Darrell P. March

The appellant appealed an arbitrator's decision dismissing her claims for medical, caregiver, attendant care, and housekeeping benefits following a motor vehicle accident.

The appellant argued the arbitrator erred in law by excluding a witness and a document disclosed shortly before the hearing, applying an incorrect causation test, and improperly weighing the medical evidence.

The Director's Delegate rejected the appeal, finding the arbitrator properly exercised his discretion to exclude late evidence to prevent trial by ambush, made reasonable credibility findings, and provided adequate reasons for preferring the respondent's medical evidence.

The appeal was restricted to questions of law, and no such errors were found.

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

The applicant applied for arbitration but failed to attend the prehearing, and his representative withdrew from the record.

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

The applicant did not respond.

The arbitrator dismissed the application for arbitration and ordered the applicant to pay the insurer's expenses fixed at $1,500.00.

The applicant was injured in a motor vehicle accident and received caregiver benefits from her insurer.

The insurer terminated the benefits after 104 weeks, arguing she no longer met the test of suffering a complete inability to carry on a normal life.

The arbitrator found that the applicant's physical injuries, combined with chronic pain and a diagnosed Somatoform Pain Disorder, continuously prevented her from engaging in substantially all of her pre-accident activities.

The arbitrator ordered the insurer to pay ongoing caregiver benefits but declined to order a special award, finding the insurer's denial was not unreasonable given the complex medical evidence.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits from his insurer, including income replacement, attendant care, housekeeping, medical benefits, and the cost of examinations.

The insurer had terminated income replacement benefits on the basis of non-compliance with a work-hardening program.

The arbitrator found that the applicant had participated in the program and that his severe back injuries and chronic pain rendered him completely incapable of engaging in suitable alternative employment.

The arbitrator awarded ongoing income replacement benefits, partial attendant care and housekeeping benefits, the requested medical benefits and examinations, and interest.

Furthermore, the arbitrator ordered the insurer to pay a maximum special award of 50% for unreasonably withholding income replacement benefits after receiving evidence of the applicant's compliance with rehabilitation.

The applicant claimed statutory accident benefits following a motor vehicle accident in November 2009.

She sought medical, caregiver, attendant care, and housekeeping benefits.

The arbitrator found the applicant's evidence to be vague, insubstantial, and prone to exaggeration.

The arbitrator preferred the evidence of the insurer's occupational therapist, who observed the applicant in her home and concluded she did not suffer a substantial inability to perform caregiving or housekeeping tasks.

The applicant failed to prove her entitlement to the claimed benefits on a balance of probabilities.

The application was dismissed, with the issues of a special award and expenses deferred.

The applicant was seriously injured in a motorcycle accident and received income replacement benefits until the insurer terminated them in March 2010.

The applicant sought ongoing benefits, arguing he was completely unable to engage in suitable employment until he completed computer repair training.

The insurer relied on surveillance and medical assessments to argue he could return to light sedentary work.

The arbitrator found that the applicant's completion of high school equivalency and demonstrated ability to sit for extended periods during commutes and classes indicated he was capable of resuming sedentary office work by September 2012.

Income replacement benefits were awarded for the closed period from March 2010 to September 2012.

The claim for a special award was dismissed, as the insurer's reliance on surveillance to terminate benefits was reasonable.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for medical treatment and examinations related to chronic pain.

The insurer denied the treatment plans, arguing the injuries were minor soft tissue injuries that did not justify further treatment two years post-accident.

The arbitrator found the applicant credible and accepted expert evidence that she suffered from a chronic pain disorder.

The arbitrator concluded the treatment at the Rehab Centre was reasonable and necessary to manage pain, improve function, and allow the applicant to continue working.

The applicant was awarded $11,695 for medical benefits, $1,462.44 for examinations, and interest on overdue payments.

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

After failing to attend a pre-hearing conference, the applicant's legal representatives were removed from the record.

The applicant subsequently failed to attend the arbitration hearing.

In the absence of any evidence from the applicant, the arbitrator dismissed the application and ordered the applicant to pay $1,500 in expenses to the insurer.

The applicant's solicitors brought a motion to be removed from the record in a statutory accident benefits dispute.

The solicitors had been unable to communicate with or obtain instructions from the applicant for several months, and the applicant failed to attend the pre-hearing conference or the motion hearing.

The insurer took no position.

The arbitrator granted the unopposed motion, finding a breakdown in the solicitor-client relationship.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, housekeeping, and medical benefits.

The insurer terminated benefits, arguing the applicant could return to work and perform housekeeping.

The arbitrator found that the applicant suffered from chronic pain and psychological impairments caused by the accident, rendering her substantially and completely unable to engage in her pre-accident employment as a personal support worker or any suitable alternative employment.

The arbitrator awarded ongoing income replacement benefits, partial housekeeping benefits, and specific medical benefits, while dismissing other claims for lack of evidence.

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

At the hearing, a new issue arose regarding the quantum of income replacement benefits, as recent productions indicated the applicant had received collateral benefits.

Neither party could quantify the amount in dispute without further information from the collateral benefits carrier.

The arbitrator adjourned the hearing to allow the parties to obtain the necessary information, schedule a longer hearing, and address evidentiary issues.

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

During the arbitration process, the applicant's representative sought adjournments to appoint a litigation guardian, citing concerns about the applicant's capacity to instruct counsel.

The arbitrator held a preliminary issue hearing to determine if the applicant required a representative and if the application should be dismissed for delay.

The arbitrator found the medical and observational evidence insufficient to rebut the presumption of capacity, concluding the applicant could act on his own behalf.

The insurer's request to dismiss the application was denied, and the matter was ordered to proceed to a pre-hearing.

Following an arbitration where the applicant's claim for statutory accident benefits was dismissed, the arbitrator determined the issue of expenses.

Applying the criteria under section 12 of Ontario Regulation 664, the arbitrator noted that the insurer was completely successful.

However, the arbitrator found that the issues regarding the specific treatment plans could have been raised at an earlier arbitration hearing between the same parties.

Concluding that both parties used the process to frustrate the other, the arbitrator ordered that each party bear their own expenses.

Following an arbitration decision regarding statutory accident benefits where success was divided, both parties sought their expenses of the proceeding.

The arbitrator ordered the applicant to pay $2,000 to the insurer for costs thrown away due to an aborted hearing caused by the applicant's former counsel.

With respect to all other expenses, the arbitrator found that because the applicant was successful on the issue of prescription medication and the insurer was successful on the issue of non-earner benefits, success was divided and each party should bear their own expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and medical/rehabilitation benefits for prescription medication (primarily Oxycontin).

The arbitrator found that the applicant did not suffer a complete inability to carry on a normal life within 104 weeks of the accident, dismissing the claim for non-earner benefits.

However, preferring the evidence of the applicant's treating physician over the insurer's paper-review assessor, the arbitrator found the ongoing prescription of narcotics to be reasonable and necessary for chronic pain management, awarding $25,546.02 for medication expenses.

Claims for the cost of medical reports and a special award were dismissed.

The applicant was struck by a motor vehicle and subsequently underwent arthroscopic knee surgery.

She sought payment for $2,261.56 in physiotherapy treatment under the Statutory Accident Benefits Schedule.

The insurer denied the claim, relying on an insurer's examination which concluded the knee surgery was unrelated to the accident and the therapy was unnecessary.

While the arbitrator found the knee injury was caused by the accident, the application was dismissed because the treating chiropractor's records did not demonstrate an understanding of the applicant's knee condition, rendering the treatment neither reasonable nor necessary.

The applicant's counsel brought a motion to withdraw as solicitor of record following the dismissal of the applicant's substantive claims due to delay, but prior to a decision on expenses.

The applicant opposed the withdrawal, wishing counsel to remain for the expense hearing.

The arbitrator reviewed the law on withdrawal of counsel and found that the solicitor-client relationship had broken down, with a loss of mutual confidence and trust.

The arbitrator granted the motion, permitting counsel to withdraw without conditions.

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

The insurer denied two treatment plans and raised a preliminary issue regarding the applicant's failure to attend an insurer's examination.

The insurer later sought to withdraw the preliminary issue after learning the applicant had not received notice of the examination.

The applicant requested $500 in costs as a condition of the withdrawal.

The arbitrator found the insurer's initial request for a preliminary issue was not improper or vexatious, and permitted the insurer to withdraw the issue without terms.

The applicant sought interim income replacement benefits following a motor vehicle accident.

The applicant had returned to work shortly after the accident but stopped working over a year later, citing medical advice.

The insurer denied benefits based on multiple assessments concluding the applicant was not substantially disabled.

The arbitrator dismissed the motion for interim benefits, finding that there were too many unanswered questions regarding causation, disability, and post-accident income, which required a full hearing to resolve.

Following a decision denying the insured's claim for income replacement benefits, the insurer sought to recover its expenses.

The arbitrator assessed the insurer's bill of costs, reducing the claimed legal fees by applying a 2.5 to 1 ratio of preparation to hearing time and deducting time spent on an ill-founded medical argument.

The arbitrator also disallowed disbursements for official examiner fees (transcripts) and the attendance fee of the insurer's medical expert.

The insurer was awarded $15,750 in legal fees and $7,440.21 in disbursements.