Cameron C. R. Godden

The plaintiffs were injured in a motor vehicle accident in Texas while driving a rental vehicle.

The at-fault driver was underinsured.

The plaintiffs settled their claims, leaving a priority dispute between two insurers providing OPCF 44R family protection coverage: Liberty (insuring the plaintiff's employer) and Unifund (insuring the plaintiff's spouse).

Liberty brought a motion for summary judgment arguing its policy did not respond.

The court held that under section 2.2.3 of OAP 1, the Liberty policy did not cover the rental vehicle because the plaintiff was an employee of the named corporate insured.

Consequently, Unifund was the sole first loss insurer.

The action against Liberty was dismissed.

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

The insurer terminated weekly income replacement benefits, and the applicants applied for arbitration.

A preliminary issue arose regarding whether the applicants were required to attend the pre-hearing discussions in person.

The insurer argued their attendance was essential because it intended to apply to disallow their representative from continuing to act for them.

The arbitrator ordered the applicants to attend in person, noting that the absence of parties can hinder settlement discussions and that the arbitrator has discretion to determine the format of the pre-hearing discussion.

Conditional expenses of $200 were ordered against each applicant if they failed to attend.

The applicant, who was involved in multiple motor vehicle accidents, brought a cross-application for an interim order compelling the insurer to pay past medical and rehabilitation expenses and ongoing treatment and medication costs pending a final arbitration hearing.

The arbitrator dismissed the request for past expenses, finding no urgency and deferring the complex claims to the imminent full hearing.

Regarding ongoing treatment, the arbitrator held that the proposed treatments had not been mediated as required by section 281(2) of the Insurance Act and directed the parties to mediation.

However, the arbitrator ordered the insurer to pay for the applicant's psychiatric and pain management medications pending the final order, as medication had been included in a prior mediation.

The insurer brought a motion for an order requiring the insured to attend several independent medical examinations, including an endocrinologist, a work capacity and functional abilities evaluation, a vocational assessment, and a psychological evaluation.

The arbitrator granted the requests for the endocrinologist, the physical examination by a medical doctor, and the psychological evaluation, finding them reasonable given the passage of time since previous assessments and the recent medical reports served by the insured.

The requests for a functional abilities evaluation and a vocational assessment were denied as unreasonable and too close to the scheduled arbitration hearing.

The applicant, a self-employed baker and greenhouse operator, was injured in a head-on motor vehicle collision.

The insurer terminated her income replacement benefits at the 104-week mark, arguing she was no longer disabled and seeking repayment for allegedly overstated pre-accident income.

The arbitrator found the applicant remained substantially disabled from the essential tasks of her pre-accident employment, relying heavily on compelling lay witness testimony regarding her post-accident cognitive and physical decline.

The arbitrator also accepted the applicant's evidence regarding her pre-accident earnings, setting the ongoing benefit at $634.82 weekly and ordering the insurer to pay $34,233 in arrears.

The appellant appealed an arbitration decision that denied him additional weekly income benefits following multiple motor vehicle accidents.

The appellant, representing himself on appeal, argued that the arbitration hearing should not have taken place because the issues were decided in a previous arbitration and he did not receive proper notice or full disclosure.

The Director's Delegate found no error in the arbitration process, noting that the previous arbitration only determined which issues could proceed and that the appellant's counsel at the hearing did not object to the proceedings or the admission of expert evidence.

The appeal was dismissed and the arbitration order was confirmed.

The applicant, a tailor, was involved in multiple motor vehicle accidents and sought statutory accident benefits from two insurers.

The insurers terminated or refused weekly income benefits, arguing the applicant was not substantially unable to perform the essential tasks of his employment.

The arbitrator found that the applicant exaggerated his symptoms and that surveillance evidence contradicted his claims of severe disability.

The arbitrator concluded the applicant failed to prove a substantial inability to perform his essential tasks and dismissed the claims for weekly income benefits, though expenses were awarded to the applicant.

The applicant sought an interim award of expenses for clinical notes and a medical-legal report under section 282(11.1) of the Insurance Act.

The insurer argued the section did not apply retrospectively to proceedings commenced before January 1, 1994.

The arbitrator held that the section applies immediately to all ongoing proceedings.

Applying a three-part test, the arbitrator found the application raised a bona fide issue, the expenses were necessary and reasonable, and the applicant was unable to carry the costs until the hearing.

The arbitrator awarded $800 in interim expenses.