David A. Payne

The appellant insurer sought leave to appeal a preliminary order of an arbitrator that directed it to proceed with a determination of catastrophic impairment based on a paper review by a previously retained psychiatrist, rather than requiring the respondent to attend four new in-person examinations.

The respondent had refused to attend the new examinations based on her treating psychologist's opinion that they posed a significant risk of harm and increased suicide risk.

The Director's Delegate refused to admit fresh evidence, denied leave to appeal the preliminary order, and denied a stay of the arbitrator's order.

The Delegate found that the insurer's right to choose its assessors under section 42 of the Schedule is qualified by reasonableness, and that the appeal did not raise novel issues or demonstrate sufficient prejudice to warrant an exception to the general rule against appealing preliminary orders.

Costs of $5,539.68 were awarded to the respondent.

The applicant, who sustained a severe closed head injury in a motor vehicle accident, brought a motion to add issues to an upcoming arbitration hearing regarding statutory accident benefits.

The proposed additional issues concerned estate management expenses and out-of-pocket travelling expenses for family members.

The arbitrator dismissed the motion, finding that adding the complex estate management issues so close to the hearing date would prejudice the insurer.

The arbitrator also refused to add the travelling expenses issue because it had not been formally mediated, which is a statutory prerequisite under the Insurance Act.

The applicant, who suffered a brain injury in a motorcycle accident, brought a motion for interim benefits to cover the cost of treatment at the Anagram Treatment Centre pending arbitration.

The insurer opposed, arguing the treatment was unreasonable and the recommending psychologist was in a conflict of interest.

The arbitrator granted the motion, finding that the applicant risked significant prejudice if treatment for organic brain damage was delayed, whereas the insurer faced little risk as it could recover any overpayment from the applicant's uninsured motorist tort claim if the treatment was later found unnecessary.

The applicant was rendered a quadriplegic in a motor vehicle accident and applied for statutory accident benefits from the insurer.

The insurer denied coverage, arguing its policy on the leased vehicle had expired months prior, and thus it was not an 'insurer' under the Insurance Act or O. Reg. 283/95.

The applicant brought a motion for interim benefits.

The arbitrator held that because the applicant asserted a contractual nexus and the insurer admitted to previously insuring the vehicle, the insurer was required to respond.

Under O. Reg. 283/95, the first insurer to receive an application must pay benefits pending the resolution of any priority dispute through private arbitration.

Finding an urgent need, the arbitrator ordered the insurer to pay specified interim medical and rehabilitation benefits.