Alon Rooz

The appellant appealed a Licence Appeal Tribunal decision denying claims for physiotherapy and an in-home assessment under the Statutory Accident Benefits Schedule.

The insurer had failed to respond to the treatment plans within the required 10-day period under s. 38(8).

The Divisional Court held that the adjudicator erred by requiring the expenses to be reasonable and necessary, as s. 38(11) mandates payment for expenses incurred during the default period and acts as consumer protection legislation.

The appeal was allowed, the insurer was ordered to pay the in-home assessment and applicable physiotherapy expenses, and the issue of a special award was remitted to a new adjudicator.

The defendant brought a motion to recover costs thrown away after the plaintiffs refused to sign consent forms at a scheduled defence medical examination, resulting in the examination's cancellation.

The plaintiffs had not been provided the consent forms in advance and were unable to reach their counsel for advice at the time of the appointment.

The court dismissed the motion, finding that the plaintiffs acted reasonably in refusing to sign unfamiliar documents in an adversarial context without the opportunity to consult their lawyer.

The defendant was ordered to pay the plaintiffs' costs of the motion.

The defendant moved to set aside an ex parte charging order obtained by his former legal counsel for unpaid fees.

The defendant argued the plaintiff failed to make full and frank disclosure and withdrew services, both of which the court rejected.

However, the court found the plaintiff commenced the proceeding before the mandatory 30-day waiting period under s. 2(1) of the Solicitors Act had expired, rendering it a technical nullity.

The charging order was set aside, but enforcement was suspended for 60 days to allow the plaintiff to regularize the proceeding.

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

The insurer scheduled section 44 insurer's examinations, which the applicant refused to attend because she objected to a check box on the clinic's consent form requiring confirmation that she provided photo identification.

The Tribunal found the insurer's consent form requirement to be reasonable and the applicant's refusal to attend unreasonable.

Consequently, the applicant is statute-barred under section 55 of the Schedule from proceeding with her application until she attends the examinations.

The insurer sought reconsideration of a decision ordering it to pay a $1,500 special award on two files for unreasonably withholding or delaying payment of attendant care benefits.

The insurer argued that the previous reconsideration decision did not explicitly order payment and that it was simply following the Tribunal's procedure to determine the final quantum.

The Vice-Chair dismissed the request, finding that the previous decision had settled a minimum amount due, which the insurer accepted and failed to pay for 10 months.

The Tribunal held that in the context of consumer protection legislation, it was unreasonable for the insurer to delay paying the undisputed minimum amount while litigating a minor remaining difference.

The applicant sought a declaration that he had submitted to an examination under oath under s. 33(2) of the Statutory Accident Benefits Schedule after attending the examiner's office and leaving after 30 minutes because the insurer's counsel was late due to a scheduling error.

The court dismissed the application, finding that the applicant thwarted the process without a legal basis and that his counsel engaged in sharp practice by taking advantage of opposing counsel's mistake without fair warning.

The applicant insurer sought judicial review of a FSCO Director's Delegate decision that allowed an insured's appeal in part regarding statutory accident benefits.

The insurer had denied claims for an in-home assessment and form preparation, alleging the clinics were engaged in a fraudulent scheme.

The Divisional Court held that the Director's Delegate exceeded his jurisdiction by interfering with the Arbitrator's findings of fact regarding the in-home assessment, as appeals are limited to questions of law.

However, the court upheld the decision requiring the insurer to pay for form preparation because the insurer failed to object to the application within the statutory timeframe.

The defendant brought a motion to compel the plaintiff to attend independent medical examinations (IMEs) without conditions and sought costs thrown away for a previously cancelled appointment.

The plaintiff requested to have a support person present and to audio record the examination, citing stress and allegations of bias against the examining doctor.

The court permitted the plaintiff to have a support person present as a passive observer due to her mental condition, but denied the request to audio record the examination, finding insufficient evidence of bias.

The court also declined to award costs thrown away, finding the defendant booked the appointment prematurely before terms were agreed upon, and held that the plaintiff was not required to sign consent forms for the IMEs.

The plaintiff brought a motion for a further and better affidavit of documents, arguing the defendant omitted documents and failed to sufficiently particularize surveillance reports in Schedule B. The plaintiff also sought to cross-examine the deponent.

The court dismissed the motion, finding no evidence of omitted documents and concluding the defendant provided sufficient particulars of the surveillance reports to allow the plaintiff to challenge the privilege claim after discovery.

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

After failing to attend a pre-hearing and numerous assessments, the arbitrator ordered the applicant to attend an in-home assessment.

The applicant failed to do so and ignored subsequent production requests and notices of resumption of the pre-hearing.

The arbitrator issued a notice of intention to dismiss the proceeding.

The applicant's counsel confirmed they had no response.

The arbitrator dismissed the proceeding without a hearing under Rule 68.1 of the Dispute Resolution Practice Code, finding it frivolous, vexatious, or commenced in bad faith due to the applicant's failure to pursue the claim.

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

After failing to attend a pre-hearing and numerous assessments, the insurer requested the case be dismissed.

The Arbitrator issued a notice of intention to dismiss the proceeding under Rule 68.1 of the Dispute Resolution Practice Code.

The Applicant failed to respond or engage meaningfully in the arbitration.

Consequently, the Arbitrator dismissed the proceeding without a hearing, finding it to be frivolous, vexatious, or commenced in bad faith.

The appellant sought the expenses of an appeal in which she was partially successful in overturning an arbitrator's decision regarding statutory accident benefits.

The Director's Delegate found that the appellant had the greater degree of success on the appeal and was entitled to her expenses.

The Director's Delegate fixed the appellant's legal expenses of the appeal proceedings at $2,000.00, inclusive of disbursements and HST.

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

The insurer denied several treatment plans and attendant care benefits, and requested the applicant attend insurer's examinations under Section 44 of the Statutory Accident Benefits Schedule.

The applicant failed to attend the scheduled examinations.

The insurer raised a preliminary issue that the applicant was precluded from proceeding to arbitration under Section 55(2) of the Schedule.

The Arbitrator found that the insurer provided sufficient medical reasons for requesting the examinations and that the applicant failed to reasonably justify his non-attendance.

Consequently, the applicant was precluded from arbitrating the disputed benefits.

The insurer brought a motion to dismiss the applicant's arbitration proceeding for statutory accident benefits, arguing that the applicant failed to provide updated address and contact information.

The arbitrator dismissed the motion, noting that a previous appeal decision had already determined that a mere failure to provide contact information does not warrant the dismissal of an arbitration proceeding.

The arbitrator also declined to order the applicant's counsel to confirm communication with the applicant or provide updated contact information, finding no evidence or statutory basis to support such orders.

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

After an arbitrator dismissed her claims for various treatment and assessment costs, she appealed.

The Director's Delegate allowed the appeal in part, finding the arbitrator erred in law by failing to award the costs of preparing treatment plans that the insurer had actually approved.

The Delegate also found the arbitrator erred in law by focusing on the reasonableness of a follow-up in-home assessment when the insurer had failed to respond to the application, and by making unsupported factual inferences that the assessment never took place.

The issue of whether the assessment expenses were actually incurred was remitted to a new arbitrator.

The appellant insured appealed an arbitrator's order dismissing his claim for statutory accident benefits due to his failure to attend an Examination Under Oath (EUO).

The Director's Delegate allowed the appeal, finding that the arbitrator lacked jurisdiction to stay or dismiss an arbitration proceeding for failure to attend an EUO, as EUOs are part of the insurer's adjusting process, not the adjudicative process.

The appropriate remedy for non-compliance under the Statutory Accident Benefits Schedule is the suspension of benefits for the period of non-compliance, not the dismissal of the arbitration.

The stay was lifted and the matter returned to arbitration.

The Appellant appealed an arbitration decision denying her claims for statutory accident benefits.

At the oral appeal hearing, the Appellant raised a new ground of appeal based on section 38.2 of the 1996 Schedule, which had not been previously raised or briefed.

To ensure fairness and avoid litigation by stealth, the Director's Delegate adjourned the hearing to allow for written submissions on whether the new ground should be permitted and its substance.

The Appellant was ordered to pay the Respondent $750 in costs thrown away for the adjourned hearing.

The plaintiff moved for summary judgment after the insurer declared her automobile insurance policy void ab initio based on an alleged misrepresentation that no other licensed drivers lived in her household.

The insurer relied on s. 233 of the Insurance Act and asserted that the plaintiff’s former partner was living with her when the application was made.

The court found the insurer failed to meet its evidentiary burden to establish a knowing misrepresentation and had not put its best foot forward on the motion.

The defendant’s evidence was largely indirect, hearsay, or overstated, while the plaintiff’s evidence was unchallenged.

Summary judgment was granted declaring the policy valid and requiring the insurer to honour its obligations.

The plaintiff brought a motion for partial summary judgment seeking payment of two treatment plans under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The plaintiff argued the insurer failed to provide adequate medical and other reasons for denial under s. 38(8) of the Schedule, thereby entitling him to payment.

The insurer maintained that it consistently provided reasons for denials, including that the injuries fell within the Minor Injury Guidelines and that the insured failed to attend insurer examinations and provide requested medical documentation.

The court held that the evidence demonstrated ongoing communication and compliance by the insurer with statutory notice requirements.

Because the claims were intertwined with numerous other treatment plans and factual issues, partial summary judgment would not fairly resolve the dispute and a trial was required.

The plaintiffs sued their insurer for allegedly breaching a hold harmless agreement related to outstanding accounts from health service providers.

When the insurer failed to deliver statements of defence, the plaintiffs obtained a noting in default and a default judgment.

The motion judge refused to set aside the defaults.

On appeal, the Court of Appeal allowed the appeal and set aside the defaults, finding that the insurer had a reasonable explanation for its failure to defend because the hold harmless agreements had not yet been triggered, and that the plaintiffs would suffer no prejudice from setting aside the defaults.