Susan Sapin

The insurer brought a motion to exclude the evidence and report of the applicant's treating physiatrist, arguing he was no longer a qualified practitioner under the Evidence Act due to the revocation of his medical license for professional misconduct.

The arbitrator dismissed the motion, holding that the Statutory Powers Procedure Act permits the admission of relevant evidence and that the prejudice to the applicant in excluding his long-term treating physician outweighed the insurer's concerns of impropriety.

The arbitrator also admitted transcripts of several witnesses from a previous arbitration hearing on consent.

The applicant was injured in a motor vehicle accident in Texas and sought statutory accident benefits under his father's Ontario insurance policy.

The insurer denied the claim on the basis that the applicant failed to submit an application within the two-year time limit prescribed by section 22 of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant failed to prove he submitted a completed application within two years of the accident.

The application for arbitration was dismissed as the claim was invalidated by subsection 22(2) of the Schedule.

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

The insurer requested an in-home occupational therapy assessment under section 42 of the Statutory Accident Benefits Schedule, which the applicant failed to attend on the advice of her agent.

The insurer sought a stay of the arbitration.

The arbitrator found that the applicant failed to make herself reasonably available for a reasonably necessary examination.

The arbitration was stayed until the applicant attends the examination, and the insurer was awarded $500 in expenses.

The applicant claimed she was injured in a minor motor vehicle accident and sought income replacement benefits and housekeeping expenses from her insurer.

The insurer denied the claims, arguing the collision was too minor to cause the alleged injuries and questioning the applicant's credibility.

The arbitrator found the applicant's evidence unreliable, noting numerous inconsistencies and implausible explanations regarding the accident and her injuries.

The arbitrator concluded the applicant did not suffer a substantial inability to perform her employment tasks or housekeeping duties as a result of the accident.

All claims for benefits and a special award were dismissed.

The applicant suffered severe burns when gasoline spilled from his taxi's gas tank during repairs at a garage and ignited.

The insurer denied statutory accident benefits, arguing the fire was an independent intervening act that broke the chain of causation from the vehicle's repair.

The arbitrator found that the injuries were directly caused by the use or operation of the vehicle, as the repair process set in motion an unbroken chain of events leading to the fire.

The presence of fire hazards in a garage was considered a normal incident of the risk created by repairing a vehicle.

The applicant was deemed to have been injured in an 'accident' under the Schedule and was awarded expenses for the preliminary hearing.

The applicant was injured in a motor vehicle accident and received loss of earning capacity benefits.

The insurer reduced these benefits based on a Designated Assessment Centre report concluding the applicant could work as a part-time telemarketer.

The arbitrator found the assessment seriously flawed, as it failed to consider the applicant's chronic pain, medications, commute, and vocational characteristics.

The arbitrator determined the applicant's residual earning capacity was zero, ordered the insurer to repay the deducted amounts, and granted a special award of $6,000 due to the insurer's unreasonable reliance on the flawed report.

The applicant was injured in a motor vehicle accident but did not notify his insurer of his intention to claim statutory accident benefits until nine months later.

The insurer refused to pay for medical expenses on the basis of late notice.

The applicant argued he had an innate fear of medical professionals and hoped his injuries would subside.

The arbitrator found the applicant's explanation lacked credibility due to inconsistencies in the evidence and his failure to attend the hearing.

The arbitrator concluded the applicant did not have a reasonable explanation for the delay and is precluded from proceeding to arbitration.

The applicant, a self-employed carpenter, was injured in a motor vehicle accident and claimed income replacement benefits (IRBs).

The insurer paid IRBs at a weekly rate of $166.84, which the applicant disputed.

The arbitrator found the applicant failed to provide sufficient evidence to support a higher rate.

Furthermore, the arbitrator ordered the applicant to repay $692.39 in IRBs because he wilfully misrepresented his employment situation by failing to disclose income earned during the period he claimed to be off work.

The applicant's claim for a special award due to alleged unreasonable delay by the insurer was dismissed as unfounded.

The applicant, a taxi driver, was injured in a motor vehicle accident and applied for statutory accident benefits, including income replacement, medical, and housekeeping benefits.

The insurer denied the benefits and the matter proceeded to arbitration.

The applicant failed to attend the pre-hearing and the hearing proceeded in writing.

The arbitrator found that while the applicant was substantially disabled for a period, he was not entitled to income replacement benefits because he failed to provide the insurer with reasonable information to calculate the quantum, such as tax returns and taxi run sheets.

The claims for medical and housekeeping benefits were also dismissed for lack of evidence.

The applicant was ordered to pay the insurer's arbitration expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various expenses, most notably over $100,000 for an unconventional treatment called 'Vistasp therapy'.

The arbitrator found that Vistasp therapy did not qualify as a 'good or service of a medical nature' under section 14 of the Schedule, as it lacked any scientific or medical basis, and was alternatively experimental, unreasonable, and unnecessary.

Claims for conventional therapies, Tai Chi, and dog-walking were allowed.

A special award of $1,000 was granted against the insurer for unreasonably denying the non-Vistasp claims.

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

The insurer disputed the claim and requested that the applicant attend psychiatric and neurological insurer examinations (IEs).

The applicant refused to attend, arguing the request was a last-minute tactic.

On a preliminary issue hearing, the arbitrator found that the insurer's request was reasonably necessary because the applicant's initial neuropsychological assessment was based on incomplete pre-accident records, which the applicant had refused to provide until shortly before the hearing.

The arbitrator ordered that the applicant is precluded from proceeding to arbitration until he makes himself reasonably available for the requested IEs.

The applicant sought statutory accident benefits after falling while alighting from a TTC bus.

The insurer denied benefits, arguing the fall was not directly caused by the use or operation of an automobile.

The arbitrator found the applicant's testimony credible that she misjudged the distance from the bottom step to the pavement, lost her balance, and stumbled before falling.

The arbitrator concluded the incident met the definition of an accident under section 2(1) of the Schedule, as the use or operation of the bus directly caused the impairment.

The applicant was injured in a motor vehicle accident and applied for income replacement benefits (IRBs).

He disputed the insurer's calculation, arguing that IRBs he received from a previous motor vehicle accident should be included as 'gross income from employment' under the Statutory Accident Benefits Schedule.

The arbitrator held that IRBs from a previous accident cannot be included as income for the purpose of determining the IRB entitlement for the subsequent accident, following established jurisprudence that distinguishes between employment income and payments for loss of income.

The applicant, a 69-year-old woman, was injured when the city bus she was riding stopped suddenly.

She applied for statutory accident benefits, but the insurer terminated medical benefits and refused to pay for housekeeping.

The arbitrator found that the applicant suffered physical and psychological impairments as a result of the accident, aggravating pre-existing conditions.

The arbitrator ordered the insurer to pay for physiotherapy, psychological treatment, medical assessments, and housekeeping expenses.

The insurer's argument that the applicant was disentitled to benefits for failing to attend a DAC assessment was rejected due to defective notice.

The applicant was awarded her arbitration expenses.

The applicant sought an assessment of his arbitration expenses following a decision that denied his claim for income replacement benefits but allowed his claim for housekeeping expenses.

The applicant claimed $35,691.16 in legal fees and disbursements.

The arbitrator reduced the hourly rate and preparation time claimed by the applicant's counsel, finding them excessive given the complexity of the case and counsel's conduct.

The arbitrator also reduced certain disbursements, including the cost of an accountant's report and travel expenses.

The insurer was ordered to pay the applicant $18,424.74 in arbitration expenses.

Following a settlement of disputed claims for statutory accident benefits, the applicant sought an assessment of his legal expenses.

The insurer agreed the applicant was entitled to expenses but disputed the amount, specifically the hourly rate of the senior counsel, the rate and hours of the law clerk, and certain disbursements including accountant's reports.

The arbitrator allowed the senior counsel's rate of $150 per hour, the law clerk's rate of $45 per hour, and most of the disbursements, awarding a total of $19,449.35 in fees and disbursements.

The applicant was injured in a motor vehicle accident in July 1996 but did not notify his insurer until March 1999.

The insurer denied the claim for statutory accident benefits based on the failure to notify within the 30-day time limit under section 59 of the Schedule.

In a preliminary issue hearing, the arbitrator found that the applicant suffered from undiagnosed paranoid schizophrenia at the time of the accident, which caused him to irrationally attribute his symptoms to other causes and focus on finding a cure rather than making a claim.

Applying the principles of reasonable excuse and drawing an analogy to the tolling of limitation periods for persons of unsound mind, the arbitrator concluded that the applicant's mental illness constituted a reasonable excuse for the delay.

The applicant was therefore not disentitled to benefits and was permitted to proceed to arbitration.

The insurer raised a preliminary issue regarding the self-represented applicant's mental competence to proceed with his arbitration for statutory accident benefits.

The applicant had a history of paranoid schizophrenia and hospitalizations.

Applying the presumption of capacity under the Substitute Decisions Act, the arbitrator reviewed medical evidence and heard testimony from the applicant.

The arbitrator found that the applicant's cognitive functions were intact while on medication, he understood the issues in dispute, and he appreciated the consequences of his decisions.

The arbitrator concluded the applicant was mentally capable and could proceed without a litigation guardian.

The applicant was injured in a motor vehicle accident and sought an order for ongoing income replacement benefits (IRBs) after the insurer unilaterally reinstated them prior to an arbitration hearing.

The applicant argued that an order was necessary to protect her benefits under section 287 of the Insurance Act.

The arbitrator held that an order for ongoing IRBs cannot be imposed absent a hearing on the merits or the consent of the parties, and dismissed the request.

Following an arbitration award for chiropractic and rehabilitation expenses, the applicants sought assessment of their arbitration expenses totaling $50,791.66.

The insurer disputed the amount, arguing the legal fees and expert disbursements were excessive.

The arbitrator assessed the expenses at $42,493.76, applying a 4:1 ratio for preparation to hearing time but reducing the fees due to the applicants' minimal success and the self-serving involvement of the rehabilitation clinic.

The arbitrator also determined that interest on the awarded benefits was payable to the husband from the date of the arbitration award (due to his failure to attend a DAC assessment) and to the wife from 14 days after the DAC assessment report.