Susan Sapin

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, claiming he suffered a catastrophic impairment due to psychological and chronic pain issues.

The insurer denied the benefits, relying on assessments that found only mild impairments and suggested symptom exaggeration.

The arbitrator preferred the evidence of the applicant's treating psychiatrist and found the applicant suffered a marked impairment in adaptation, qualifying as a catastrophic impairment.

The arbitrator awarded ongoing income replacement benefits, finding the applicant completely unable to engage in suitable employment, as well as attendant care, housekeeping benefits, and the cost of a chronic pain assessment.

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

The insurer brought a preliminary motion to determine whether the applicant had the mental capacity to proceed in the dispute resolution process, given his history of mental health issues and erratic behaviour, including repeatedly hiring and firing legal counsel.

The arbitrator reviewed extensive medical records and the applicant's conduct during the proceedings.

The arbitrator concluded that the applicant lacked the mental capacity to proceed unrepresented and ordered him to advise within 30 days if a suitable person or guardian could act on his behalf, failing which the Public Guardian and Trustee would be requested to conduct an assessment.

The applicant was injured in a motor vehicle accident in 1998 and applied for statutory accident benefits.

The insurer denied certain benefits but failed to provide a valid refusal containing the required dispute resolution information.

Almost 16 years later, the applicant applied for arbitration.

The insurer raised a preliminary issue that the claims were statute-barred.

The arbitrator held that despite the defective refusal, the applicant was precluded from proceeding because he was aware of the time limits and his extraordinary delay caused significant prejudice to the insurer.

The application for arbitration was dismissed.

The insurer brought a motion to stay an upcoming arbitration hearing regarding statutory accident benefits, arguing that the applicant had failed to produce necessary medical, educational, and employment records.

The applicant, who was injured as a child and now resides in the United States, claimed catastrophic impairment after a 14-year gap in treatment.

The arbitrator denied the stay at this time but ordered the production of the requested records from various third parties, including doctors and educational institutions.

The insurer was granted leave to renew the stay request if the documents are not produced 90 days before the hearing.

The applicant claimed she was injured when she fell on a TTC bus in February 2007 and sought statutory accident benefits.

The insurer denied the claim on the basis that no accident occurred.

At the preliminary issue hearing, the applicant requested an adjournment, which was denied due to her history of delay and failure to provide evidence.

The arbitrator found that the applicant failed to establish on a balance of probabilities that an incident occurred, noting inconsistencies in her reports and the insurer's thorough investigation which found no record of the alleged incident.

The application for arbitration was dismissed.

The applicant claimed statutory accident benefits after allegedly being struck by a vehicle and hitting his head on a concrete planter.

The insurer stopped paying benefits and later raised the preliminary issue that the incident did not meet the definition of an 'accident' under the Schedule, while also seeking repayment of benefits already paid.

The arbitrator held that the insurer was not estopped from raising the 'no accident' defence.

On the merits, the arbitrator found the applicant failed to prove on a balance of probabilities that his injuries were caused by the use or operation of a motor vehicle, citing significant inconsistencies in witness testimony and timing.

However, the insurer's claim for repayment was dismissed as it failed to prove the applicant made wilful misrepresentations.

The applicant brought a preliminary motion to remove the insurer's counsel due to an alleged conflict of interest, which was dismissed.

The insurer sought its expenses of $3,378.99 for the motion.

The arbitrator found that the insurer was not entirely successful, as its request to stay the motion was denied, warranting a 20% reduction.

The arbitrator further reduced the insurer's costs by 40% because the applicant's motion was not unnecessary given conflicting court decisions, the issue was of public interest, and the applicant was impecunious.

The insurer was awarded $1,297.38 in expenses, payable at the conclusion of the hearing on the merits.

The applicant's representative brought a motion to be removed as representative of record because the applicant could not be located.

The arbitrator granted the motion to withdraw.

As the applicant did not attend the hearing and no evidence was submitted in support of her claim for a non-earner benefit, the application for arbitration was dismissed with $500 in costs payable to the insurer.

The applicant, a wheelchair user, was injured when a bus stopped suddenly.

The insurer terminated attendant care and housekeeping benefits after 104 weeks, finding she did not suffer a catastrophic impairment.

The applicant brought a motion for interim benefits pending arbitration.

The arbitrator found the applicant established a prima facie case that she suffered a total and permanent loss of use of her left arm, meeting the catastrophic impairment definition.

The arbitrator also found urgency and hardship, as the applicant required additional attendant care following her husband's death to avoid moving to a long-term care facility.

Interim attendant care benefits of $1,117.25 per month were awarded, but interim housekeeping benefits were denied.

The applicant brought a motion to remove the insurer's counsel from the arbitration proceeding, alleging a conflict of interest because the same law firm represented the insurer in both the accident benefits claim and the tort action.

The insurer requested a stay of the motion pending a Divisional Court appeal on the same issue in the tort action.

The arbitrator denied the stay, finding it would cause unnecessary delay.

On the conflict issue, the arbitrator held that the law firm was not in a conflict of interest, as there was no prior solicitor-client relationship with the applicant, and the insurer was not required to retain separate counsel for the accident benefits and tort proceedings.

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

After disputes arose, the applicant applied for arbitration.

The applicant failed to attend multiple pre-hearings and failed to produce ordered documents.

The insurer brought a motion to dismiss the arbitration proceeding under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator granted the motion, dismissing the application for arbitration as vexatious due to the applicant's failure to participate, and awarded the insurer $500 in costs thrown away.

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

The insurer denied income replacement benefits (IRBs) on the basis that the applicant had not worked the required 26 weeks in the 52 weeks preceding the accident.

The applicant applied for mediation more than two years after the denial.

The arbitrator found that the insurer's denial was clear and unequivocal, triggering the two-year limitation period, and thus the applicant was precluded from proceeding to arbitration on the IRB claim.

However, the arbitrator found that the applicant was not precluded from proceeding with his claim for non-earner benefits (NEBs), as the insurer had separately denied that claim within the limitation period.

The applicant was injured in a motor vehicle accident and sought funding for a four-year university teaching degree as a vocational rehabilitation measure under section 15 of the Statutory Accident Benefits Schedule.

The insurer denied the claim on the basis that the applicant failed to submit a Treatment Plan (OCF-18) prior to incurring the expenses, as required by section 38.

The arbitrator held that the insurer could not rely on the applicant's failure to submit a Treatment Plan because the insurer breached its duty under section 32(2)(c) to assist the applicant in applying for benefits and failed to adjust the claim in good faith.

The arbitrator awarded the applicant the costs of two years of university tuition and books, plus interest and a 35% special award due to the insurer's unreasonable withholding of benefits.

The applicant claimed to have been injured in a motor vehicle accident and received statutory accident benefits from the insurer.

The insurer subsequently investigated and obtained an engineering report concluding that the damage to the vehicles was inconsistent with the reported accident and that the accident was likely staged.

The insurer suspended benefits after the applicant failed to attend an Examination Under Oath.

The applicant applied for arbitration but failed to attend the hearing or pursue his claims.

The arbitrator dismissed the application for arbitration, finding it was commenced in bad faith and abandoned.

The arbitrator ordered the applicant to repay $24,242.01 in benefits obtained through misrepresentation, plus interest, and awarded the insurer $7,541.54 in expenses.

The applicant was injured in a motor vehicle accident and received caregiver benefits from her insurer.

The insurer terminated the benefits after 104 weeks, arguing she no longer met the test of suffering a complete inability to carry on a normal life.

The arbitrator found that the applicant's physical injuries, combined with chronic pain and a diagnosed Somatoform Pain Disorder, continuously prevented her from engaging in substantially all of her pre-accident activities.

The arbitrator ordered the insurer to pay ongoing caregiver benefits but declined to order a special award, finding the insurer's denial was not unreasonable given the complex medical evidence.

The applicant was injured in a motor vehicle accident and applied for medical and non-earner benefits.

The insurer refused to pay for medical benefits because the applicant failed to attend insurer's examinations to determine if her injuries fell within the Minor Injury Guideline, and argued this precluded her from mediating the refusal.

The insurer also refused to pay a non-earner benefit, arguing she did not apply for it.

The arbitrator held that the insurer's notices did not comply with the Statutory Accident Benefits Schedule, so the applicant was not precluded from mediating her medical benefits claim.

The arbitrator also found the applicant was not precluded from pursuing her non-earner benefit claim, as her initial application and disability certificate triggered the insurer's obligation to determine continuing entitlement.

The insurer was ordered to pay the claimed treatment expenses.

The insurer brought a motion to compel the applicant to produce certain documents and for third-party production orders under Rule 67 of the Dispute Resolution Practice Code.

The insurer also requested relief, including dismissal or a stay of the arbitration, due to the applicant's refusal to attend insurer examinations.

The arbitrator declined to address the non-attendance issue, finding it was not properly before her on a productions motion and should be determined by the hearing arbitrator.

The arbitrator ordered the applicant to produce employment and income records, ordered the insurer to produce its adjusting file, and granted third-party production orders for clinical, employment, and collateral benefits files.

The arbitrator also ordered counsel to personally bear the costs of their unnecessary correspondence.

The insurer brought a motion to compel the applicant to produce certain documents and for third-party production orders, as well as relief for the applicant's failure to attend Insurer Examinations (IEs).

The arbitrator ordered the production of various relevant documents, including medical and employment records, and initiated the process for third-party production orders.

However, the arbitrator declined to address the applicant's non-attendance at IEs, deferring that issue to the hearing arbitrator to ensure procedural fairness.

The arbitrator also ordered both counsel to personally bear their own costs for unnecessary correspondence.

The insurer brought a motion seeking an order that the applicant attend several Insurer Examinations (IEs) to determine his ongoing entitlement to income replacement benefits (IRBs) more than 104 weeks after the accident.

The applicant argued the request was delayed and intended to bolster the insurer's case for arbitration.

The arbitrator found that the IEs were reasonably required, noting that the insurer acted promptly after receiving late medical reports from the applicant supporting his post-104 claim.

The arbitrator also found that the applicant was not precluded from mediating his disputes because the insurer's notices for the IEs were deficient in failing to list the assessors' qualifications.

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

After mediation failed, they applied for arbitration but subsequently failed to pursue their claims, instruct counsel, or attend pre-hearings and the scheduled arbitration hearing.

The arbitrator dismissed the applications for arbitration without a hearing under Rule 68 of the Dispute Resolution Practice Code due to abandonment.

The insurer was awarded $1,500 in expenses because the applicants' conduct unnecessarily prolonged the proceedings.