David S. Wilson

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

The insurer terminated the benefits and sought to compel the applicant to attend examinations by an orthopaedic surgeon, a physiatrist, and a psychologist.

The insurer argued the applicant was precluded from proceeding to arbitration for failing to attend.

The arbitrator held that the insurer's notice of examination was deficient because it listed benefits not in dispute, and thus could not be relied upon to preclude arbitration.

The arbitrator further held that examinations by an orthopaedic surgeon and a physiatrist were reasonable and necessary, but a psychological examination was not, given the passage of time since any psychological issues were reported.

The appellant was involved in three motor vehicle accidents and sought income replacement benefits (IRBs) and loss of earning capacity benefits (LECBs) for each.

The arbitrator found the appellant was not entitled to IRBs for the second and third accidents, as they did not materially contribute to his disability.

The arbitrator also held the appellant was only entitled to one LECB offer, and that LECBs were payable from April 12, 2001, not earlier.

The appellant appealed, arguing the arbitrator erred in fact and law, and that the arbitrator had improperly participated in pre-hearing settlement discussions.

The Director of Arbitrations dismissed the appeal, finding no error in the arbitrator's conclusions and insufficient evidence of prejudice regarding the settlement discussions.

The Applicant sought to recover GST on disbursements for medical reports as part of her hearing expenses.

The Insurer argued that the medical reports were GST-exempt.

The Arbitrator found that while the reports may be exempt when billed to the lawyer, CCRA policy requires the lawyer to charge GST when billing the client, making the GST recoverable.

The Insurer also argued that the disbursements should be reduced because they were partially recovered in a related tort settlement.

The Arbitrator held he had no jurisdiction to alter his previous costs order based on the subsequent tort settlement.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until they were terminated by the insurer.

In a preliminary decision during the arbitration hearing, the arbitrator determined that the period of entitlement to IRBs before him included the post-104-week period.

The arbitrator also ruled that the appropriate disability tests were those set out in subsections 5(1) and 5(2)(b) of the Schedule for the pre- and post-104-week periods, respectively.

Finally, the arbitrator allowed the insurer to add the issue of repayment of IRBs to the proceeding based on alleged wilful misrepresentation.

The applicant was injured in a motor vehicle accident and elected to receive caregiver benefits after meeting with the insurer's adjuster.

She later sought to change her election to income replacement benefits, arguing the election was invalid because the adjuster failed to fully inform her of the consequences.

The arbitrator found that the insurer failed to comply with its obligation under section 32(2)(d) of the Statutory Accident Benefits Schedule to provide complete information, specifically that the benefit paying the most money might not pay for the longest period.

The election was deemed invalid, and the applicant was permitted to claim income replacement benefits.

Following earlier decisions regarding statutory accident benefits, the parties disputed the applicant's entitlement to interest on reinstated income replacement benefits and the quantum of hearing expenses.

The insurer argued the interest claim was res judicata because a special award had already been granted.

The arbitrator held that the applicant was entitled to interest under section 46 of the Schedule, finding the special award did not preclude a separate claim for interest.

The arbitrator also assessed the applicant's bill of costs, allowing deductions for premature motion expenses while denying other requested reductions, and remained seized of any remaining disputes.

Following a successful arbitration for statutory accident benefits, the applicant sought her expenses.

The insurer challenged the entitlement and quantum, arguing the applicant unnecessarily prolonged the proceeding through lengthy cross-examinations and objected to fees for outside counsel, pre-arbitration mediation, and GST on reports.

The arbitrator found the applicant's cross-examinations were effective and necessary, allowed the use of outside counsel at the requested rate, and confirmed GST is payable on expert reports.

The arbitrator awarded the applicant $39,058.98 in expenses.

The insurer appealed an arbitration order requiring it to pay ongoing income replacement benefits.

The insurer had terminated the insured's benefits based on an insurer examination (IE) report, despite having received a Designated Assessment Centre (DAC) report that supported the insured's disability claim.

The Director's Delegate dismissed the appeal, holding that under section 37(5) of the SABS-1996, an insurer cannot terminate benefits based on an IE report in the face of a positive DAC report, but must instead continue paying benefits pending the resolution of the dispute.

The applicant sought to reopen an arbitration hearing after the conclusion of evidence and submissions, but prior to the issuance of the decision, to present fresh evidence and submissions based on the recent Supreme Court of Canada decision in Smith v. Cooperators.

The arbitrator dismissed the motion, finding that the applicant failed to demonstrate exceptional or extraordinary circumstances justifying the reopening of the hearing.

The arbitrator noted that the new issue could have been raised earlier and that reopening the hearing would cause prejudice, delay, and extra expense.

The applicant sought an assessment of expenses following an arbitration for statutory accident benefits where he was unsuccessful but still awarded expenses due to the novelty and complexity of the issues.

The insurer disputed the amount of time claimed for legal fees, arguing it was excessive for a one-day hearing.

The arbitrator found the issues were complex and novel, justifying the preparation time, but reduced the time claimed for correspondence from 24.2 hours to 12 hours.

The applicant was awarded $11,745 plus GST for legal fees.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) which were later terminated by the insurer.

In an earlier decision, the arbitrator found that the insurer breached section 37(5) of the Statutory Accident Benefits Schedule by terminating IRBs without initiating the dispute resolution process following a positive Designated Assessment Centre (DAC) finding.

In these supplementary reasons, the arbitrator determined the effect of this breach on the ongoing arbitration.

The arbitrator held that the insurer must comply with the procedure set out in section 37(5), meaning it must commence mediation and a court action, and pay IRBs pending the resolution of the dispute.

Consequently, the arbitration concerning the applicant's entitlement to IRBs was concluded, though it could continue regarding housekeeping benefits and a special award.

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

The insurer terminated benefits after an insurer medical examination, despite a prior Designated Assessment Centre (DAC) report concluding the applicant remained disabled.

The applicant applied for arbitration, arguing the insurer breached section 37(5) of the Statutory Accident Benefits Schedule by failing to dispute the DAC report through the dispute resolution process and instead relying on a new medical examination to terminate benefits.

The arbitrator found that the insurer did not respect the role of the DAC and improperly attempted to circumvent the dispute resolution process.

The insurer was ordered to pay income replacement benefits pending the resolution of the dispute.

The applicant was involved in three motor vehicle accidents in 1995 and 1996.

He sought income replacement benefits and loss of earning capacity benefits (LECB) for the second and third accidents, arguing he was entitled to multiple LECB offers.

The arbitrator found that the applicant was substantially disabled by the first accident and that the subsequent accidents did not materially contribute to his disability.

The arbitrator also interpreted the Statutory Accident Benefits Schedule to mean that an insured is only entitled to one LECB offer for a qualifying disability, even if multiple accidents contributed to it.

The applicant's claims for additional benefits and a special award were dismissed, but he was awarded his arbitration expenses due to the novelty of the legal issues raised.

The applicant applied for arbitration regarding her entitlement to loss of earning capacity benefits following a motor vehicle accident.

The insurer raised a preliminary issue, arguing the applicant was precluded from proceeding to arbitration because she refused to attend an updated insurer's medical examination.

The arbitrator found the insurer's request for a single updated examination by a doctor who had previously examined the applicant was reasonable and not overly onerous.

The applicant was ordered to attend the examination before proceeding to arbitration.

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

The insurer terminated benefits based on an orthopaedic surgeon's report that the applicant's ongoing disability was psychological and caused by a prior accident.

The applicant also received a temporary supplement from another insurer for the prior accident.

The arbitrator held that the insurer was entitled to deduct the temporary supplement from the income replacement benefits, as the applicant's inability to work was partly due to the prior accident.

However, the arbitrator also found that the insurer unreasonably delayed reinstating the income replacement benefits by relying on an orthopaedic surgeon's opinion regarding a psychological disability, and ordered the insurer to pay a special award of $2,060.67.

The appellant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them.

After an unsuccessful mediation, the appellant waited almost five years to commence an action claiming damages for the insurer's bad faith conduct in terminating the benefits.

The insurer successfully moved to strike the claim as statute-barred under the two-year limitation period in s. 281(5) of the Insurance Act.

The Court of Appeal dismissed the appeal, holding that any dispute 'in respect of' an insurer's refusal to pay no-fault benefits, including bad faith claims, must be brought within the two-year limitation period.

The applicant was injured in a motor vehicle accident and sought ongoing statutory accident benefits.

The insurer requested that the applicant attend an insurer's medical examination with a rheumatologist, which the applicant refused, arguing her injuries were primarily orthopaedic.

On a preliminary motion, the arbitrator found the examination reasonably necessary, noting the applicant suffered from both orthopaedic and rheumatological conditions and relied heavily on her own treating rheumatologist's medical-legal reports.

The insurer's request for an order precluding the applicant from proceeding to arbitration if she failed to attend was dismissed as premature.

The applicant sought an assessment of legal expenses following a decision on motions regarding her claim for statutory accident benefits.

The arbitrator determined the appropriate hourly rate for the applicant's counsel, the number of compensable hours, and allowable disbursements.

The arbitrator awarded the applicant $4,913.98 in legal expenses, finding that an hourly rate of $150 was justified given counsel's experience and the good faith nature of the proceeding.

Following an arbitration hearing where the applicant was largely successful in her claims for statutory accident benefits, the parties disputed her entitlement to expenses.

The insurer argued that the applicant's pursuit of an indexation issue and an evidentiary objection prolonged the hearing.

The arbitrator found that these matters did not unduly prolong the hearing and, given the applicant's relative success, ordered the insurer to pay the applicant's expenses of the arbitration.

The applicant was injured in a motor vehicle accident and received income replacement benefits, which the insurer later terminated.

The applicant applied for arbitration.

Prior to the hearing, the insurer reinstated the benefits and did not contest entitlement at the hearing.

The applicant sought an order establishing her entitlement to benefits to gain procedural protection under section 287 of the Insurance Act.

The arbitrator held he had jurisdiction to issue the order and granted it.

The arbitrator also held that the applicant's accrued vacation pay must be included in the calculation of her income replacement benefit, distinguishing previous case law based on the applicant's history of taking vacation pay as contributions to a vacation account rather than as paid time off.