Marcel D. Mongeon

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

The Insurer denied several treatment plans and assessments, arguing the Applicant's injuries fell within the Minor Injury Guideline (MIG).

The arbitrator found that the Applicant's psychological and orthopaedic expert reports were tainted by a conflict of interest, as the primary psychologist had a close personal and financial relationship with the Applicant, and other experts relied on her clinic's flawed assessments.

The arbitrator excluded or gave no weight to the Applicant's expert evidence and accepted the Insurer's independent medical examinations.

The arbitrator concluded the injuries were predominantly minor and dismissed the claims for further benefits.

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

The parties disputed whether the applicant, who worked as a driving school instructor, was self-employed or an employee at the time of the accident.

The arbitrator found that the applicant was self-employed, as he engaged in his occupation as a sole proprietor, filed his taxes as such, and received payments inclusive of HST without employment deductions.

The clear definition of 'self-employed person' in section 3(1) of the Schedule was met, rendering traditional factual indicia tests unnecessary.

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

During the pendency of the arbitration, the applicant passed away.

Over two years later, no estate trustee had been appointed.

The applicant's representative sought an adjournment, which the insurer opposed.

The arbitrator denied the adjournment, noting that the family had not acted to appoint an estate trustee and an adjournment would serve no useful purpose.

As there was no one to instruct the representative and no evidence to present, the application for arbitration was dismissed.

No expenses were ordered.

The applicant was injured in a motor vehicle accident and sought accident benefits.

The parties settled the claims for income replacement and medical benefits, leaving only the issue of whether the applicant was entitled to a Special Award under s. 282(10) of the Insurance Act for the insurer's initial denial of benefits.

The arbitrator found that the insurer acted reasonably at all relevant times based on the medical information available, which supported a theory that the applicant's impairments were due to pre-existing degenerative disc disease rather than the accident.

The claim for a Special Award was dismissed.

The Applicant was catastrophically injured in a motor vehicle accident and sought attendant care benefits under the Statutory Accident Benefits Schedule.

The Insurer denied the benefits, arguing they were not "incurred" because the Applicant's caregivers did not sustain an economic loss.

The arbitrator found that the Applicant's friend, who housed and cared for him while acting as his surety on bail, sustained an economic loss by charging reduced rent and incurring additional grocery and utility costs.

The arbitrator awarded attendant care benefits of $3,526.34 per month for the period the Applicant resided with this friend.

Claims for other periods, including while the Applicant was hospitalized, staying with other family members, or incarcerated, were dismissed due to a lack of evidence of attendant care services provided or economic loss sustained.

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

After the applicant's representative withdrew, the applicant failed to attend a pre-hearing discussion and the subsequent arbitration hearing, despite being provided notice.

The arbitrator proceeded in the applicant's absence pursuant to Rule 37.7 of the Dispute Resolution Practice Code.

As the applicant bore the onus of proving entitlement and presented no evidence, the application for arbitration was dismissed.

The applicant was injured in a motor vehicle accident and subsequently determined to be catastrophically impaired due to chronic pain and depression.

She sought retroactive statutory accident benefits for housekeeping, attendant care, and medical marijuana.

The arbitrator held that the catastrophic impairment determination had retroactive effect, entitling the applicant to $17,800 for housekeeping benefits despite a lack of incurred expense receipts.

For attendant care, the arbitrator preferred the insurer's assessment of $864 per month, finding the applicant did not require 24/7 care.

The arbitrator also awarded $12,600 for medical marijuana purchases, noting that the applicant could not claim both growing equipment and purchasing costs.

The applicant sought accident benefits following a motor vehicle accident.

At the arbitration hearing, the applicant did not attend in person.

The arbitrator denied the insurer's motions to dismiss the application based on the applicant's absence and failure to comply with production orders.

However, the arbitrator granted the insurer's motion to exclude the applicant's arbitration brief and witness list because they were served late without extraordinary circumstances.

The arbitrator denied the applicant's subsequent request for an adjournment.

As the applicant presented no evidence to prove her claim, the application for arbitration was dismissed.

The insurer was awarded expenses of $8,033.71.

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

After the applicant's representative was removed from the record, the applicant failed to attend the rescheduled arbitration hearing despite receiving notice.

The arbitrator dismissed the application for arbitration due to the applicant's failure to appear and present evidence.

The insurer was awarded $2,500 in expenses for preparation and attendance.

The Applicant was catastrophically injured in a motor vehicle accident and sought $75,461.75 in attendant care benefits for services provided by his daughter, a child and youth worker.

The Insurer denied the claim.

The Arbitrator found that the daughter did not sustain an economic loss, her employment as a child and youth worker was not analogous to providing attendant care to her father, there was no legal obligation to pay her, and the services were not reasonable and necessary given the availability of other family members.

The claim for attendant care benefits was dismissed.

The applicant sought a death benefit following the death of his mother in a motor vehicle accident, claiming he was her dependant.

At the time of the accident, the 26-year-old applicant lived with his parents but earned over $1,000 per week.

The arbitrator applied the 50% formula for financial dependence, finding that the applicant's needs did not exceed twice his income.

Consequently, the applicant was not principally financially dependent on his parents and was not entitled to the death benefit.

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

The insurer requested an Examination Under Oath (EUO), which the applicant refused to attend, arguing the insurer failed to provide sufficient reasons as required by s. 33(4)3 of the Schedule.

On a motion, the Arbitrator held that the requirement to provide reasons for an EUO is a matter of form, not substance, and the insurer's notice was sufficient.

The Arbitrator also ordered the insurer to produce its complete accident benefits file, redacted for privilege, and directed that this production must occur prior to the applicant attending any further EUO to prevent a tactical advantage.

The Insurer brought a motion for an order staying the arbitration proceedings pending the Applicant's attendance at a new psychiatric examination with Dr. Wiesenthal.

The Applicant had previously attended insurer examinations, but subsequently submitted a new OCF-19 claiming catastrophic impairment under Criterion 8 (mental or behavioural disorder), supported by new assessments.

The Arbitrator found that the proposed examination was reasonably necessary given the new information and the passage of time.

The Arbitrator ordered that if the Applicant failed to attend the examination by March 1, 2016, the proceedings would be stayed.

The applicant sought accident benefits after a vehicle crashed into her home, causing her severe psychological and cognitive decline.

The insurer sought to stay the arbitration until the applicant attended further insurer examinations (IEs) under section 44 of the Schedule.

The applicant sought interim benefits.

The arbitrator dismissed the insurer's request for a stay, finding that further IEs would not assist the insurer and were not reasonably necessary given the unopposed expert evidence that further assessments risked causing the applicant serious psychological deterioration.

The arbitrator granted the applicant's request for interim benefits in part, awarding $7,000 for past medical expenses based on a demonstrated prima facie case, financial need, and urgency.

The Applicant sought to withdraw his application for arbitration of accident benefits at the outset of a scheduled three-day hearing.

The Insurer opposed the withdrawal unless costs were ordered.

The Arbitrator granted the withdrawal but ordered the Applicant to pay $2,500 in expenses and $1,800 in disbursements, noting that the late withdrawal warranted a partial indemnity costs order under the Dispute Resolution Practice Code.