurer from relying on the limitation period.

The arbitrator also found that the applicant was not precluded from proceeding to mediation for a treatment plan despite failing to cooperate with insurer's examinations, as the relevant provision of the Schedule applied to designated assessments, not insurer's examinations.

The applicant was injured in a motor vehicle accident and applied for attendant care and housekeeping benefits.

The insurer refused to pay and requested that the applicant attend an insurer's examination.

The applicant failed to attend, and the insurer raised a preliminary issue arguing that she was prohibited from proceeding to arbitration under s. 55(2) of the Statutory Accident Benefits Schedule.

The arbitrator found that the insurer's notices of examination failed to comply with the strict requirements of s. 44(5) of the Schedule, as they omitted necessary details such as the regulated health profession of the assessor and the exact location of the examination.

Consequently, the applicant was not prohibited from proceeding to arbitration.

The Applicant sought expenses following a successful arbitration regarding statutory accident benefits.

The arbitrator applied the criteria under section 12(2) of Ontario Regulation 664, noting the Applicant's success and the insurer's conduct in prolonging the proceeding.

The arbitrator awarded the Applicant $45,595.50 in legal fees, inclusive of HST, after deducting hours claimed for an unsuccessful motion and travel time.

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

The parties settled the claims for $15,000 plus costs and disbursements.

They could not agree on expenses, so an expense hearing was held.

The applicant claimed $20,462.04 in legal fees.

The arbitrator found the claimed amount disproportionate and excessive, noting the insurer's early offer to settle and the applicant's delays in requesting adjournments.

The arbitrator reduced the allowable hours and awarded the applicant $6,162.57 in legal fee expenses, inclusive of HST.

An allegation of bias against the arbitrator was dismissed.

Following a finding that the insurer unreasonably withheld income replacement and housekeeping benefits, the arbitrator determined the quantum of a special award under s. 282(10) of the Insurance Act.

The insurer had terminated benefits despite its own assessors concluding the applicant was unable to work and required housekeeping assistance.

The arbitrator fixed the special award at $58,000, representing approximately 20% of the withheld payments inclusive of interest, to punish the insurer's blameworthy conduct and deter future similar actions.

The applicant, a self-employed plumber, was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer terminated income replacement and housekeeping benefits and denied various medical benefits.

The arbitrator found that the applicant suffered a complete inability to engage in suitable employment due to his injuries, which aggravated pre-existing conditions, and awarded ongoing income replacement benefits.

The arbitrator also awarded the claimed medical benefits, housekeeping benefits, the cost of an MRI, and interest at 2% per month.

A special award was granted against the insurer for unreasonably withholding payments, with the amount to be determined.

The applicant sought production of the insurer's entire file up to the date of the arbitration.

The insurer claimed litigation privilege over its file from the date of the Application for Mediation.

The arbitrator held that litigation privilege attached to the insurer's file on the day the insurer received FSCO's letter notifying it of the Application for Mediation, as that is when litigation was reasonably anticipated.

The insurer was ordered to produce its file up to that date, subject to any claims for privilege and redaction of reserve information.

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

The insurer requested a psychiatric medical examination under s. 42(1) of the Statutory Accident Benefits Schedule and sought to stay the arbitration proceeding until the applicant attended.

The arbitrator found that the insurer's notice of examination was defective as it failed to specify the type of examination to be conducted.

Furthermore, the examination was not reasonably necessary given the insurer's three-year delay in requesting it after being aware of the applicant's psychological issues.

The requests for the examination and the stay were dismissed.

The applicant was injured in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment under the Statutory Accident Benefits Schedule.

The applicant relied on assessments indicating a 74% whole person impairment, while the insurer's assessors concluded she had a 31% combined impairment.

The arbitrator rejected the applicant's primary expert evidence, finding the assessor opined outside his expertise and acted as an advocate.

Preferring the insurer's experts and finding the applicant's evidence lacked credibility, the arbitrator concluded the applicant's combined physical and mental impairments resulted in a 28% whole person impairment.

The application for catastrophic impairment benefits was dismissed.

The applicants, two young boys, were injured when an unhitched trailer rolled down a driveway and crushed one of them against a utility pole.

They applied for statutory accident benefits from the insurer of their parents' vehicles.

The insurer denied the claim, arguing the incident was not an 'accident' under section 2(1) of the Statutory Accident Benefits Schedule.

The arbitrator found that the trailer was being used in connection with the pickup truck that towed it, satisfying the purpose test.

The arbitrator also found that the use of the truck and trailer directly caused the injuries, as the trailer was not properly secured and rolled down the driveway immediately after being unhitched.

The arbitrator concluded the incident was an 'accident' and the applicants were entitled to benefits.

The applicant sought statutory accident benefits after being assaulted by a co-worker who dragged him out of his truck and threw him against it.

The insurer denied benefits on the basis that the incident was not an 'accident' under section 2 of the Statutory Accident Benefits Schedule.

The arbitrator agreed, finding that the applicant's injuries were caused by the assault, not by the use or operation of the automobile.

As there was no accident, the insurer was not required to pay benefits pending dispute resolution under subsection 59(5).

The applicant was injured in a motor vehicle accident and successfully opposed the insurer's motion to compel her attendance at a medical examination.

In this subsequent hearing on expenses, the arbitrator applied the criteria under section 12(2) of Ontario Regulation 664.

Finding that the applicant was completely successful and that the insurer's motion was unnecessary, the arbitrator awarded the applicant her expenses of the motion, assessed at $2,998.61.

The insurer brought a motion for a preliminary issue seeking an order that the insured attend a medical examination under s. 42 of the Statutory Accident Benefits Schedule, and to stay the arbitration proceedings until she did so.

The arbitrator found that the requested examination was not reasonably necessary because the insurer had delayed its request for over a year after learning of the insured's multiple sclerosis, suggesting the examination was sought to bolster its case for arbitration rather than to adjust the claim.

Furthermore, the notice of examination was deficient.

The arbitrator also noted a lack of jurisdiction to order attendance at a medical examination.

The motion was dismissed and the arbitration was not stayed.

Following the dismissal of the applicant's arbitration for statutory accident benefits due to his failure to attend pre-hearings, the insurer sought its expenses.

The arbitrator found that the applicant had abandoned his arbitration without explanation, rendering the proceeding frivolous and vexatious.

Applying the criteria under section 12(2) of Ontario Regulation 664, the arbitrator awarded the insurer its requested expenses of $1,511.34.

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

The insurer denied various benefits, leading to arbitration.

On a preliminary motion, the arbitrator ruled that the applicant's claims for certain examination costs were barred because she failed to seek prior approval under s. 24(1.1) of the Schedule.

However, the arbitrator allowed the applicant to proceed with claims for treatment expenses incurred before the insurer first raised the lack of treatment plans, as the insurer had breached its duty to assist the applicant.

The arbitrator also ordered the insurer to produce portions of its accident benefits file up to the date of the second mediation application, but denied the applicant's request for the insurer's internal policies on lumping out claims.

The applicant applied for arbitration at the Financial Services Commission of Ontario after the insurer refused to pay various statutory accident benefits following a motor vehicle accident.

The applicant's representatives withdrew from the record due to an inability to communicate with her.

The applicant failed to attend the pre-hearings, a motion, and the scheduled arbitration hearing.

As no evidence was adduced in support of the application, the arbitrator dismissed the application as abandoned and ordered the applicant to pay the insurer's expenses of the proceeding, fixed at $587.28.