William J. Renahan

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

A dispute arose regarding the application of indexation provisions under section 79 of the Statutory Accident Benefits Schedule to the calculation of her loss of earning capacity (LEC) benefit.

The arbitrator determined that, unlike income replacement benefits, the indexation of the net weekly income used to determine the LEC is not limited by section 79(2).

Therefore, the applicant's net weekly income used to determine her pre-accident earning capacity is to be indexed every year starting January 1, 1995.

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

In a prior decision, the applicant achieved mixed success, recovering approximately $7,000 in medical benefits but failing on claims for income replacement and other expenses.

The arbitrator considered the criteria under section 12 of Ontario Regulation 664 to determine entitlement to arbitration expenses.

Finding that both parties had prolonged the proceedings at different stages and that success was divided, the arbitrator ordered that each party bear its own expenses.

The applicant sought payment for a chiropractic treatment plan following two motor vehicle accidents in 2001.

The insurer refused to fund the treatment.

The arbitrator found that the applicant had a history of chronic pain and psychological factors, including somatization, which prevented her from benefiting from physical therapies.

Relying on the opinion of a pain medicine and psychiatry specialist retained by the applicant's own lawyer, the arbitrator concluded that no specific treatment could help the applicant's condition.

The application for arbitration was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits, housekeeping expenses, medical benefits, and costs of examinations.

The insurer terminated benefits, and the applicant applied for arbitration.

The arbitrator found that the applicant did not suffer a substantial inability to perform the essential tasks of her employment, noting she felt well enough to try working.

Claims for housekeeping were dismissed due to lack of persuasive evidence.

Medical benefits for chiropractic treatment were denied as the treatment was not justified, reasonable, or necessary.

Claims for assessment costs were also dismissed as the reports were not reasonably required.

The application was dismissed in its entirety.

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

The insurer terminated weekly caregiver and housekeeping benefits, leading the applicant to apply for arbitration at the Financial Services Commission of Ontario.

Prior to the hearing, the parties resolved all substantive issues and the applicant withdrew his claims.

During the hearing, the parties also resolved the issue of expenses and consented to its withdrawal.

The arbitrator granted permission for the parties to withdraw all issues in dispute.

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

The insurer claimed the applicant was precluded from receiving benefits under section 59 of the Schedule because he was entitled to receive WSIB benefits.

On a preliminary issue, the arbitrator held that the Financial Services Commission of Ontario lacks jurisdiction to determine whether an individual is entitled to WSIB benefits, as the Workplace Safety and Insurance Board has exclusive jurisdiction over that question.

Since there was no evidence the Board had made such a determination, section 59(1) did not apply, and the applicant was not precluded from receiving accident benefits.

The applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment.

The insurer's Designated Assessment Centre concluded she did not suffer a catastrophic impairment.

The arbitrator found that the applicant suffered a marked impairment in social functioning due to the accident, satisfying the definition of catastrophic impairment under section 2(1)(g) of the Schedule.

The arbitrator also assessed her physical impairments at 52% WPI, which combined with her psychological impairment would exceed the 55% threshold.

The applicant was awarded her expenses of the arbitration.

Following the dismissal of the insured's application for statutory accident benefits, the insurer sought its expenses of the arbitration proceeding.

The insured's counsel did not file a response to the insurer's bill of expenses.

The arbitrator reviewed the claimed fees and disbursements, allowing the fees as claimed but disallowing a $1,112.00 disbursement for the attendance of a rheumatologist, finding the expert's opinion was neither necessary nor helpful.

The insurer was awarded total expenses of $8,795.97.

The applicant was injured in a motor vehicle accident and subsequently experienced mental deterioration.

A preliminary issue hearing was held to determine if the applicant had the mental capacity to proceed in the dispute resolution process.

Relying on the uncontradicted psychiatric evidence of Dr. Hoffman and the testimony of the applicant's wife, the arbitrator found the applicant incapable of managing property and personal care under the Substitute Decisions Act.

The arbitrator appointed the applicant's wife to act on his behalf in the arbitration proceedings.

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

The insurer terminated the benefits but, due to a clerical error, continued to issue payments for nearly a year, resulting in an overpayment of $19,542.86.

The applicant applied for arbitration but failed to appear at the hearing.

The arbitrator dismissed the applicant's claims for ongoing benefits and ordered the applicant to repay the overpaid amount plus interest, as the insurer had provided notice of the error within the required 12-month period.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for caregiving and housekeeping expenses.

The insurer terminated these benefits based on in-home assessments and independent medical examinations indicating the applicant was not substantially disabled.

The applicant submitted invoices for services allegedly provided by her sister and a neighbour.

The arbitrator found the invoices to be unreliable and fabricated, noting they contradicted the applicant's own statements to assessors and the testimony of the service providers.

The application for benefits and a special award was dismissed, and the insurer was awarded its expenses of the arbitration proceeding.

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

At the scheduled arbitration hearing, neither the applicant nor her representative appeared.

The insurer requested that the application be dismissed.

The arbitrator noted that the Commission had sent the Notice of Hearing to the applicant's old address, despite having updated her address in its system.

Finding that the applicant was not notified of the hearing through no fault of her own, the arbitrator declined to dismiss the application and ordered an adjournment to a date to be arranged.

The applicants were injured in a motor vehicle accident and sought payment for chiropractic treatment and housekeeping expenses from their insurer.

The arbitrator found the applicants' evidence regarding the necessity of the treatment and housekeeping services to be implausible and unreliable.

However, because the insurer failed to comply with the mandatory procedures under section 38(12) of the Schedule for rejecting a treatment plan, the arbitrator ordered the insurer to pay for the second treatment plans submitted by the applicants.

The arbitrator also awarded each applicant a $500 special award due to the insurer's procedural non-compliance, but denied the claims for housekeeping expenses and ordered each party to bear their own arbitration expenses.

The applicant was injured in a motor vehicle accident and received income replacement benefits for over two years.

The insurer terminated benefits, arguing his ongoing disability was caused by pre-existing fibromyalgia and psychological issues, not the accident.

The arbitrator found the applicant was completely disabled from suitable employment but concluded that neither party presented reliable evidence on whether the accident caused the disability.

The arbitrator determined that the applicant bore the legal burden of proving causation.

Because the applicant failed to discharge this burden, his claim for ongoing income replacement benefits was dismissed.

The applicant was injured in a low-speed motor vehicle accident and sought statutory accident benefits for chiropractic and massage treatment.

The insurer refused to pay for one year of treatment, arguing it was not reasonable or necessary.

The arbitrator dismissed the application, finding the applicant's evidence of accident-related pain unreliable due to his pre-accident medical history and pre-occupation with his health.

The arbitrator rejected the opinions of the applicant's chiropractors, citing methodological flaws, deficient record-keeping, and a failure to consider the applicant's full medical history.

The arbitrator accepted expert evidence that the applicant would benefit more from cognitive therapy and an exercise program rather than ongoing passive physical therapy.

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

After the insurer terminated certain benefits, the applicant applied for arbitration.

Following several pre-hearings and adjournments, the applicant failed to participate in teleconferences, sign agreed-upon authorizations, or maintain a valid contact address.

The insurer brought a motion to dismiss the application.

The arbitrator found that the applicant had likely abandoned the application and put the insurer to unnecessary expense.

The application was dismissed as frivolous, and the applicant was ordered to pay $500 in expenses to the insurer.

The applicant sought payment for three medical assessments totaling $3,700 following a motor vehicle accident.

At the arbitration hearing, the self-represented applicant was the only witness and provided no documentary evidence.

The arbitrator dismissed the application, finding no evidence that the invoices or assessments were ever submitted to the insurer, nor any evidence that the costs were reasonable or necessary to resolve a dispute over benefits.

The applicant was ordered to pay $500 in costs to the insurer.

The insurer brought a motion for a preliminary order to compel the insured to attend a further insurer's examination under section 42 of the Statutory Accident Benefits Schedule.

The arbitrator dismissed the motion because the insurer failed to provide the insured with the mandatory notice required by subsection 42(4), which sets out the reasons, type, and details of the examination.

The arbitrator held that compliance with the notice provision cannot be waived by the parties, as the information is necessary to determine whether the examination is reasonably required.

Each party was ordered to bear their own expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for housekeeping and attendant care.

The insurer terminated housekeeping benefits after an occupational therapy assessment concluded the applicant only needed minimal help with gardening.

The applicant withdrew his claim for attendant care benefits at the hearing.

The arbitrator found the applicant failed to prove a substantial inability to perform his pre-accident housekeeping tasks, as the evidence regarding his limitations was unclear and contradictory.

The application was dismissed, and the applicant was ordered to pay the insurer's arbitration expenses.

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

The parties settled all substantive issues in dispute prior to the conclusion of the arbitration.

The applicant sought an order for the expenses of the arbitration proceeding.

The insurer argued the arbitrator lacked jurisdiction to award expenses because the settlement ended the proceeding.

The arbitrator held that jurisdiction continues until an order is made ending the proceeding.

After considering the criteria for awarding expenses, including the mixed success of the parties and the unnecessary motion brought by the applicant, the arbitrator ordered each party to bear their own expenses.