Darrell P. March

The applicant sought arbitration after the insurer denied his claim for medical benefits for treatment plans totaling $2,589 following a motor vehicle accident.

The arbitrator found the applicant lacked credibility, noting significant inconsistencies between his testimony of debilitating pain and the clinical notes of his long-time family doctor, which made no mention of the accident or musculoskeletal complaints.

The arbitrator gave no weight to the evidence of the applicant's chiropractors, as one failed to provide clinical notes or a reasonable explanation for his conclusions, and the other merely repeated progress reports without examining the applicant.

The arbitration was dismissed, and the claims for medical benefits and a special award were denied.

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

The insurer terminated weekly caregiver and housekeeping benefits and denied medical benefits.

The arbitrator found that the applicant was substantially disabled from engaging in most caregiving activities for a period, and later was able to assume lighter duties but not strenuous sports activities.

The arbitrator awarded partial caregiver and housekeeping benefits, as well as medical benefits for chiropractic treatment.

The insurer's claim for repayment of caregiver benefits was dismissed because the applicant was the primary caregiver.

Interest was awarded on the overdue benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the insurer.

The parties disputed entitlement to a medical benefit for a treatment plan and the cost of an in-home assessment.

The arbitrator found that the applicant was entitled to $502.00 for the treatment plan, as the treatment was reasonable and necessary up to a certain date.

However, the claim for the in-home assessment was dismissed because it was duplicative of an insurer's assessment and not reasonably required.

Interest was awarded on the overdue payment, and the issue of expenses was deferred.

The applicant sought statutory accident benefits for caregiving, housekeeping, and medical rehabilitation following a motor vehicle accident.

The arbitrator dismissed the claims for caregiving and housekeeping benefits, finding the applicant's evidence lacked credibility and was inconsistent with his return to full-time work and school.

However, the arbitrator allowed the claim for medical and rehabilitation benefits in the amount of $5,067, finding that the chiropractic and massage treatments provided reasonable pain relief and assisted the applicant's functional improvement.

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

The arbitrator found that the applicant suffered from accident-related depression that substantially disabled her from performing the essential tasks of her employment and housekeeping for a limited period.

The applicant was awarded income replacement and housekeeping benefits for the period from March to June 2005, along with interest.

Claims for ongoing income replacement, further medical benefits, examination expenses, and a special award were dismissed.

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

The insurer terminated benefits, arguing the applicant's injuries fell within the Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II (WAD II).

The arbitrator found that the applicant's impairments did not fall outside the WAD II Guideline, relying on independent assessments and surveillance evidence showing the applicant working and driving.

The arbitrator dismissed the claims for further medical treatment, income replacement, and housekeeping benefits, and ordered the applicant to repay an overpayment of income replacement benefits.

The claim for a special award was also dismissed as the insurer acted reasonably.

The applicant applied for statutory accident benefits and the matter proceeded to arbitration.

At the hearing, the insurer brought a court reporter and argued that because it paid for the reporter, only the insurer could order transcripts and the arbitrator had no authority over the reporter prior to transcripts being ordered.

The arbitrator held that a court reporter retained by a party has no formal reporting status unless designated by the tribunal under s. 22(3) of the Insurance Act.

The arbitrator rejected the insurer's conditions, finding they compromised the neutrality and fairness of the proceeding, and ordered the hearing to proceed without a sworn stenographer.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic, massage, and active rehabilitation treatment.

The insurer denied the medical benefits, relying on a Designated Assessment Centre report that found only a portion of the treatment was reasonable and necessary, and that a transition to self-directed care was appropriate.

The arbitrator preferred the DAC assessor's opinion over the applicant's treating chiropractors, finding the applicant's experts failed to provide a rationale for the ongoing treatment.

The arbitrator also found that the applicant's right knee pain was unrelated to the accident.

The application for medical benefits was dismissed, and the applicant was found liable to pay the insurer's arbitration expenses.

The applicant was injured in a motor vehicle accident and sought caregiver and housekeeping benefits under the Statutory Accident Benefits Schedule.

The insurer paid benefits initially but terminated them.

The arbitrator dismissed the application, finding the applicant's evidence regarding his pre-accident responsibilities and post-accident needs to be inconsistent, contradictory, and lacking credibility.

The applicant failed to establish on a balance of probabilities that he suffered a substantial inability to perform his caregiving and housekeeping duties.

The insurer renewed a request to impose terms and conditions on an adjournment that had been granted to the applicant ten months prior.

The insurer sought to make the hearing peremptory to the applicant, suspend interest payable, prohibit new medical evidence, and bind over witnesses.

The arbitrator dismissed the request, finding no reasonable explanation for the ten-month delay in seeking the terms.

Furthermore, the arbitrator noted that even if the request had been timely, most of the requested terms would not have been granted, as the applicant had sought the adjournment promptly upon retaining new counsel and restricting medical evidence would unfairly prejudice his ongoing claim for income replacement benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment, massage therapy, acupuncture, and prescription medication.

The insurer denied the claims.

The arbitrator found that the applicant failed to establish on a balance of probabilities that the disputed treatments and medications were reasonable and necessary as a consequence of the accident.

The applicant's testimony regarding the benefits of the treatment was vague, and the prescription medications were for pre-existing conditions.

The application for medical benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement and housekeeping benefits from her insurer under the Statutory Accident Benefits Schedule.

The insurer terminated her income replacement benefits in February 2004.

At arbitration, the arbitrator found that the applicant's inability to work was primarily due to a pre-existing shoulder injury from a prior workplace incident, and there was insufficient medical evidence to prove the car accident caused an ongoing inability to perform her pre-accident employment beyond the termination date.

The claim for income replacement benefits was dismissed.

The arbitrator awarded a limited housekeeping benefit of $15.00 per week for a period of approximately five months following the accident, based on an occupational therapy assessment.

At a pre-hearing discussion, the applicant requested a hearing date within four to six months due to financial hardship.

Counsel for the insurer requested a delay of eleven months due to his unavailability.

The arbitrator ruled that the hearing must proceed within the standard four to six month timeframe, citing the applicant's financial urgency, the readiness of the case, and institutional policy reasons against prolonged delays.

The Applicant, injured in a motor vehicle accident, sought to participate in a pre-hearing discussion by telephone due to an eye infection.

The Insurer opposed, arguing it had a right to require her in-person attendance to assess her as a witness.

The Arbitrator allowed the Applicant to participate by telephone, finding she had a valid medical reason, the Insurer had no right to discovery in the arbitration process, and requiring an adjournment for an in-person attendance would cause unnecessary delay and expense for a dispute involving a small amount.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment, housekeeping services, and a functional capacity evaluation.

The arbitrator found the applicant's credibility was compromised by inconsistent statements and questionable documentation.

The arbitrator awarded $673 for the outstanding balances of the first two chiropractic treatment plans, finding them reasonable and necessary.

The claims for further chiropractic treatment, housekeeping benefits, and the functional capacity evaluation were dismissed for lack of persuasive evidence.

Interest was awarded on the overdue medical benefits.

The applicant was injured in a motor vehicle accident in 1994 and received statutory accident benefits.

She returned to work but her condition deteriorated, forcing her to stop working in November 2000.

The insurer denied her claims for reinstated income replacement benefits and supplementary medical expenses.

The arbitrator found that the applicant's impairments were caused by the accident and that she suffered a substantial inability to perform the essential tasks of her pre-accident employment as of November 2000.

The arbitrator awarded income replacement benefits, medical expenses for chiropractic and massage therapy, and a $10,000 special award against the insurer for unreasonably withholding payments.

The insurer appealed an arbitration order requiring it to pay income replacement benefits, medical benefits, and a $15,000 special award to the claimant following a motor vehicle accident.

The insurer argued the arbitrator erred in accepting the claimant's pre-accident employment contract and finding him disabled from that prospective job.

The Director's Delegate dismissed the appeal regarding the benefits, finding the arbitrator's conclusions were supported by the evidence and no error of law occurred.

However, the appeal was allowed in part regarding the special award.

The Director's Delegate found the arbitrator erred in her analysis by penalizing the insurer for relying on a Designated Assessment Centre report and for an adjuster's poor performance as a witness.

The special award was reduced by 50 percent to $7,500.

The applicant sought an assessment of her arbitration expenses following a previous decision awarding her 70 percent of her expenses.

The insurer refused to pay the claimed amount of $6,038.61, arguing it was excessive and that the applicant had rejected a settlement offer.

The arbitrator found the insurer's settlement offer did not comply with the Settlement Regulation.

Applying a 1:1 ratio for preparation to hearing time, the arbitrator awarded the applicant $4,840 plus GST for legal fees and disbursements, including $200 for the assessment proceeding.

At a pre-hearing discussion for a statutory accident benefits dispute, the insurer sought an order requiring the applicant to serve all expert reports at least 90 days prior to the arbitration hearing, rather than the 30 days required by Rule 39 of the Dispute Resolution Practice Code.

The arbitrator declined to make the order, noting that increasing the notice period would delay hearings, increase motions for relief, and undermine the principle of expeditiousness.

The parties were ordered to comply with the standard 30-day notice period under Rule 39, though they were encouraged to voluntarily exchange documents earlier.

The applicant withdrew his arbitration application for statutory accident benefits after commencing a court action.

The insurer brought a motion seeking to dismiss the arbitration, prohibit the applicant from commencing future FSCO arbitrations, and recover its $1,500 in expenses and $3,000 assessment fee, arguing the proceeding was frivolous, vexatious, and an abuse of process.

The arbitrator dismissed the insurer's motion, finding no evidence that the claim was trivial, commenced in bad faith, or pursued for an improper purpose.

The arbitrator also found the requested prohibition order overly broad and noted that the statutory provision allowing an award for the assessment fee had been repealed.

Each party was ordered to bear its own expenses.