Maggy Murray

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

After his representatives withdrew from the record, the applicant failed to attend the arbitration hearing.

As no evidence was adduced in support of the application, the arbitrator dismissed the application as abandoned.

The applicant was ordered to pay the insurer's arbitration expenses in the amount of $978.80.

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

After his representatives withdrew from the record, the applicant failed to attend the scheduled arbitration hearing.

As no evidence was adduced in support of the application, the arbitrator dismissed the application as abandoned.

The applicant was ordered to pay the insurer's expenses of the arbitration, fixed at $587.28, due to his conduct which prolonged and hindered the proceeding.

The Applicant applied for statutory accident benefits following a motor vehicle accident.

The parties reached a settlement at a pre-hearing, and the Applicant cashed the settlement cheque but failed to execute the settlement documents.

The Applicant and his representative subsequently failed to attend a resumed pre-hearing or respond to communications from the Commission.

The Insurer requested that the arbitration be dismissed.

The Arbitrator found that the Applicant had abandoned the arbitration and dismissed the proceeding as frivolous, vexatious, and commenced in bad faith pursuant to Rule 68.1 of the Dispute Resolution Practice Code.

The applicant was injured in a motor vehicle accident and received non-earner benefits of $185 per week.

After 104 weeks, he sought an increased benefit of $320 per week under s. 12(3) of the Statutory Accident Benefits Schedule, arguing that his pre-accident employment did not reflect his education and training.

The insurer denied the increase, contending that his jobs as a general labourer and turkey catcher were consistent with his high school education.

The arbitrator found that the applicant had a basic secondary school education with an emphasis in art, and that his pre-accident jobs did not reflect this education and training.

The applicant was awarded the increased non-earner benefit of $320 per week, along with interest on the overdue amounts.

The applicant, who sustained a catastrophic brain injury in a motor vehicle accident, sought interim attendant care benefits.

The insurer denied the benefits, arguing his needs were met by the long-term care facility where he resided.

The arbitrator found the applicant established a prima facie case for entitlement and demonstrated urgency and risk of irreparable harm due to the likelihood of another seizure and the facility's staff-to-patient ratio.

The arbitrator ordered the insurer to pay past and ongoing interim attendant care benefits, plus interest, and ruled that the facility's co-payment for accommodation and meals is a medical benefit, not deductible from attendant care benefits.

The applicant was injured in a motor vehicle accident and sought payment for $1,828.00 in medical benefits for treatment received at a health clinic.

The insurer denied the treatment plan based on perceived 'red flags' and a subsequent Designated Assessment Centre (DAC) report that concluded the treatment was not reasonable and necessary.

The arbitrator gave little weight to the DAC report due to factual errors and internal inconsistencies, preferring the evidence of the treating chiropractor and the applicant.

The arbitrator found the treatment was reasonable and necessary, ordered the insurer to pay the medical benefit with interest, and deferred the issues of a special award and expenses to a resumed hearing.

The applicant applied for statutory accident benefits following a motor vehicle accident.

The parties reached a settlement at a pre-hearing, but the applicant failed to execute the settlement documents despite cashing the settlement cheque.

The applicant and his representative failed to attend the resumed pre-hearing or respond to communications.

The arbitrator issued a notice of intention to dismiss the proceeding without a hearing on the grounds that it is frivolous, vexatious, or commenced in bad faith.

The applicant applied for arbitration after the insurer terminated her housekeeping benefits following a motor vehicle accident.

The applicant failed to attend the pre-hearings and the scheduled arbitration hearing, and her representative was previously permitted to withdraw.

As no evidence was adduced in support of the application, the arbitrator dismissed the application as abandoned.

The applicant was ordered to pay the insurer's arbitration expenses in the amount of $1,703.11 due to her conduct which prolonged and hindered the proceeding.

The applicant was completely successful on a preliminary motion regarding post-104 week examinations.

The arbitrator assessed the applicant's expenses under s. 282(11) of the Insurance Act and s. 12 of O. Reg. 664.

Finding the applicant's claim for 10.4 hours of legal work reasonable, the arbitrator awarded expenses of $1,653.60 inclusive of GST.

Following a decision dismissing the applicant's claim for statutory accident benefits for overseas airline tickets, the insurer sought its expenses for the arbitration proceeding.

The arbitrator applied the criteria under section 12(2) of Ontario Regulation 664 and found that the insurer was completely successful.

The arbitrator rejected the applicant's argument that her modest means should preclude a costs award, noting that only the prescribed criteria could be considered.

The insurer was awarded $1,875.29 in expenses.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits from her insurer.

The insurer denied a physiotherapy treatment plan, terminated housekeeping benefits, and refused to pay for several medical assessments.

At arbitration, the arbitrator found the physiotherapy treatment plan to be reasonable and necessary, rejecting the insurer's DAC assessor whose opinion improperly relied on vehicle damage estimates.

The arbitrator also reinstated the housekeeping benefits, finding the applicant suffered a substantial inability to perform her pre-accident chores, and preferred the evidence of the applicant and her family over the insurer's occupational therapist.

The arbitrator awarded the cost of one orthopaedic assessment but denied two others because the applicant failed to follow the required pre-approval process.

Interest was awarded on the overdue housekeeping benefits.

The insurer brought a motion for an order permitting it to schedule post-104 week examinations of the insured and requiring the insured to attend.

The arbitrator dismissed the motion, finding that an order permitting the scheduling of examinations was unnecessary as section 42 of the Statutory Accident Benefits Schedule already permits insurers to schedule them.

Furthermore, the arbitrator held that she lacked jurisdiction to order an insured to attend an examination, noting that the insurer had not yet served the insured with the required notice under section 42(4).

The Applicant applied for statutory accident benefits following an alleged motor vehicle accident.

The Insurer denied the benefits, alleging that the accident was staged and that the Applicant's vehicle was struck while stationary.

The Insurer relied on the reports of an investigator and two accident reconstruction experts who concluded the collision did not occur as described.

The Arbitrator found the Applicant to be a credible witness and accepted her version of events.

The Arbitrator gave little weight to the Insurer's expert reports because the experts did not examine the vehicles or interview the drivers, and relied on inaccurate information.

The Arbitrator concluded that the Applicant was involved in an accident as defined in section 2 of the Schedule.

The applicant, who was injured in a motor vehicle accident, sought a rehabilitation benefit under the Statutory Accident Benefits Schedule for the cost of two round-trip airline tickets to India for herself and her husband.

She argued the trip would provide a therapeutic environment.

The arbitrator dismissed the application, applying the ejusdem generis rule to find that airline tickets for visiting family and friends do not fall within the same class as the specific rehabilitation benefits contemplated by the Schedule.

The claims for interest and expenses were also dismissed or deferred.

The insurer brought a motion for the production of the applicant's welfare records, employment records, and income tax returns in an arbitration for statutory accident benefits.

The arbitrator ordered the production of the medical and drug benefit portions of the welfare file, as well as employment records detailing job duties and hours, finding them relevant to the applicant's claim for medical and housekeeping benefits.

The request for income tax returns was dismissed as they were not relevant to the applicant's physical capabilities.

The applicant sought statutory accident benefits for medical treatment following a motor vehicle accident.

The insurer denied the claims, arguing the treatment plan was submitted late and the treatment was not reasonable and necessary.

The arbitrator found that the applicant was precluded from arbitrating the treatment plan because it was submitted beyond the 30-day limit.

In the alternative, the arbitrator relied on insurer examinations and a DAC assessment to conclude the treatment was not reasonable and necessary.

The application was dismissed.