Darrell P. March

The applicants were injured in a motor vehicle accident and sought medical benefits.

The insurer refused the treatment plans and required a Designated Assessment Centre (DAC) assessment.

The applicants requested to reschedule the assessment due to work conflicts, but the DAC and insurer refused.

The insurer then denied benefits, claiming the applicants failed to make themselves reasonably available for the assessment.

On a preliminary issue motion, the arbitrator found that the applicants' request to reschedule was reasonable and that the insurer and DAC acted unreasonably in refusing to accommodate them.

The insurer's motion to bar the arbitration was denied.

The applicant was injured in a motor vehicle accident and claimed ongoing weekly income replacement benefits and medical expenses.

The insurer terminated benefits, arguing the applicant could return to his pre-accident employment as a bricklayer's assistant.

The arbitrator found that the applicant suffered from chronic right shoulder tendinitis caused by the accident, which prevented him from performing his pre-accident heavy labour duties.

Furthermore, the applicant's limited English language skills and lack of transferable skills rendered him continuously prevented from engaging in any suitable employment.

The arbitrator ordered the insurer to pay ongoing weekly income benefits at $600 per week and certain medical expenses.

The appellant appealed an arbitration order denying his claim for ongoing income replacement benefits and ordering him to repay $51,761.86 to the insurer.

The arbitrator found that the appellant had misrepresented his employment status and pre-accident income, and that he was actually self-employed and earning more post-accident than pre-accident.

The Director's Delegate dismissed the appeal, finding that the arbitrator's conclusions were overwhelmingly supported by the evidence and that the insurer had met its burden to prove the overpayment resulted from the appellant's misrepresentations.

The applicant sought her expenses for an arbitration proceeding regarding statutory accident benefits following a motor vehicle accident.

Although she was awarded only $1,050 on a claim of over $17,000, the arbitrator found she was successful because she had to pursue arbitration to recover her entitlement.

The insurer's settlement offer of $2,500 was given little weight because it required a full release of future medical and rehabilitation claims.

The arbitrator concluded the applicant was entitled to her expenses of the arbitration proceeding.

The applicant sought interim expenses pending the completion of an arbitration for statutory accident benefits.

The hearing was delayed for six months due to the insurer's counsel's schedule.

The arbitrator applied the Bernicky criteria, noting the applicant's financial inability to carry the expenses of the arbitration and the bona fide issues raised.

The arbitrator ordered the insurer to pay $3,100.50 in interim expenses for medical reports and records, subject to a final order on expenses at the conclusion of the hearing.

The applicant sought assessment of his expenses following a successful arbitration for ongoing income replacement benefits arising from a motor vehicle accident.

The arbitrator reviewed the claimed legal fees, law clerk time, expert witness fees, and various disbursements.

After adjusting the hourly rates and disallowing certain unsubstantiated disbursements, the arbitrator ordered the insurer to pay the applicant $15,427.42 for his expenses of the arbitration process.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for housekeeping expenses, medical expenses for massage and chiropractic treatment, and the cost of two medical assessments.

The arbitrator found that the applicant was not substantially disabled from performing her pre-accident housekeeping duties and that the ongoing medical treatments were not reasonable or necessary, as they likely promoted abnormal illness behaviour.

The claims for housekeeping and medical expenses were dismissed.

The arbitrator allowed the cost of a disability certificate and half the cost of a psychological assessment, finding them reasonable.

Following a preliminary issues hearing where the applicant was ordered to pay the insurer's expenses, the insurer sought $1,059.11 in costs.

The arbitrator found the preparation time claimed by the insurer to be somewhat excessive, reducing it from 9.1 hours to 5.1 hours.

The applicant was ordered to pay the insurer $757.59 in expenses for the preliminary issues hearing.

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

The arbitrator awarded the insurer legal fees for 36 hours of preparation and attendance, along with reasonable disbursements.

The insurer's claim for a $3,000 assessment fee under subsection 282(11.2) of the Insurance Act was denied because it was not raised during the arbitration hearing.

The insurer was also denied the costs of the expense assessment itself, as the applicant successfully disputed the assessment fee claim.

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

The insurer terminated benefits and sought repayment, alleging the applicant wilfully misrepresented his employment status and income, and continued to operate his drywall business post-accident.

The arbitrator found the applicant was self-employed, had submitted a false income confirmation, and was capable of performing his essential duties.

The applicant's claims for ongoing benefits and a special award were dismissed.

The insurer's claim for repayment was granted, and the applicant was ordered to repay $51,761.86 due to wilful misrepresentation.

The applicant was injured in a motor vehicle accident and sought income replacement benefits, which the insurer terminated for insufficient documentation of pre-accident income.

At the arbitration hearing, the insurer brought a preliminary motion to dismiss the application, arguing the applicant failed to comply with a pre-hearing order to produce his complete WCB file, clinical notes, and banking records.

The arbitrator dismissed the motion, finding the applicant had not refused to comply but had provided the documents he intended to rely on, and declined to draw an adverse inference at the preliminary stage.

However, because the applicant's late production of voluminous records caused substantial delay, the arbitrator ordered the applicant to pay the insurer's expenses for the preliminary hearing.

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

The insurer argued the applicant's subsequent application for arbitration was time-barred under the Insurance Act and the Statutory Accident Benefits Schedule.

The arbitrator found that the insurer's explanation of assessment did not constitute a clear and unequivocal refusal of benefits, and the insurer failed to prove when the applicant received it.

Furthermore, the application was filed within 90 days of the mediator's report.

The arbitrator concluded the arbitration was brought in a timely manner and the applicant was entitled to proceed.

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

The applicant failed to attend the arbitration hearing, and the arbitrator proceeded in his absence.

Based on the uncontroverted evidence from the insurer, including medical assessments indicating the applicant sustained no injuries and was exaggerating symptoms, and evidence that the applicant was working as a construction labourer while receiving income replacement benefits, the arbitrator dismissed the claims for ongoing benefits.

The arbitrator ordered the applicant to repay $1,897.86 in benefits previously paid due to wilful misrepresentation.

The insurer was awarded $500 in expenses, but its request for repayment of the assessment fee under section 282(11.2) of the Insurance Act was denied as the proceeding was not found to be frivolous, vexatious, or an abuse of process.

The applicant was injured in a motor vehicle accident and applied for arbitration after a dispute over weekly income benefits.

He subsequently disappeared, failing to attend the pre-hearing or the hearing, and failing to comply with production orders.

The arbitrator found that the applicant had constructively withdrawn his application and that his conduct amounted to an abuse of process.

The application was stayed, and the applicant was ordered to pay the insurer's $2,000 assessment fee and $500 in expenses.

The applicant was involved in a motor vehicle accident and subsequently applied for income replacement benefits, claiming she was substantially disabled from her employment as a waitress due to a liver ailment, abdominal pain, and a soft tissue injury.

The insurer denied the claim.

At arbitration, the arbitrator found that the applicant failed to present reliable, objective medical evidence linking her liver fistula or abdominal pain to the accident, or proving that any soft tissue injury substantially disabled her from working.

The claim for income replacement benefits was dismissed.

Furthermore, the arbitrator exercised her discretion under section 282(11) of the Insurance Act to deny the applicant her arbitration expenses and ordered her to pay the insurer's expenses, finding the claim lacked merit and abused the arbitration process, though the insurer was denied expenses for one day due to unnecessarily prolonging the proceeding.

The applicants sought various statutory accident benefits following a 1992 motor vehicle accident.

After repeatedly delaying the proceedings and failing to retain counsel despite claims to the contrary, the applicants failed to attend the peremptory arbitration hearing.

The arbitrator proceeded in their absence under the Statutory Powers Procedure Act.

The applicants' claims were dismissed for failing to meet the burden of proof.

The insurer withdrew its claim for repayment of benefits.

Finding the applicants' conduct throughout the process to be contemptuous and an abuse of process, the arbitrator ordered them to pay the insurer $2,000 as an award in respect of its assessment.

The Applicant was injured in a motor vehicle accident and claimed ongoing income replacement benefits.

The Insurer argued his condition was not caused by the accident and he was not motivated to return to work.

The Arbitrator found that the Applicant suffered continuous depression, reduced cognitive skills, and chronic pain as a result of the accident.

Due to these cognitive and physical disabilities, the Applicant suffered a substantial inability to perform the essential tasks of his job as a welder.

The Arbitrator ordered the Insurer to pay ongoing income replacement benefits and the expenses of the arbitration.

The insurer appealed an arbitration order that allowed the insured to withdraw his application for arbitration shortly before the hearing date without ordering him to pay an assessment for abuse of process.

The Director's Delegate dismissed the appeal, finding that the arbitrator properly exercised his discretion in allowing the withdrawal and correctly concluded that the insured's conduct did not amount to an abuse of process.

The applicant applied for statutory accident benefits after a motor vehicle accident in his employer's parking lot.

The insurer denied the claim, arguing the applicant was entitled to workers' compensation benefits.

At mediation, the parties reached a tentative agreement, but the insurer later refused to pay upon learning the Workers' Compensation Board had allowed the applicant's claim for health care benefits while denying lost time benefits.

The Arbitrator held that the mediation agreement was based on a misunderstanding and was not binding.

Furthermore, because the applicant was entitled to receive some workers' compensation benefits, section 20 of the Statutory Accident Benefits Schedule precluded him from receiving accident benefits.

He was also not entitled to interim benefits under section 21 because he had elected to receive workers' compensation benefits and the WCB had already determined his entitlement.

The applicant sought to withdraw his application for arbitration regarding statutory accident benefits one month before the scheduled hearing, intending to proceed in court instead.

The insurer objected, arguing the withdrawal was an abuse of process and seeking costs under the Insurance Act and Practice Code.

The arbitrator found the applicant had not acted for an improper purpose or to harass the insurer, and therefore the withdrawal was not an abuse of process.

The withdrawal was permitted on the condition that the applicant could not re-apply for arbitration on the same issues.

The applicant's request for expenses of the withdrawal hearing was denied.