Arvin Gupta

The applicant sought a non-earner benefit following a 2013 motor vehicle accident, claiming it exacerbated her pre-existing psychiatric issues and chronic pain.

The insurer denied the benefit, arguing her activities of daily living had not substantially changed.

The arbitrator found that the applicant's normal life had changed due to a prior 2011 accident and family conflicts, not the 2013 accident.

Despite an aggravation of her chronic pain, she continued to engage in substantially all her pre-accident activities, such as attending workshops, driving, and socializing.

The application was dismissed, and expenses were awarded to the insurer.

Following an arbitration where the insurer was completely successful in defending against the applicant's claims for statutory accident benefits, the insurer requested an expense hearing.

The arbitrator reviewed the insurer's claimed expenses of $18,251.15, considering factors such as the degree of success, offers to settle, and the applicant's failure to comply with undertakings.

Finding the insurer's hours and disbursements reasonable, the arbitrator ordered the applicant to pay the full claimed amount of $18,251.15.

The applicant was injured in a motor vehicle accident and claimed attendant care benefits for services provided by his wife, a professionally qualified personal attendant.

The insurer denied the claim.

The Licence Appeal Tribunal found that the applicant's wife did not provide the services in the course of her ordinary employment, nor did she sustain an economic loss as a result of providing the care.

Consequently, the applicant failed to prove that the attendant care expenses were 'incurred' under section 3(7)(e)(iii) of the Statutory Accident Benefits Schedule.

The appeal for benefits, interest, and costs was dismissed.

The applicant was injured in a motor vehicle accident and submitted a treatment plan to the respondent insurer.

The respondent denied the plan, arguing it was unsigned and that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant submitted a valid treatment plan for $369.47.

Furthermore, the respondent failed to respond within the required 10 business days under section 38 of the Schedule.

As a result, the respondent was prohibited from taking the position that the applicant's impairment fell within the MIG and was ordered to pay the treatment plan costs along with accrued interest.

The applicant's claim for costs was dismissed.

The applicant sought a medical benefit of $2,233.46 for chiropractic treatment and massage therapy following a motor vehicle accident.

The insurance company denied the treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended they suffered from cervical radiculopathy, which falls outside the MIG.

The Tribunal found that the applicant failed to meet the burden of proving their injuries fell outside the MIG, as their medical evidence lacked sufficient objective testing and persuasive analysis to support a diagnosis of cervical radiculopathy.

The Tribunal preferred the insurance company's medical assessment, which diagnosed a whiplash injury.

The application for benefits and interest was dismissed.

The applicant sought income replacement benefits (IRBs) and non-earner benefits (NEBs) following two motor vehicle accidents.

The insurer denied the benefits and sought repayment of $42,402.58 in IRBs previously paid, alleging material misrepresentation regarding the applicant's employment and income.

The arbitrator dismissed the applicant's claims, finding that his pain complaints were long-standing and pre-existing, and he failed to prove a substantial inability to perform his employment tasks or a complete inability to carry on a normal life.

The arbitrator also dismissed the insurer's claim for repayment, concluding there was insufficient evidence to prove the applicant wilfully misrepresented his employment or committed fraud.

The applicant sought statutory accident benefits, including income replacement and housekeeping benefits, following a motor vehicle accident.

The insurer denied the claims, and the applicant applied for arbitration.

The arbitrator dismissed the application, finding the applicant lacked credibility regarding his pre-accident job duties and a pre-existing wrist injury.

The arbitrator preferred the evidence of the applicant's employer, who testified that the applicant's job was sedentary and did not involve the heavy tasks he claimed he could no longer perform.

The claims for income replacement, housekeeping benefits, and a special award were denied.

The insurer sought repayment of $14,557.94 in accident benefits and its expenses following an arbitration where the applicant failed to prove he was involved in a motor vehicle accident.

The arbitrator dismissed the claim for repayment, finding the insurer failed to prove the applicant wilfully misrepresented material facts or that the amounts claimed were actually benefits paid to the applicant.

However, as the insurer was completely successful in the preliminary issue hearing, the arbitrator awarded the insurer its arbitration expenses, fixed at $7,000.00 inclusive of disbursements for its accident reconstruction experts.

The insurer brought a motion for the production of clinical notes and records from three third-party medical clinics regarding the applicant, who claimed statutory accident benefits following a motor vehicle accident.

The insurer withdrew its request against one clinic that complied.

The arbitrator applied Rule 67.7 of the Dispute Resolution Practice Code and found that the remaining two clinics failed to respond despite reasonable efforts by the applicant's counsel to obtain the documents.

The arbitrator ordered the two clinics to produce the records forthwith and ordered each to pay $150 in expenses to the insurer for prolonging the proceeding.

The applicant claimed statutory accident benefits following an alleged rear-end motor vehicle collision.

The insurer disputed the claim, raising the preliminary issue of whether an "accident" actually occurred as defined in the Statutory Accident Benefits Schedule.

The arbitrator found the applicant's testimony lacked credibility due to numerous inconsistencies regarding the time, location, weather, and vehicle condition.

Furthermore, two accident reconstruction specialists concluded that the physical damage to the vehicles was inconsistent with the reported collision.

The arbitrator concluded the applicant failed to prove on a balance of probabilities that he was involved in an accident, and dismissed the claims for accident benefits.

The appellant appealed an order of the Superior Court of Justice.

The Court of Appeal agreed with the reasons of the motion judge and dismissed the appeal, awarding costs to the respondent.

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.

The insurer sought its expenses of an appeal and variation/revocation proceeding after successfully defending an arbitration order that required the appellant, former counsel for the insured, to personally pay the insurer's arbitration expenses.

The appellant argued the expenses claimed were excessive and sought to offset them based on his success on a preliminary procedural issue.

The Director's Delegate rejected the offset, noting the preliminary issue was merely deferred and the appellant ultimately lost the appeal.

After adjusting the claimed preparation time and disbursements, the Director's Delegate fixed the insurer's expenses at $2,246.60 inclusive of GST.

Following the dismissal of the appellant's appeal, the parties were unable to agree on the legal expenses of the appeal.

The respondent initially sought to summons the appellant to the expense hearing to determine if he or his counsel should be personally liable for costs.

The appellant brought a motion to quash the summons.

The respondent subsequently withdrew its request, rendering the motion redundant, but was ordered to pay the costs of the motion.

Additionally, a lawyer from the firm representing the appellant brought a motion in his personal capacity seeking particulars and bifurcation regarding his potential personal liability for costs.

The Director's Delegate dismissed this motion, finding that the lawyer lacked independent standing to bring a motion while his firm continued to represent the appellant, as it raised conflict of interest concerns.

The insurer brought a motion to dismiss or stay the arbitration proceeding on the grounds that the applicant had commenced both an arbitration and a Superior Court action for different benefits arising from the same motor vehicle accident and the same failed mediation.

The arbitrator held that section 281 of the Insurance Act, consistent with the rule against multiple proceedings, requires an insured person to choose a single forum for all issues in dispute arising from a single mediation.

The arbitration was stayed pending the outcome of the court case, with leave for the applicant to amend her application to include all issues if she chooses to proceed in arbitration.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from Unifund Assurance Company based on a fraudulent pink insurance slip provided by the owner of the vehicle he was driving.

Unifund refused to respond, arguing there was no nexus between it and the applicant.

The arbitrator held that the applicant's choice of insurer was not arbitrary or random, as he relied on the police report which listed Unifund based on the fraudulent slip.

Therefore, a sufficient nexus existed, and Unifund was the first insurer required to pay benefits pending any priority dispute.

The appellant appealed an arbitrator's decision awarding him $6,628.75 in legal expenses following a settlement of his statutory accident benefits claim.

The appellant argued the arbitrator erred by not bifurcating the expense hearing to separately determine expenses incurred preparing for the hearing itself, and alleged a reasonable apprehension of bias.

The Director's Delegate dismissed the appeal, finding no evidence that the parties jointly requested a bifurcated expense hearing as required by the Dispute Resolution Practice Code, and no evidence that the arbitrator had closed her mind or prejudged the issues.

The applicant was injured in a motor vehicle accident in Ontario and applied for statutory accident benefits from the Motor Vehicle Accident Claims Fund (MVAC).

At the time of the accident, the applicant's refugee claim had been denied and she was subject to a removal order, making her presence in Canada unlawful.

The arbitrator held that a person unlawfully in Canada cannot be considered 'ordinarily resident' in Ontario.

As the applicant's domicile state of Kazakhstan did not offer reciprocal coverage, she was precluded from claiming benefits under section 25(1) of the Motor Vehicle Accident Claims Act.

The appellant appealed an arbitration decision dismissing his claims for statutory accident benefits.

On appeal, the appellant sought to expand the grounds of appeal beyond the initial Notice of Appeal and to introduce fresh evidence via an affidavit from his counsel regarding an alleged undertaking.

The Director's Delegate allowed the expanded grounds of appeal, finding the prejudice to the respondent was merely tactical and could be cured by granting time to respond.

However, the request to introduce fresh evidence was denied, as the evidence could have been adduced at arbitration with due diligence and would not have reasonably affected the outcome given the lack of other supporting evidence for the housekeeping claims.

The appellant sought to appeal an arbitrator's decision regarding legal expenses following a settlement of his statutory accident benefits claim.

The respondent argued the appeal was filed out of time.

The Director's Delegate found reasonable grounds to extend the time for the appeal, noting the appellant's early intention to pursue the issue.

The Delegate also ruled on the admissibility of fresh evidence, refusing an affidavit but allowing certain correspondence and exhibits to form part of the appeal record.