Marcel D. Mongeon

The applicant was struck by a vehicle while crossing a street and sought income replacement benefits (IRBs) and medical benefits from her insurer.

The insurer terminated IRBs and denied further medical benefits.

At arbitration, the applicant claimed physical and psychological impairments, relying on a multi-disciplinary assessment.

The arbitrator rejected the applicant's expert psychological evidence, noting the assessors had little to no contact with the applicant and their conclusions were inconsistent with her failure to seek psychological treatment and her academic achievements post-accident.

Finding no physical or psychological impairments caused by the accident, the arbitrator dismissed the claims for IRBs, medical benefits, and a special award.

Following a successful arbitration where the applicant's claims for accident benefits outside the Minor Injury Guideline were dismissed, the insurer sought costs.

The insurer claimed $27,852.64 in expenses, while the applicant argued for a nominal amount.

The arbitrator found the insurer was entitled to expenses but reduced the amount, noting the limited financial risk of the matter and that it was unreasonable for the insurer to have two lawyers.

Applying the legal aid rate for one lawyer, the arbitrator awarded the insurer $11,311.31, inclusive of disbursements and HST.

Following an arbitration hearing where the applicant achieved mixed success, including an award for ongoing income replacement benefits, the applicant sought expenses.

The arbitrator considered the criteria under section 12 of Regulation 664 and awarded the applicant partial indemnity costs.

The applicant was awarded $8,459.47 in fees plus HST, and $17,191.54 in disbursements, for a total of $26,750.74.

The insurer sought expenses following a successful arbitration where no accident benefits were awarded to the three applicants.

The applicants argued that no costs should be awarded against two of the applicants as they were persons under a disability.

The arbitrator found that the estate was legally responsible for costs, but declined to award costs against the autistic applicant, as there was no evidence of a substitute decision-maker agreeing to be bound for costs.

The arbitrator awarded proportionate costs to the insurer against the remaining two applicants, applying legal aid rates.

The Applicant was injured in a motor vehicle accident and sought accident benefits from the Insurer, including a declaration of catastrophic impairment, income replacement benefits (IRBs), attendant care benefits, and medical benefits.

The arbitrator found that the Applicant suffered a mental disorder but did not sustain a catastrophic impairment, as he did not have a marked impairment in any of the four domains of functioning.

However, the arbitrator concluded that the Applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment and a complete inability to engage in any employment for which he was reasonably suited, entitling him to IRBs.

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

Following a decision where the insurer prevailed in an arbitration for statutory accident benefits, the insurer sought over $20,000 in expenses.

The arbitrator considered the criteria under section 12 of Regulation 664, noting that the parties had previously attempted to settle the matter for $18,000 but failed to consummate the settlement.

The arbitrator awarded the insurer a modest expense amount of $5,010.98, representing an indemnity for time and effort only from the point the settlement failed, using legal aid rates.

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits from the Insurer, including income replacement benefits, attendant care benefits, and payment for various medical treatments and assessments.

The Arbitrator found that the Applicant suffered from chronic pain and functional limitations, exacerbated by his functional illiteracy, which rendered him substantially unable to perform his pre-accident employment and completely unable to engage in any suitable employment post-104 weeks.

The income replacement benefit claim was granted.

The claim for attendant care benefits was dismissed, as the Applicant's family and friends did not suffer an economic loss, and the evidence did not support the need for 24/7 supervision.

Claims for medical treatments and assessments were partially granted based on reasonableness and necessity.

The applicant sought non-earner benefits following a motor vehicle accident.

At the outset of the arbitration hearing, the applicant's representative requested an adjournment based on the applicant's health and alleged defects in the insurer's explanation of benefits.

The arbitrator denied the adjournment, finding no clear medical evidence of incompetence to testify and no statutory remedy for the alleged explanation of benefits defect.

Subsequent requests for a stay of proceedings and for the arbitrator's recusal based on systemic bias were also denied.

The applicant then withdrew the application.

The arbitrator permitted the withdrawal and declined to award expenses to either party.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the insurer.

The central issues were whether the applicant's injuries fell within the Minor Injury Guideline (MIG) and whether the insurer's payment of over $3,500 in treatment costs constituted a waiver of the MIG limit.

The arbitrator found that the applicant's injuries were minor and that the insurer did not waive the MIG limit simply by overpaying.

The arbitrator rejected the applicant's experts' diagnoses of chronic pain and WAD III, preferring the insurer's experts who concluded the applicant suffered only soft tissue injuries.

All claims for additional rehabilitation benefits and examination costs were dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and medical benefits.

The arbitrator found the applicant was entitled to pre-104 week IRBs because the insurer's own occupational therapy expert concluded she could not perform the essential tasks of her pre-accident employment.

However, post-104 week IRBs were denied as the applicant failed to prove a complete inability to engage in any suitable employment, given her ability to manage a household and work part-time as a house cleaner.

A claim for massage therapy was denied as not reasonable or necessary.

The arbitrator awarded a $1,000 special award against the insurer for unreasonably terminating the pre-104 week IRBs despite clear evidence of the applicant's inability to perform her pre-accident job.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment based on mental or behavioural disorders (Criterion 8).

The applicant suffered a severe breast injury resulting in chronic pain, which she argued caused marked impairments in social functioning and adaptation.

The arbitrator applied the AMA Guides and found that while the applicant suffered from mental disorders, her impairments in social functioning and adaptation were at most moderate (Class 3).

The arbitrator concluded that the applicant's work challenges stemmed primarily from physical pain rather than a mental disorder, and dismissed the application for catastrophic impairment.

The three applicants were involved in a motor vehicle accident and sought various statutory accident benefits, including non-earner benefits, attendant care benefits, and medical rehabilitation benefits.

The insurer denied the claims based on independent medical examinations indicating that the applicants' ongoing impairments were related to pre-existing conditions rather than the accident.

The arbitrator found that none of the applicants suffered a complete inability to carry on a normal life, and that the proposed treatment plans and attendant care were neither reasonable nor necessary.

All claims for benefits were dismissed.

The applicant was involved in two motor vehicle accidents in November and December 2012.

She sought accident benefits including a non-earner benefit and payment for three assessment treatment plans (chronic pain, neurological, and attendant care needs).

The arbitrator found that the applicant's injuries from both accidents fell within the Minor Injury Guideline, noting a lack of medical evidence to support injuries outside the guideline.

The claim for a non-earner benefit was dismissed as the applicant failed to provide sufficient evidence of her pre- and post-accident life to establish a complete inability to carry on a normal life.

The proposed assessments were also denied as they were deemed neither reasonable nor necessary, and exceeded the minor injury limit.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment from the insurer.

The insurer denied the determination, and the applicant applied for arbitration at the Financial Services Commission of Ontario.

The insurer raised a preliminary issue of whether an arbitrator has jurisdiction to determine catastrophic impairment when the application does not seek payment of any specific benefits.

The arbitrator held that, following the Court of Appeal's decision in Machaj, a claim for a determination of catastrophic status is distinct from a claim for specific benefits.

Because there was no claim for specific benefits in this matter, a finding of catastrophic impairment could not be made, as it would have no practical effect and be merely academic.

The applicant sought expenses following an arbitration decision where he was awarded a portion of the attendant care benefits claimed.

The insurer argued that each party should bear their own expenses since the applicant only achieved partial success.

The arbitrator found that the applicant was required to proceed to arbitration to obtain the benefits awarded and that denying expenses would be unfair, as the award could be consumed by the costs incurred.

The arbitrator awarded the applicant expenses of $11,401.28, calculated at Legal Aid rates.

The applicant was injured when a garage door closed on her vehicle and sought accident benefits from her insurer.

The insurer denied treatment plans on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG).

At arbitration, the applicant failed to present medical evidence or expert testimony to establish that her injuries fell outside the MIG or that her ongoing pain was causally linked to the accident.

The arbitrator accepted the uncontradicted expert evidence of the insurer's medical and psychological assessors, concluding that the applicant's impairments were predominantly minor injuries.

The application for additional treatment was dismissed.

The Applicant sought to withdraw his Application for Arbitration for accident benefits at the outset of the scheduled three-day hearing.

The Insurer agreed to the withdrawal on a with-prejudice basis, provided it was awarded expenses.

The Arbitrator permitted the withdrawal on a with-prejudice basis and awarded the Insurer expenses for one day of hearing and two days of preparation, noting the late notice of withdrawal resulted in time thrown away.

The Applicant was ordered to pay the Insurer $4,535.23 in expenses and disbursements.

The applicant was injured in a motor vehicle accident and sought an Income Replacement Benefit (IRB) from the insurer.

The insurer conceded the medical tests for the IRB but disputed the applicant's proof of employment and income, as the applicant had not received T4s, Records of Employment, or pay stubs from his former employer.

The arbitrator found that the applicant provided a reasonable explanation for failing to call his former employer as a witness and declined to draw an adverse inference.

Relying on time sheets, uncashed cheques, text messages, and the applicant's testimony, the arbitrator concluded on a balance of probabilities that the applicant was employed at the time of the accident with an expected income of $2,000 per month.

The arbitrator ordered the payment of an IRB based on a gross weekly income of $461.54, plus interest, but denied the applicant's claim for a Special Award, finding the insurer's actions in waiting for the arbitration decision were reasonable.

The applicant sought a special award in an arbitration for statutory accident benefits, but the insurer prevailed.

The parties could not agree on expenses.

The arbitrator applied the criteria under section 12 of Regulation 664 and found the insurer was entitled to its expenses.

The arbitrator awarded the insurer $5,738.05, calculating the fees based on Legal Aid Rates and allowing for two days of hearing and preparation, noting the hearing was prolonged by the inexperience of the applicant's representatives.

The applicant sought a non-earner benefit following a motor vehicle accident.

The matter proceeded to an arbitration hearing before the Financial Services Commission of Ontario.

The applicant, who had previously discharged her representative, failed to attend the scheduled telephone hearing.

The insurer's representative advised of a verbal agreement to withdraw the application on a with-prejudice basis without costs.

Due to the applicant's non-attendance, the arbitrator dismissed the application with prejudice and ordered no expenses.