Alon Rooz

The insurer brought motions to set aside a noting in default and a default judgment in two actions brought by insured plaintiffs concerning obligations under a hold harmless agreement relating to unpaid accident benefit treatment accounts.

The insurer also sought summary judgment dismissing the actions, while the plaintiffs brought cross-motions for summary judgment.

The court held that the insurer had no plausible excuse for failing to deliver timely defences despite repeated warnings that strict compliance with the Rules of Civil Procedure would be required.

Although the insurer may have had an arguable defence and brought its motion promptly, the prejudice to the elderly plaintiffs and the integrity of the administration of justice weighed against granting relief.

All motions were dismissed and the default judgment remained in force.

The insured was injured in a motor vehicle accident and claimed statutory accident benefits for twenty-nine treatment plans.

The Arbitrator dismissed most claims but found six plans, totaling $6,398.23, were deemed approved because the insurer failed to respond.

On appeal, the Director's Delegate revoked this order, holding that under s. 38(8.2) of the SABS, an insurer is only required to pay for goods and services actually provided under the treatment plan.

Since the Arbitrator found it impossible to determine what treatment had been administered, the insurer was not required to pay for the plans.

Following the dismissal of the applicant's claims for statutory accident benefits, the insurer sought its expenses for the arbitration.

The arbitrator found that the applicant was completely unsuccessful and his evidence was unbelievable, but his conduct did not cross the threshold of an improper or vexatious proceeding.

The insurer was awarded its expenses fixed at $8,532.81.

The arbitrator declined the insurer's request to order the applicant's solicitors to personally pay a portion of the expenses, holding the applicant completely liable.

Following the dismissal of the appellant's appeal regarding statutory accident benefits, the parties made written submissions on the costs of the appeal.

The appellant sought $3,657.80, while the respondent sought $8,569.58.

The Director's Delegate found the respondent's claimed hours disproportionate but noted the respondent was successful in the main appeal.

Balancing the criteria under the Expense Regulation, the Director's Delegate ordered the appellant to pay the respondent $1,500 in legal expenses.

The applicant in a statutory accident benefits dispute requested that the prehearing arbitrator step down from deciding the insurer's motion to dismiss the arbitration, alleging lack of jurisdiction and a reasonable apprehension of bias.

The arbitrator held that subsection 282(3) of the Insurance Act and the Dispute Resolution Practice Code grant broad authority to prehearing arbitrators to decide preliminary issues, including motions to dismiss.

The arbitrator also found no factual basis to support the applicant's allegations of bias, noting that clarifying issues, referencing similar cases, and refusing to release an unpublished decision do not create a reasonable apprehension of bias.

The motion to disqualify the arbitrator was dismissed.

The respondent was injured in a motor vehicle accident and applied to the appellant for statutory accident benefits.

An arbitrator found the appellant was the first insurer to receive the application and ordered it to pay benefits pending the resolution of a priority dispute, despite the appellant's claim that it was a victim of a fraudulent pink slip and had no real nexus to the respondent.

The appellant appealed and sought a stay of the arbitrator's order pending the appeal.

The Director's Delegate denied the stay request, finding that granting a stay would thwart the clear legislative intent of O. Reg. 283/95, which is to ensure that the payment of accident benefits to claimants is not delayed due to disputes between insurers over who is liable to pay.

Following the dismissal of the applicant's claim for statutory accident benefits, the insurer sought its expenses of the arbitration against both the applicant and his solicitor personally.

The arbitrator ordered the applicant to pay $7,000 in expenses to the insurer, finding the insurer was completely successful and the applicant lacked credibility.

The arbitrator dismissed the insurer's claim for expenses against the solicitor personally and ordered the insurer to pay $1,000 in expenses to the solicitor for having to defend against the unreasonable claim.

The appellant was injured in a motor vehicle accident and sought accident benefits, including payment for treatment plans and housekeeping expenses.

The arbitrator dismissed the claims, finding insufficient evidence that the treatment and housekeeping expenses were reasonable, necessary, or actually incurred as claimed.

On appeal, the appellant argued the insurer failed to provide adequate reasons for denying the treatment plans, which should trigger mandatory payment under the Schedule.

The Director's Delegate dismissed the appeal, upholding the arbitrator's findings that the insurer provided adequate reasons for one plan and that the statutory consequence for the other did not mandate payment regardless of reasonableness.

The claims for housekeeping benefits and a special award were also dismissed.

The Insurer brought a preliminary motion to dismiss the Applicant's arbitration for attendant care benefits, arguing that the Applicant had simultaneously filed a Superior Court action for other accident benefits arising from the same motor vehicle accident.

The Arbitrator found that maintaining multiple proceedings created significant diseconomies and that the Applicant failed to provide a reasonable explanation for splitting the claims.

The arbitration was dismissed to allow the Applicant to join the attendant care claim into the lawsuit.

The Insurer was awarded $500 in motion expenses.

The appellant insurer sought to appeal a preliminary arbitration order determining it was responsible for paying statutory accident benefits to the respondent.

The appellant also requested a stay of the order.

Two other entities, another insurer and an industry association, sought intervenor status.

The Director's Delegate accepted the appeal from the preliminary order but declined to grant a stay, emphasizing the need for seamless receipt of benefits pending dispute resolution.

Both requested intervenors were granted status on specific terms to make submissions on issues of law.

The Insurer sought an order for expenses against the Applicant and his solicitor personally, alleging the solicitor advanced frivolous claims and caused unreasonable delay.

The solicitor brought a motion for summary judgment to dismiss the claim against him.

The Arbitrator granted the motion, finding no evidence that the solicitor knowingly participated in misrepresentations or advanced the claims in bad faith, and no evidence of substantial delay attributable solely to his default.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which were denied by the insurer.

The parties resolved all outstanding issues prior to the arbitration hearing, leaving only the issue of expenses.

The applicant submitted a Bill of Costs for $8,544.13.

The arbitrator reviewed the claimed fees and disbursements, noting the lack of supporting dockets and the uncomplicated nature of the case.

The arbitrator reduced the claimed fees but allowed the disbursements in full, awarding the applicant a total of $6,628.75 in expenses.

In a pre-hearing for a statutory accident benefits dispute, the applicant sought an order compelling the insurer to produce an affidavit of documents for its file subsequent to mediation.

The insurer sought an order compelling the applicant to disclose whether a tort claim had been initiated.

The arbitrator dismissed the applicant's request, finding no evidence to justify ordering an affidavit of documents and noting that documents created post-mediation are highly likely to be protected by litigation privilege.

The arbitrator granted the insurer's request, ordering the applicant to provide a written answer regarding the existence of a tort claim, as such information is relevant to the arbitration.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for caregiver, housekeeping, and medical expenses.

The insurer terminated caregiver and housekeeping benefits based on medical assessments indicating the applicant no longer suffered a substantial inability to perform those tasks.

The insurer also denied further medical benefits and sought repayment of caregiver benefits paid pending a designated assessment centre evaluation.

The arbitrator dismissed the applicant's claims, finding she failed to prove entitlement to the disputed benefits.

The arbitrator ordered the applicant to repay $600 in caregiver benefits to the insurer, as the insurer was justified in terminating the benefits when it did.

The applicant was injured in a motor vehicle accident while driving his former wife's uninsured vehicle.

He applied for statutory accident benefits from the insurer of the other vehicle.

The insurer argued the applicant was excluded from receiving income replacement and housekeeping benefits under s. 30(1)(a) of the Schedule because he knew or ought reasonably to have known the vehicle was uninsured.

The arbitrator found that the applicant was principally responsible for arranging insurance on the vehicle and had been notified of the policy's cancellation 14 months prior to the accident.

The arbitrator concluded the applicant ought reasonably to have known the vehicle was uninsured and dismissed his claims for those benefits.

The insurer sought its expenses of an arbitration proceeding against the applicant's former representative, Alon Rooz, personally.

The arbitrator found that the representative commenced the arbitration without the authority of the insured person, who had moved to Ukraine and had no knowledge of the claim.

The representative was ordered to personally pay the insurer's expenses of $4,621.17 pursuant to subsection 282(11.2) of the Insurance Act.

The applicants were involved in a motor vehicle accident and sought statutory accident benefits.

The insurer settled the outstanding accounts for medical and examination expenses directly with the service providers, obtaining full and final releases.

The applicants subsequently sought to proceed to arbitration for those same expenses.

On a preliminary issue, the arbitrator held that the claims could not proceed, as the insurer had validly settled the accounts directly with the providers under the Schedule and no further expenses were incurred by the applicants.

The insurer's request for costs against the applicants' legal representatives personally was dismissed, as the claims, while lacking merit, did not constitute an abuse of process.

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

At a scheduled pre-hearing, the insurer's counsel attended without a representative authorized to bind the insurer, in breach of a prior order by the arbitrator and section 279(5) of the Insurance Act.

The arbitrator found that the insurer knowingly flouted the order, constituting an abuse of process.

The insurer was ordered to pay $400 in expenses to the applicant, with payment suspended until the completion of the arbitration.

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

The insurer denied benefits, alleging material misrepresentation based on discrepancies between the applicant's statement and a truck driver's statement.

The insurer sought production of the Crown brief from related criminal charges against the applicant.

The arbitrator held that the insurer must follow the screening mechanism established in D.P. v. Wagg to compel production of the Crown brief, which requires notice to the Attorney General and the relevant police service.

The arbitrator ordered the applicant to first disclose the nature of the charges and list any Crown brief materials in her possession.

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

After failing to attend medical examinations, pre-hearings, and failing to communicate with his counsel, the insurer brought a motion to dismiss the application and sought expenses against both the applicant and his counsel.

The applicant's counsel also brought a motion to withdraw as representative of record.

The arbitrator deemed the application withdrawn due to the applicant's failure to pursue his claim.

The applicant's counsel was permitted to withdraw and was not held personally liable for the insurer's expenses, as they acted within the normal scope of representation.

The applicant was ordered to pay $750 in expenses to the insurer.