William J. Renahan

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

The insurer denied income replacement and housekeeping benefits under s. 30(1)(b) of the Statutory Accident Benefits Schedule, arguing the applicant was driving with an expired licence.

The arbitrator held that the exclusion for driving without a valid licence is subject to a due diligence defence.

Finding that the applicant reasonably relied on the Ministry of Transportation to send a renewal notice, which was delayed due to a public service strike, the arbitrator concluded the applicant reasonably believed his licence was valid.

The exclusion did not apply, and the applicant was permitted to proceed to arbitration.

The applicant sought expenses following an arbitration decision where he recovered over $20,000 in income replacement benefits but withdrew fabricated claims for attendant care and housekeeping expenses.

The arbitrator applied the criteria under section 12 of Ontario Regulation 664.

Although the applicant was more successful overall, his claims for attendant care and housekeeping were found to be frivolous and fabricated.

Consequently, the arbitrator ordered that each party bear their own expenses of the arbitration proceeding.

The insurer terminated the applicant's income replacement benefits without complying with the stoppage provisions in section 37 of the Statutory Accident Benefits Schedule.

The arbitrator previously ordered the insurer to pay benefits until it complied with section 37, subject to a potential repayment obligation.

After the insurer complied and benefits were properly terminated, the arbitrator determined that the applicant did not meet the disability test after the initial termination date.

However, the arbitrator held that requiring the applicant to repay benefits paid before the insurer issued a compliant notice of stoppage would render the consumer protection provisions of section 37 meaningless.

The applicant was not required to repay the benefits.

The applicant was injured in a motor vehicle accident and applied for arbitration after the insurer terminated her income replacement benefits.

At the hearing, the parties resolved all substantive issues but disagreed on the form of the order.

The insurer sought a dismissal of the arbitration based on its agreement to reinstate benefits, while the applicant sought an order confirming her entitlement.

The arbitrator ruled that an agreement to pay benefits is not equivalent to an order, as an order restricts the insurer's rights to terminate benefits.

The hearing was adjourned to allow the applicant to pursue an order for entitlement.

A preliminary issue regarding the non-production of documents was deemed moot due to the adjournment.

The applicant was injured in a rear-end motor vehicle collision and claimed income replacement benefits for fibromyalgia and psychological impairments.

The insurer terminated benefits after June 24, 2003.

The arbitrator found that the applicant's physical complaints were not objectively verifiable and preferred the insurer's psychological assessment, which concluded she was not substantially disabled from performing the essential tasks of her employment as a computer sales representative.

The application for arbitration was dismissed.

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

At the outset of the arbitration hearing, the applicant's representative withdrew, and the applicant represented himself.

Following a recess, the parties advised the arbitrator that they had resolved all issues and agreed to an order dismissing the arbitration without costs.

The application for arbitration was dismissed.

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

The Insurer refused to pay for certain treatments and examinations, leading the Applicant to apply for arbitration.

At the hearing, the Applicant failed to appear.

In the absence of any evidence from the Applicant, the Arbitrator dismissed the application.

The Insurer was awarded $1,650 for the expenses of the arbitration proceeding.

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

The insurer refused to pay and sought permission to call three expert witnesses at the upcoming hearing, contrary to Rule 42.4 of the Dispute Resolution Practice Code which limits parties to two experts without permission.

The arbitrator applied the criteria from Burgess v. Wu and R. v. Mohan, emphasizing the tribunal's mandate to provide a quick and inexpensive resolution.

Given that the amount in dispute was only $1,350, the arbitrator found the time and cost of calling three experts disproportionate and denied the insurer's request to call more than two expert witnesses.

The applicant was injured in a motor vehicle accident and received income replacement benefits until they were terminated by the insurer.

The applicant sought further income replacement benefits, arguing he was unable to return to his pre-accident employment as a concrete cutter due to physical and psychological impairments.

The arbitrator found the applicant's physical impairment evidence unreliable, but accepted the psychological evidence that he suffered from major depressive disorder and anxiety which prevented him from working.

The arbitrator preferred the applicant's psychological expert over the insurer's expert.

The applicant was awarded income replacement benefits for the disputed period.

Claims for attendant care and housekeeping were withdrawn, and a claim for the cost of a functional abilities evaluation was denied for failing to seek prior approval.

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

In a previous decision, the insurer successfully defended the claim for income replacement benefits, while the applicant recovered a small amount for a functional capacity evaluation.

On the issue of expenses, the arbitrator found that both parties unnecessarily prolonged the hearing.

The applicant failed to produce hospital records on a timely basis, and the insurer's counsel conducted lengthy and unhelpful cross-examinations regarding the applicant's pre-existing psychiatric illness.

Consequently, the arbitrator ordered that each party bear their own expenses of the arbitration proceeding.

The insurer raised a preliminary issue seeking to exclude the applicant's statutory accident benefits representative from the arbitration hearing due to an undisclosed conflict of interest.

The representative had a business relationship with a medical assessor to whom he referred the applicant for a digital motion x-ray.

The arbitrator found that this relationship created an appearance of a possible or potential conflict of interest, as the representative could receive a financial benefit.

Applying the principles from civil litigation regarding fiduciary duties, the arbitrator concluded that the failure to disclose the conflict was an unfair or deceptive practice under the Insurance Act.

The representative was excluded from the hearing pursuant to the Statutory Powers Procedure Act.

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

The insurer terminated the benefits but failed to comply with the statutory notice requirements under section 37 of the Statutory Accident Benefits Schedule.

The arbitrator held that the applicant was entitled to ongoing income replacement benefits until the insurer properly complied with the stoppage provisions.

The arbitrator denied the claim for chiropractic and physiotherapy treatments, finding them unreasonable and unnecessary, but allowed the cost of an orthopaedic mattress cover.

A special award of $1,000 was granted against the insurer for unreasonably delaying the payment of benefits.

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

The insurer terminated these benefits based on a Designated Assessment Centre (DAC) report.

However, the DAC was not authorized to conduct the required post-104 week disability assessment and applied the wrong test.

The arbitrator held that the insurer failed to comply with the statutory termination procedures under section 37 of the Statutory Accident Benefits Schedule, rendering the termination invalid.

The applicant was awarded ongoing income replacement benefits, housekeeping benefits, and a nominal special award of $1 for the insurer's unreasonable conduct.

Claims for attendant care benefits and hearing expenses were dismissed.

The applicant sought a variation or revocation of an earlier arbitration decision, arguing that the arbitrator mistakenly recorded the date the insurer terminated income replacement benefits as February 1, 2001, instead of February 1, 2002.

The arbitrator acknowledged the error but found it did not affect the substantive conclusion that the applicant's accident-related disability ended on August 28, 2001, after which any disability was due to a pre-existing psychiatric illness.

Because the insurer had already paid benefits beyond August 28, 2001, the original order requiring payment of benefits was revoked and the application for income replacement benefits was dismissed.

Each party was ordered to bear their own expenses for the variation application.

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

During the arbitration hearing, the arbitrator reviewed correspondence regarding a prior adjournment request, which inadvertently disclosed a confidential settlement offer.

Citing a reasonable apprehension of bias, the arbitrator recused himself and adjourned the hearing to be heard by a different arbitrator, while remaining seized of the issue of expenses for the aborted hearing.

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

The insurer terminated her income replacement benefits, arguing she was capable of returning to work.

The arbitrator found that the applicant made honest and sustained attempts to return to her pre-accident employment as an accountant, but was unable to continue due to her injuries.

The arbitrator rejected the insurer's medical assessments suggesting a lack of motivation, finding the applicant's testimony credible and her attempts to work genuine.

The applicant was found to be substantially disabled from performing the essential tasks of her employment and completely unable to engage in suitable employment, entitling her to ongoing income replacement benefits.

The applicant applied for arbitration after the insurer terminated her weekly caregiver benefits following a motor vehicle accident.

The applicant failed to appear at the arbitration hearing.

Consequently, the arbitrator dismissed the application for arbitration.

The insurer was awarded its expenses for the arbitration proceeding in the amount of $5,436.59.

Following a finding that the insurer unreasonably withheld and delayed payment of income replacement benefits, the arbitrator determined the quantum of a special award and arbitration expenses.

The arbitrator calculated the notional interest amount under section 282(10) of the Insurance Act and awarded $39,900, representing approximately half of the maximum allowable amount, citing the insurer's blameworthy conduct and intransigence.

The applicant was also awarded $16,118.80 in arbitration expenses due to the insurer's unreasonable positions that prolonged the hearing.

The applicant was injured in a motor vehicle accident and his claims for statutory accident benefits were dismissed in a previous arbitration decision.

In this subsequent decision on expenses, the arbitrator ordered the applicant to pay the insurer's expenses.

Applying the criteria under Ontario Regulation 664, the arbitrator found the insurer was completely successful and awarded $12,112.66 in fees and disbursements.

The applicant was struck by a vehicle and claimed statutory accident benefits, including attendant care and housekeeping benefits beyond the 104-week mark.

The insurer terminated these benefits on the basis that the applicant did not suffer a catastrophic impairment.

The arbitrator reviewed the medical evidence, including a Designated Assessment Centre (DAC) assessment, and found that the applicant's whole person impairment was 30 per cent, falling short of the 55 per cent threshold required for a catastrophic impairment.

The arbitrator also found no evidence of a class 4 or 5 mental or behavioural disorder.

The claims for attendant care, housekeeping, and auto repair expenses were dismissed, and the applicant was ordered to pay the insurer's arbitration expenses.