Richard Feldman

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, claiming he sustained a catastrophic impairment due to mental and behavioural disorders.

The insurer denied the claim, relying on an assessment that found only mild impairments.

The arbitrator found the insurer's assessment flawed for failing to follow the AMA Guides and ignoring relevant medical documentation.

Relying on the applicant's experts and treating practitioners, the arbitrator concluded the applicant suffered marked impairments in activities of daily living, social functioning, and adaptation, qualifying as a catastrophic impairment.

The arbitrator also awarded attendant care benefits of $2,460.69 per month and interest on overdue payments.

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

A preliminary issue hearing was held to determine whether the applicant sustained a catastrophic impairment under clauses 2(1.2)(f) and (g) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant did not suffer a marked or extreme mental or behavioural impairment under clause (g).

However, combining the applicant's physical impairments (34%) and mental/behavioural impairments (29%), the arbitrator concluded that the applicant sustained a 55% whole person impairment.

Therefore, the applicant was deemed to have sustained a catastrophic impairment under clause (f).

The applicant repeatedly failed to attend scheduled pre-hearing conferences without adequate excuse.

The applicant's representative was unable to contact him and was removed from the record.

The insurer requested that the application be dismissed as frivolous or vexatious under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator gave the applicant twenty days to provide written submissions objecting to the dismissal.

The applicant failed to respond.

The arbitrator found the application had become vexatious and dismissed it.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, specifically non-earner benefits, from the insurer.

The parties proceeded to arbitration at the Financial Services Commission of Ontario.

The arbitrator applied the principles from Heath v. Economical Mutual Insurance Co. to determine whether the applicant suffered a complete inability to carry on a normal life.

The arbitrator found that the applicant failed to prove that the accident continuously prevented her from engaging in substantially all of her pre-accident activities, as she continued to perform most of her usual activities despite increased pain.

The application for non-earner benefits and interest was dismissed, and the issue of expenses was deferred.

The applicant's counsel brought a motion to be removed as solicitors of record due to a breakdown in the solicitor-client relationship and a lack of meaningful instructions.

The applicant failed to attend previous pre-hearing conferences and could not be reached by his counsel or the arbitrator.

The arbitrator granted the uncontested motion, removing the law firm as solicitors of record.

The insurer brought a motion for the production of documents and information relating to the applicant's prior motor vehicle accident in 2000, arguing it was relevant to assessing her claims arising from a subsequent 2007 accident.

The insurer also sought clarification regarding the applicant's capacity and her substitute decision-maker.

The arbitrator found that the capacity issue had been resolved by the applicant filing the necessary documentation.

The arbitrator ordered the applicant to provide the names and details of her caretakers from two years prior to the 2007 accident to the present, as well as the Settlement Disclosure Notice from the 2000 accident, finding them relevant to her pre-accident condition and needs.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and medical/rehabilitation benefits for prescription medication (primarily Oxycontin).

The arbitrator found that the applicant did not suffer a complete inability to carry on a normal life within 104 weeks of the accident, dismissing the claim for non-earner benefits.

However, preferring the evidence of the applicant's treating physician over the insurer's paper-review assessor, the arbitrator found the ongoing prescription of narcotics to be reasonable and necessary for chronic pain management, awarding $25,546.02 for medication expenses.

Claims for the cost of medical reports and a special award were dismissed.

The applicant failed to attend two scheduled pre-hearing conferences.

At the second conference, the applicant's counsel was removed from the record, and the insurer requested that the application be dismissed as frivolous or vexatious.

The arbitrator issued a notice of intent to dismiss the application under Rule 68 of the Dispute Resolution Practice Code, giving the applicant 20 days to provide written submissions.

The applicant failed to respond.

The arbitrator concluded the application had become vexatious and dismissed it.

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

After two days of hearing, the parties reached a settlement wherein the Insurer agreed to pay $10,000 for benefits, $3,000 for interest, and the Applicant's expenses in accordance with the Expense Regulation.

The parties could not agree on the quantum of expenses.

The Arbitrator interpreted the Insurer's offer to settle and awarded the Applicant $12,639.40 in fees and disbursements, rejecting the Insurer's argument that the fees should be reduced due to the Applicant's delay in accepting the offer.

Following the dismissal of the applicant's claim for statutory accident benefits, the insurer sought its expenses of the arbitration against both the applicant and his solicitor personally.

The arbitrator ordered the applicant to pay $7,000 in expenses to the insurer, finding the insurer was completely successful and the applicant lacked credibility.

The arbitrator dismissed the insurer's claim for expenses against the solicitor personally and ordered the insurer to pay $1,000 in expenses to the solicitor for having to defend against the unreasonable claim.

Following the settlement of a dispute over non-earner benefits, the parties disagreed on the quantum of expenses payable to the applicant.

The arbitrator awarded $21,490.38 in fees and disbursements, applying the maximum hourly rates permitted under the Expense Regulation.

The arbitrator denied the applicant's claim for disbursements related to witness travel time, finding no provision in the Expense Regulation or jurisprudence to support such compensation.

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

A preliminary issue hearing was held to determine the quantum of his income replacement benefits, which depended on whether he was employed or self-employed at the time of the accident.

The arbitrator found that while the applicant's work for an employment agency had many indicia of employment, his tax status as a 'Code 11' placement worker allowed him to deduct business expenses.

Giving primary weight to how the employment was treated for tax purposes, the arbitrator concluded the applicant was self-employed and accepted the insurer's calculation of the benefit amount.

The Insurer sought an order for expenses against the Applicant and his solicitor personally, alleging the solicitor advanced frivolous claims and caused unreasonable delay.

The solicitor brought a motion for summary judgment to dismiss the claim against him.

The Arbitrator granted the motion, finding no evidence that the solicitor knowingly participated in misrepresentations or advanced the claims in bad faith, and no evidence of substantial delay attributable solely to his default.

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

A preliminary issue hearing was directed to determine whether the applicant possessed the mental capacity to proceed in the dispute resolution process, given his acquired brain injury and difficulties organizing his thoughts.

The arbitrator found that the applicant was presumed to have capacity and that there was insufficient evidence to rebut this presumption.

The applicant demonstrated an understanding of the process, the relief sought, and the possible outcomes.

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

The arbitrator dismissed the application in its entirety, finding the applicant lacked credibility due to numerous inconsistencies, deliberate misrepresentations about his living arrangements, and evidence of symptom exaggeration.

The arbitrator also found that the applicant made a material misrepresentation by failing to notify the insurer that he was residing and working in Illinois, which voided his entitlement to income replacement and housekeeping benefits under section 30(2) of the Schedule.

The applicant was injured in a motor vehicle accident in 1998, sustaining a traumatic brain injury.

She applied for arbitration after a dispute with her insurer over the quantum of attendant care benefits.

The applicant claimed she required 24-hour care due to cognitive impairments and safety concerns, while the insurer argued she only required limited assistance.

The arbitrator found that while the applicant suffered from executive functioning impairments caused or exacerbated by the accident, she did not require around-the-clock care.

The arbitrator accepted the insurer's occupational therapist's assessment, awarding attendant care benefits of $649.52 per month, plus interest on overdue payments.

The applicant sought statutory accident benefits from the insurer following a motor vehicle accident.

At the outset of the arbitration hearing, the insurer raised procedural objections regarding the applicant's late service of the arbitration brief and failure to identify witnesses in accordance with the Dispute Resolution Practice Code.

The arbitrator waived the time requirements for the brief but excluded a witness the applicant intended to call due to lack of notice.

Following these rulings, the applicant's counsel requested to be removed from the record, and the applicant sought an adjournment to retain new counsel.

The arbitrator granted the removal of counsel and the adjournment, ordering the insurer entitled to its costs thrown away for the morning of the hearing.

The applicant was injured in motor vehicle accidents in 1997 and 2003, developing chronic pain.

She sought payment for massage therapy incurred between 2002 and 2008, which the insurer denied on the basis that ongoing passive therapy was not reasonable and necessary.

The arbitrator found that the massage therapy was reasonable and necessary as supportive care to manage the applicant's chronic pain and allow her to maintain her function and participate in active therapies.

The insurer was ordered to pay $57,078.50 for the incurred massage therapy, plus interest.

The parties settled all issues in dispute regarding statutory accident benefits except for the wording of the consent order for ongoing income replacement benefits.

The insurer requested a term limiting the order's effect to November 9, 2008, to avoid the burden of applying to vary or revoke the order under sections 284 and 287 of the Insurance Act when the test for entitlement changes at the 104-week mark.

The arbitrator declined to impose the requested time limitation, finding it inappropriate to deprive the applicant of the procedural benefits of the Insurance Act without evidence or agreement.

The consent order was issued on the terms agreed upon by the parties.

The insurer brought a motion for disclosure of information and documents in a statutory accident benefits dispute.

The insurer sought the addresses of the applicant's attendant care and housekeeping service providers, Defence Medical Reports from a related tort action, and details of the tort settlement.

The arbitrator ordered the applicant to provide the names and addresses of the service providers, finding it necessary for the insurer to prepare its defence.

However, the arbitrator denied the requests for the Defence Medical Reports and tort settlement details, as the insurer failed to provide sufficient evidence to justify production and the settlement details were not relevant to the issues in dispute.