Alexander Voudouris

The insurer, Pilot Insurance Company, failed to file a Response to the insured's Application for Arbitration within the 20-day period prescribed by the Dispute Resolution Practice Code.

Five and a half months after the deadline, Pilot retained counsel and filed a Response.

Pilot brought a motion for an order nunc pro tunc extending the time for delivery of its Response.

The arbitrator found that the default was due to human error, the insurer had a non-frivolous defence, and the insured consented to the application.

The arbitrator granted the motion, waiving the default and validating the late Response.

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

A dispute arose, and the applicant filed an Application for Mediation.

Due to a backlog at the Financial Services Commission of Ontario, a mediator was not appointed within the prescribed 60-day period.

The applicant subsequently filed an Application for Arbitration, arguing that mediation was deemed to have failed.

The insurer argued the application was premature because the 60-day period only begins when a mediator is appointed.

The Arbitrator held that an application is 'filed' when delivered to the Commission, and therefore mediation was deemed to have failed before the arbitration commenced.

Following a successful claim for statutory accident benefits, the applicant sought expenses for the arbitration and expense hearings.

The insurer conceded entitlement but disputed the quantum of hours claimed and the applicability of HST to certain disbursements.

The Arbitrator reduced the billable hours using a 3:1 ratio for the hearing length, awarding 98 hours at $150 per hour.

The Arbitrator also found that HST was applicable to the disbursements for expert reports, as they were not incurred as an agent.

Total expenses of $26,669.63 were awarded to the applicant.

The applicant sought payment for an orthopaedic assessment, two chronic pain assessments, and housekeeping expenses following a motor vehicle accident.

The insurer argued that the orthopaedic assessment was not incurred, the chronic pain assessments were duplicative, and the housekeeping expenses had already been paid.

The arbitrator agreed with the insurer, finding that the orthopaedic assessment was not payable until incurred, the two chronic pain assessments were an unreasonable duplication of services, and the housekeeping expenses had been paid as evidenced by a cashed cheque.

The arbitration was dismissed.

Following a final arbitration decision that found the applicant was not entitled to income replacement benefits, the parties sought a determination on expenses.

The arbitrator awarded the insurer its expenses for the main arbitration proceeding, as it was the successful party.

However, the applicant was awarded her expenses for her successful interim benefits motion.

The arbitrator also held that she lacked jurisdiction to order the applicant to repay the interim benefits received, because the final arbitration decision was silent on the issue and the insurer had not brought an application to vary that decision.

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

Following an interim order for income replacement benefits, the insurer paid the arrears but argued that no special award was payable because no benefits were 'outstanding' when the matter was finally resolved.

The arbitrator held that because the interim payments were subject to a repayment condition until the final settlement, the benefits remained 'outstanding' within the meaning of the previous order and the Insurance Act.

The insurer's position was rejected, and the special award remained payable.

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

The insurer terminated benefits based on an orthopaedic surgeon's opinion that the applicant could work, despite contrary evidence from its own vocational expert and the applicant's treating physicians.

The arbitrator found the insurer's reliance on the surgeon's opinion to be unreasonable and a breach of its duty of good faith.

The arbitrator awarded a special award of 40% of the outstanding benefits and interest, noting the applicant's vulnerability and the foreseeable harm caused by the termination.

The applicant sought production of the insurer's entire file up to the date of the arbitration.

The insurer claimed litigation privilege over its file from the date of the Application for Mediation.

The arbitrator held that litigation privilege attached to the insurer's file on the day the insurer received FSCO's letter notifying it of the Application for Mediation, as that is when litigation was reasonably anticipated.

The insurer was ordered to produce its file up to that date, subject to any claims for privilege and redaction of reserve information.

The applicant was completely successful in an arbitration regarding statutory accident benefits.

She sought her expenses for the arbitration hearing.

The arbitrator found that the applicant was entitled to her expenses, noting that the hearing involved a novel issue and required interpretation for witnesses, which increased preparation time.

The arbitrator awarded the applicant $45,470.25 for legal fees and $11,853.65 for disbursements, for a total of $57,323.90 inclusive of GST.

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

The insurer terminated her income replacement and housekeeping benefits.

In a preliminary decision, the arbitrator found the insurer failed to properly terminate the benefits under section 37 of the Schedule and ordered payment until proper termination.

In this decision, the applicant sought a special award under subsection 282(10) of the Insurance Act, arguing the insurer unreasonably withheld benefits.

The arbitrator dismissed the claim for a special award, finding that the insurer's reliance on its medical evidence and its failure to comply with section 37 did not amount to unreasonable behaviour.

The applicant was injured in a motor vehicle accident in December 2005 and received income replacement benefits (IRBs) until August 2008.

She sought IRBs beyond the 104-week mark, requiring her to prove a complete inability to engage in any employment for which she was reasonably suited, caused by the accident.

The applicant advanced several theories of causation, including spinal injuries, exacerbation of pre-existing fibromyalgia, and a psychological disorder.

The arbitrator rejected all theories, finding that the applicant likely only sustained minor soft tissue injuries in the accident, that the cause of fibromyalgia is unknown making exacerbation unprovable, and that the psychological diagnoses lacked adequate foundation.

The application for ongoing IRBs and a special award was dismissed.

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

She also received long-term disability (LTD) benefits from a group insurance plan.

The insurer deducted the LTD benefits from her income replacement benefits.

The applicant disputed the deductibility of the LTD benefits.

The arbitrator held that the LTD benefits were payments for loss of income under an income continuation benefit plan and were therefore deductible from the income replacement benefits pursuant to section 7(1) of the Statutory Accident Benefits Schedule.

The applicant brought a motion for interim income replacement benefits pending the resolution of his dispute with the insurer over statutory accident benefits arising from a motor vehicle accident.

At the motion, the parties reached an agreement to reinstate the applicant's interim income replacement benefits at the rate of $400 per week, plus interest.

The arbitrator ordered the reinstatement of benefits on consent and adjourned the main hearing.

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

The applicant brought a motion for interim income replacement benefits pending the final arbitration hearing.

The arbitrator found that the applicant established a prima facie case for post-104 week income replacement benefits based on medical evidence of chronic pain and fibromyalgia.

The applicant also demonstrated financial need.

The motion was granted, and the insurer was ordered to pay interim benefits of $400 per week.

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

The insurer terminated her income replacement and housekeeping benefits after conducting section 42 insurer's examinations.

However, the insurer did not request a new, up-to-date disability certificate before scheduling these examinations, as required by section 37(1) of the Statutory Accident Benefits Schedule.

On a preliminary issue, the arbitrator found that the insurer failed to properly terminate the benefits because it relied on an outdated disability certificate.

Applying the principles from Smith v. Co-operators, the arbitrator held that the consequence of failing to properly terminate benefits is that the benefits remain payable until the insurer complies with the statutory termination procedures.

The insurer was ordered to pay the outstanding benefits with interest.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them at the two-year mark.

The applicant brought a motion for interim benefits pending arbitration.

The arbitrator found that the applicant had demonstrated a strong case for ongoing entitlement and severe financial hardship.

The arbitrator also excluded video surveillance evidence proffered by the insurer due to late and incomplete disclosure under Rule 40 of the Dispute Resolution Practice Code.

The motion for interim benefits was granted.

Following an arbitration decision where the applicant achieved divided success regarding statutory accident benefits, both parties sought their expenses.

The arbitrator reviewed the criteria under section 12 of Ontario Regulation 664, noting that the 'degree of success' was the only relevant factor.

Finding that both parties succeeded and failed in roughly equivalent measures, the arbitrator ordered each party to bear their own expenses.

The plaintiff commenced an action against his insurer for statutory accident benefits.

The plaintiff's counsel sent a settlement offer to the insurer's adjuster, which the insurer's counsel accepted.

When the plaintiff refused to proceed with the settlement because costs were to be assessed rather than fixed, the insurer moved for judgment under Rule 49.

The motions judge dismissed the motion, finding the offer was improperly served and the insurer failed to provide a notice under section 9.1 of the Automobile Insurance Regulation.

The Court of Appeal allowed the insurer's appeal, holding that the technical defect in service did not invalidate the Rule 49 offer, and that section 9.1 does not apply to settlements reached after litigation has commenced.

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

The insurer scheduled three insurer examinations after the pre-hearing, which the applicant refused to attend, arguing the request was late and constituted trial brinkmanship.

The insurer brought a preliminary motion to stay the arbitration hearing until the applicant attended the examinations.

The arbitrator found the insurer's request reasonable, noting a change in the applicant's circumstances and a novel aspect to her claim since the last examinations.

The hearing was adjourned pending the applicant's attendance at the requested examinations.

The applicant was injured in a motor vehicle accident and received physiotherapy treatments.

His employment insurer paid 80% of the cost, and the no-fault insurer paid the remaining 20%.

The applicant sought full reimbursement from the no-fault insurer, arguing that the employment benefits were not 'reasonably available' because they reduced his lifetime maximum coverage.

The arbitrator dismissed the claim, finding that the employment benefits were reasonably available and that the no-fault insurer is a secondary insurer under the No-Fault Benefits Schedule.

The applicant was awarded his arbitration expenses for bringing an arguable case on a novel issue.