Richard Feldman

The insurer brought a motion to stay the arbitration proceeding until the applicant attended a section 42 assessment with a physiatrist.

The applicant had previously attended multiple insurer examinations and the insurer had consistently denied his claim for non-earner benefits.

The arbitrator found that the insurer's request, made almost a year after learning of the applicant's physiatrist treatment and only five months before the hearing, was primarily to bolster its case rather than adjust the claim.

The motion was denied as the proposed assessment was not reasonable and necessary at this time.

The applicant sought expenses following a mixed-success arbitration decision regarding statutory accident benefits.

The arbitrator found that success was divided on the issues that proceeded to hearing, which would normally result in each party bearing their own expenses.

However, because the applicant withdrew several claims two days before the hearing, putting the insurer to unnecessary expense, the arbitrator ordered the applicant to pay the insurer's 'costs thrown away' fixed at $400.00.

Following an arbitration where the applicant's claims for statutory accident benefits were denied and the insurer was partially successful on its claim for repayment, the insurer sought its expenses of the proceeding.

The arbitrator considered the criteria under the Expense Regulation, primarily the degree of success.

The insurer claimed $5,674.48 but the arbitrator reduced this amount, disallowing the cost of a court reporter and an unsubstantiated expert fee.

The arbitrator fixed the insurer's expenses at $2,000.00, inclusive of fees, disbursements, and GST, after applying a modest set-off because the insurer failed to attempt to resolve the expense issue prior to the hearing.

The Applicant was injured in a motor vehicle accident and claimed statutory accident benefits for caregiver and housekeeping expenses.

The Insurer paid portions of the claims but denied others based on in-home assessments and insurer examinations.

The Arbitrator reviewed the medical evidence, including reports from occupational therapists and physiatrists, and found the Applicant was entitled to an additional $310.00 for caregiver benefits and $42.50 for housekeeping expenses for specific periods where the Insurer unreasonably denied or miscalculated the benefits.

Claims for periods after October 2005 were dismissed as the evidence showed the Applicant had regained independence in her activities of daily living.

The applicant sought to withdraw her application for arbitration regarding statutory accident benefits shortly before a scheduled pre-hearing conference.

The insurer opposed a withdrawal without conditions, requesting payment of its expenses, the $3,000 assessment fee, and an order precluding future applications on the same issues.

The arbitrator permitted the withdrawal without conditions, finding no evidence of abuse of process to justify ordering payment of the assessment fee or barring future applications.

However, the arbitrator ordered the applicant to pay the insurer's expenses fixed at $750 for the unnecessary costs incurred in preparing for the pre-hearing conference and responding to the withdrawal request.

Following a successful arbitration regarding statutory accident benefits, the applicant sought his legal expenses.

The insurer did not dispute entitlement or the hourly rate but challenged the number of hours claimed for preparation and correspondence.

The arbitrator found the claimed hours reasonable, noting the complexity of the case, the insurer's late concessions, and the insurer's failure to disclose its own counsel's docketed hours.

The insurer was ordered to pay the applicant's expenses in the amount of $42,456.87.

Following a finding that the applicant failed to prove he was involved in a motor vehicle accident and made wilful misrepresentations, the insurer sought repayment of $16,855.58 and its arbitration expenses.

The arbitrator held that under s. 47(1)(a) of the Statutory Accident Benefits Schedule, an insured is only required to repay benefits actually 'paid to the person'.

Consequently, the applicant was ordered to repay only the $6,800.00 in income replacement benefits paid directly to him, and not the amounts paid to third-party service providers or for insurer's examinations.

The applicant was also ordered to pay the insurer's arbitration expenses of $13,292.73.

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

After his counsel was removed from the record, the applicant failed to attend a rescheduled pre-hearing conference and did not respond to a notice advising that the application might be dismissed.

The arbitrator concluded the applicant had abandoned the application and dismissed it as vexatious under Rule 68 of the Dispute Resolution Practice Code.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for caregiver, housekeeping, and medical expenses.

The insurer terminated caregiver and housekeeping benefits based on medical assessments indicating the applicant no longer suffered a substantial inability to perform those tasks.

The insurer also denied further medical benefits and sought repayment of caregiver benefits paid pending a designated assessment centre evaluation.

The arbitrator dismissed the applicant's claims, finding she failed to prove entitlement to the disputed benefits.

The arbitrator ordered the applicant to repay $600 in caregiver benefits to the insurer, as the insurer was justified in terminating the benefits when it did.

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

The applicant failed to attend two pre-hearing discussions and the scheduled hearing.

The applicant's solicitors brought a motion to be removed from the record due to a breakdown in communication, which was granted.

Due to the applicant's failure to attend and pursue the matter, the application was dismissed as an abuse of process.

The insurer was awarded its expenses of the arbitration fixed at $2,534.86.

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

The parties disputed entitlement to a medical benefit for a treatment plan and the cost of an in-home assessment.

The arbitrator found that the applicant was entitled to $502.00 for the treatment plan, as the treatment was reasonable and necessary up to a certain date.

However, the claim for the in-home assessment was dismissed because it was duplicative of an insurer's assessment and not reasonably required.

Interest was awarded on the overdue payment, and the issue of expenses was deferred.

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

At the scheduled hearing, the applicant failed to attend.

The applicant's representative requested to be removed from the record due to a breakdown in communication, which was granted.

As the applicant failed to adduce any evidence to prove entitlement to the claimed benefits, the application was dismissed.

The insurer was awarded its expenses of the arbitration, fixed at $879.40.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The insurer disputed the claim, raising the preliminary issue of whether an 'accident' actually occurred.

The arbitrator found the applicant's testimony to be highly inconsistent and lacking credibility, noting that the applicant had previously given a different sworn statement.

Expert evidence indicated the vehicle damage was inconsistent with the applicant's description and more consistent with being driven against a rough surface.

Furthermore, the other individuals allegedly involved in the accident had been convicted of fraud related to the same incident.

The arbitrator concluded the applicant failed to prove on a balance of probabilities that he was involved in an accident.

The insurer brought an application to vary a consent order that required it to pay ongoing income replacement benefits to the insured.

The insurer argued that the change in the test for entitlement to income replacement benefits at the 104-week mark constituted a material change in circumstances justifying a variation of the order.

The arbitrator dismissed the application, finding that the change in the test for entitlement, in isolation, did not constitute a material change in circumstances, especially since the insurer had consented to the order shortly before the 104-week mark without insisting on a time limit and later conceded that the insured met the post-104-week test.

The applicant was injured in a motor vehicle accident and received income replacement benefits.

Following a consent order requiring the insurer to pay ongoing benefits, the insurer unilaterally terminated the benefits based on new medical information, arguing the test for entitlement had changed at the 104-week mark.

The arbitrator found that the insurer acted unreasonably by terminating benefits in contravention of the consent order and section 287 of the Insurance Act, which requires an insurer to continue payments until a variation order is obtained.

The arbitrator ordered the insurer to pay a special award of $6,000 for unreasonably withholding payments.

The insurer brought a motion to compel the applicant to attend a psychological examination under section 42 of the Statutory Accident Benefits Schedule.

The applicant opposed the motion, arguing that the insurer delayed its request and was seeking the examination to bolster its case for the upcoming arbitration hearing.

The arbitrator found that the insurer's request was reasonable, as the applicant claimed ongoing inability to work due to psychological impairments, and there was no evidence that the delay caused prejudice or would postpone the hearing.

The motion was granted, and the arbitration was stayed pending the applicant's attendance at the examination.

The insurer brought a motion to adjourn the arbitration hearing until the applicant attended insurer examinations by a physiatrist and a cardiologist.

The insurer sought these examinations to assess the applicant's entitlement to post-104 week income replacement benefits, particularly after learning the applicant suffered a heart attack.

The arbitrator dismissed the motion, finding the request for a physiatric examination unreasonable as there is no presumptive right to an examination at the 104-week mark.

The request for a cardiological examination was also denied due to the insurer's delay in requesting it, creating a presumption that it was primarily for obtaining evidence for the hearing rather than adjusting the claim.

The prejudice to the applicant in adjourning the hearing outweighed the potential prejudice to the insurer.

Following a finding that the insurer unreasonably withheld funeral and death benefits, the arbitrator determined the quantum of the special award.

Applying the Persofsky framework, the arbitrator found the insurer's conduct egregious, noting its wilful blindness, inflexible attitude, and adversarial approach.

The insurer ignored reliable evidence, including a police report, and failed to reassess the claim as new information became available.

The arbitrator awarded $10,000 to the estate for the withheld funeral benefits and $40,000 to the applicant for the withheld death benefits, emphasizing the need for deterrence.

The applicant brought a motion for interim statutory accident benefits, which was denied.

The insurer subsequently sought its expenses for the motion.

The arbitrator found that the insurer was completely successful on the motion and awarded expenses in the amount of $2,449.68, payable by the applicant in any event of the cause.

However, enforcement of the order was delayed until the final determination of the applicant's main arbitration proceeding.

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

After failing to attend three scheduled pre-hearing conferences and losing contact with his own legal representative, the insurer requested that the application be dismissed as frivolous and vexatious.

The arbitrator found that the applicant was no longer interested in pursuing the matter and dismissed the application.

The insurer was awarded its expenses for the arbitration, fixed at $500.00.