Darrell P. March

Following an arbitration decision awarding the applicant income replacement and medical benefits, both parties sought their arbitration expenses.

The arbitrator awarded expenses to the applicant, finding he was entirely successful and that the insurer's counsel and representative caused undue delays through fruitless cross-examination and uncooperative behaviour.

The applicant's claimed costs of over $39,000 were reduced to $20,000 due to excessive hours billed, lack of complexity, and the applicant's own contribution to some delays.

The insurer's claim for expenses was dismissed.

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

The applicant failed to attend the arbitration hearing and had a history of failing to communicate with counsel or comply with production orders.

The arbitrator dismissed the arbitration due to the applicant's failure to meet the burden of proof.

The applicant was ordered to pay $500 in expenses to the insurer.

The applicant, who was injured in a 1991 motor vehicle accident, brought a motion seeking reinstatement of income replacement benefits.

He argued that the insurer improperly terminated his benefits by failing to comply with the notice requirements under sections 37 and 49 of the Statutory Accident Benefits Schedule (Bill 59).

The arbitrator dismissed the motion, finding that the applicant's claims arose under the Bill 68 Schedule, which was in effect at the time of the accident.

As Bill 68 did not contain the procedural requirements found in Bill 59, the insurer was not required to follow them when terminating the benefits.

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

The insurer denied the claims, arguing the applicant did not have a legitimate contract of employment and was not substantially disabled.

The arbitrator found that the applicant had a valid employment contract as a van driver/delivery person and that his accident-related injuries substantially disabled him from performing the heavy lifting and repetitive movements required for the job.

The arbitrator awarded income replacement benefits, medical benefits, and the cost of a disability certificate.

Furthermore, the arbitrator ordered the insurer to pay a $15,000 special award, finding that the insurer had unreasonably delayed and withheld benefit payments by failing to properly investigate the employment contract and by ignoring procedural notice requirements.

The appellant appealed an arbitration order finding that he had validly settled his claim for statutory accident benefits.

The appellant argued that under the Settlement Regulation, a settlement is not finalized until the insured confirms it after receiving the disclosure notice, and the two-day cooling-off period runs from that point.

The Director of Arbitrations rejected this 'three-step approach', holding that if the parties agree on all terms, the insurer fulfills its obligations by sending the required notice.

Unless the insured rescinds within two business days of receiving the notice, the settlement is binding.

The appeal was dismissed.

The applicant was previously ordered to pay the insurer's expenses after her application for arbitration was dismissed as abandoned.

The insurer submitted a bill of expenses for $7,696.28, which included a $3,000 assessment fee already ordered to be paid and counsel fees billed at twice the permitted legal aid rate.

The arbitrator found the bill of expenses to be non-compliant with the Dispute Resolution Practice Code, lacking supporting evidence, and containing frivolous and vexatious claims.

Rather than requiring further proceedings, the arbitrator fixed the insurer's expenses at $750, representing three hours of hearing time at legal aid rates plus necessary disbursements and preparation time.

The insurer brought a motion for the production of medical and employment records from several non-parties.

The applicant did not object to the production and had previously attempted to obtain the records.

The arbitrator ordered the non-party doctors to produce their complete charts, finding that reasonable efforts had been made and the doctors had a reasonable opportunity to respond.

However, the arbitrator declined to order the non-party employer to produce employment records, as there was insufficient evidence that the employer had been properly served with the motion record and given an opportunity to respond.

The applicant sought production of the insurer's entire accident benefits file, including post-mediation documents and communications with counsel, arguing the insurer waived privilege by abandoning its position on an insurer examination.

The arbitrator found no factual basis for waiver of solicitor-client privilege.

However, due to concerns about the insurer's compliance with a prior production order and its refusal to particularize claims of privilege, the arbitrator ordered the insurer to serve a detailed Affidavit of Documents for both the pre-mediation and post-mediation periods.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including housekeeping.

The Insurer scheduled an insurer's examination (IE) for the housekeeping claim, which the Applicant failed to attend.

The Insurer argued the Applicant was precluded from proceeding to arbitration on all issues under section 50 of the Schedule.

The Arbitrator held that the exclusion under section 50 would only apply to the housekeeping claim, not all claims.

Furthermore, the Arbitrator found the Insurer's notice of the IE was fatally flawed because it failed to clearly set out the consequences of non-attendance and the Insurer failed to make reasonable efforts to schedule the examination at a convenient time.

Therefore, the Applicant was not precluded from proceeding to arbitration on any issues.

The insurer brought a motion seeking an order sanctioning the applicant for her refusal to attend a proposed insurer's medical examination on the eve of the arbitration hearing.

The insurer argued that a late medical report from the applicant's family physician created exceptional circumstances justifying a last-minute examination.

The arbitrator dismissed the motion, finding that the insurer had ample notice of the issues and that scheduling an examination at this late date constituted tactical brinkmanship.

The applicant was permitted to proceed to arbitration, and the insurer was ordered to pay $250 in fixed costs.

The applicant claimed she was injured in a bus rollover accident in New York and sought income replacement benefits, medical expenses, and clothing expenses from her insurer.

The insurer denied the benefits.

At arbitration, the arbitrator found that while an accident likely occurred, the medical evidence did not establish that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a chambermaid.

Claims for taxi, motel, and clothing expenses were also dismissed for lack of evidence.

The insurer's late argument that the applicant was disentitled for failing to provide information was rejected.

The insurer was ordered to pay 70% of the applicant's arbitration expenses due to the applicant advancing legitimate claims, reduced because of late production of her arbitration brief.

The applicant claimed statutory accident benefits following a motor vehicle accident and applied for arbitration after mediation failed.

The applicant and her representatives failed to attend the scheduled arbitration hearing, failed to comply with undertakings, and failed to serve documents.

The arbitrator dismissed the application as abandoned.

Finding that the applicant commenced the arbitration with no intention of proceeding, which constituted an abuse of process designed to pressure the insurer into settlement, the arbitrator ordered the applicant to pay the insurer $3,000 under section 282(11.2) of the Insurance Act, plus the insurer's expenses thrown away.

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

The parties reached an oral settlement agreement, and the insurer forwarded the settlement documents and a release.

The applicant reconsidered and did not sign the release.

The insurer argued the claim was settled on a full and final basis.

The arbitrator found that the settlement was enforceable because the insurer complied with the Settlement Regulation by forwarding the disclosure and release, and the applicant failed to deliver a written notice of rescission within the two-day cooling-off period.

The applicant was precluded from proceeding to arbitration.

In a pre-hearing discussion regarding a claim for statutory accident benefits, the arbitrator ordered the applicant to execute authorizations for the disclosure of various employment, educational, and medical records.

The arbitrator also found that the insurer's request for a further medical examination by an orthopaedic surgeon was reasonably necessary, given new information about the physical demands of the applicant's employment.

Consequently, the scheduled arbitration hearing was adjourned to allow time for the productions and examination.

The applicant was injured in two motor vehicle accidents in 1995 and sought ongoing income replacement benefits (IRBs) and rehabilitation benefits from the insurer.

The arbitrator found that the applicant had a legitimate contract of employment as a truck driver trainee prior to the second accident and was substantially unable to perform the essential tasks of that employment due to injuries sustained in the accident, specifically heterotopic bone formation affecting his ability to sit for prolonged periods.

The applicant was awarded IRBs based on the truck driving contract, as well as funding for a vocational assessment at Goodwill Industries and case management services.

The applicant's claim for a higher IRB rate based on his pre-accident work as a taxi driver was dismissed due to a lack of reliable income evidence.

The Applicant sought to withdraw her application for arbitration mid-hearing after an unfavourable evidentiary ruling, intending to pursue the matter in court.

The Insurer opposed the withdrawal.

The Arbitrator denied the request, finding that permitting a withdrawal after three days of hearing and testimony from two witnesses would be unfair to the Insurer, detrimental to the arbitration process, and amount to forum shopping.

The hearing was ordered to continue, and the Insurer was awarded $350 in costs for the withdrawal request.

Following a previous decision determining the applicant's entitlement to medical benefits, the parties could not agree on the quantum payable for treatment.

The arbitrator determined that the insurer must pay $3,070 plus interest for treatment received in accordance with the submitted treatment plans, finding that while the duration of treatment was significantly extended without new plans, the frequency and cost did not vary significantly from the estimates.

The arbitrator also ordered the insurer to pay the applicant's arbitration expenses, noting that the applicant achieved a more favourable outcome than the insurer's settlement offer and her claims were not frivolous.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them on June 25, 1997.

The applicant later attempted to return to school and work but was unable to continue.

He applied for arbitration on February 28, 2000, seeking reinstatement of IRBs from May 1999 onwards.

The insurer argued the application was time-barred under the two-year limitation period in the Insurance Act and the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant failed to request reinstatement of benefits after his temporary return to work, meaning there was no new refusal by the insurer to trigger a new limitation period.

The application was dismissed as time-barred.

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

Disputes arose regarding her entitlement to medical benefits for treatment at a rehabilitation clinic, housekeeping expenses, the cost of a psychological assessment, and a special award.

The arbitrator found that the applicant's right knee problems and chronic pain syndrome were materially contributed to by the accident, making the clinic's treatment reasonable and necessary.

The claim for housekeeping expenses was dismissed due to inconsistencies in the evidence.

The cost of the psychological assessment was awarded as it was reasonable for the applicant's counsel to request it.

The claim for a special award was dismissed as the insurer's denials were not unreasonable.

The applicant sought an assessment of her expenses following an arbitration for statutory accident benefits where she achieved minor success.

The arbitrator assessed the expenses on a party and party basis, reducing the claimed legal fees and disbursements significantly.

The arbitrator found the applicant's initial demand for expenses unreasonable and reduced her counsel fee to reflect the time the insurer spent responding to it.

The total expenses were assessed at $4,680.18.