David S. Wilson

The applicant was injured in a motor vehicle accident and sought an order for ongoing income replacement benefits (IRBs) after the insurer unilaterally reinstated them prior to an arbitration hearing.

The applicant argued that an order was necessary to protect her benefits under section 287 of the Insurance Act.

The arbitrator held that an order for ongoing IRBs cannot be imposed absent a hearing on the merits or the consent of the parties, and dismissed the request.

The insurer moved to stay the applicant's arbitration hearing on the basis that she refused to attend the insurer's health care and vocational examinations.

The examinations were scheduled shortly before the hearing, and the resulting reports would not have been served within the 30-day disclosure period required by the Dispute Resolution Practice Code.

The arbitrator found that the late delivery of the reports would prejudice the applicant's ability to prepare for the hearing.

The insurer's request for the examinations was deemed unreasonable, and the motion to stay the arbitration was dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits that the insurer had terminated or denied.

The arbitrator found that the applicant's ongoing chiropractic and massage therapy treatments were reasonable for pain relief, and that her physical and cognitive limitations justified the cost of taxi transportation to treatment sessions and ongoing housekeeping expenses.

However, the claim for opioid prescription medication was denied, as the weight of medical opinion indicated it was not beneficial and potentially harmful.

The arbitrator rejected the applicant's argument that her income replacement benefits should include the indexation percentage for the first year following the onset of disability, finding the statutory language clear.

Finally, the arbitrator ordered the insurer to pay a $5,000 special award for unreasonably withholding payment for treatments and medication in blatant disregard of the pay-pending-dispute provisions of the Schedule.

The applicant, an elderly pedestrian, sustained a closed head injury when struck by a vehicle.

She claimed statutory accident benefits for care-giving services provided by her daughter and travel expenses for her granddaughter.

The arbitrator found that the accident materially contributed to the applicant's cognitive impairments.

However, applying the Court of Appeal's decision in Monochino, the arbitrator held that the applicant was not entitled to care-giver benefits because her daughter did not lose income and did not qualify as a professional care-giver.

The claim for travel expenses was dismissed as the trip was not for the applicant's benefit.

The claim for a special award was also dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them at the 104-week mark, asserting she could return to work in alternative occupations.

The applicant brought a motion for interim benefits pending the full arbitration hearing.

The arbitrator reviewed the standard for interim benefits, noting it requires establishing a prima facie case and urgency.

The arbitrator found that the applicant's entitlement raised difficult questions of law regarding the "complete inability" test that should be determined at a full hearing.

Furthermore, the applicant failed to establish sufficient urgency, as the hearing was scheduled to begin in three months.

The motion for interim benefits was dismissed.

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

A dispute arose regarding the calculation of his weekly income replacement benefits, as he held two jobs prior to the accident but could only continue one post-accident.

The applicant brought a motion for interim benefits pending the final arbitration.

The arbitrator found that the applicant presented prima facie evidence of his self-employment as a cleaner at the time of the accident and his inability to continue this work due to his injuries.

The arbitrator also accepted the applicant's evidence of financial urgency.

The insurer was ordered to pay interim income replacement benefits based on the lost cleaning income, without deduction for deemed employment income that was no longer available.

The applicant sought an assessment of her expenses following an arbitration regarding statutory accident benefits where she was awarded a special award and interim benefits.

The insurer disputed the number of hours claimed and the hourly rate of $150.

The arbitrator found that the 42.75 hours claimed by the applicant's counsel were reasonable, noting that extensive preparation time resulted in a settlement and a significant special award, thereby decreasing hearing time.

The arbitrator also approved the maximum hourly rate of $150 given counsel's year of call and expertise.

The applicant was awarded $6,412.50 in legal fees and $466 in disbursements, plus GST.

The appellants, secured creditors of a bankrupt company, sought to amend their statement of claim in an Ontario action to allege informal liquidation and improvident realization by the respondent bank.

The respondent argued these issues were res judicata due to a prior Quebec court decision involving another creditor, in which the appellants had intervened.

The Court of Appeal held that the appellants were privies to the plaintiff in the Quebec action due to their active involvement and shared interest.

Therefore, issue estoppel applied, and the appellants were bound by the Quebec court's findings.

The appeal was dismissed, the cross-appeal allowed, and the motion to amend the statement of claim was dismissed.

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

He sought an adjustment to his net weekly income based on the 1996 indexation percentage, despite having received benefits for less than one year at that time.

The Arbitrator held that under subsection 79(2) of the Statutory Accident Benefits Schedule, the Applicant was not entitled to the 1996 indexation percentage because he had been receiving benefits for less than one year.

The Arbitrator also awarded the Applicant his arbitration expenses for the period between June 16, 2000 and December 11, 2000, finding that his conduct did not unduly prolong the proceedings and his delay in accepting a settlement offer was reasonable.

The applicant sought to vary a special award of $6,500 previously ordered by another arbitrator on a motion for interim benefits.

The hearing arbitrator held that she lacked jurisdiction to vary the amount of the special award, as the prior decision was final with respect to the insurer's conduct leading up to the motion.

The arbitrator further noted that even if jurisdiction existed, she would not vary the amount, as the facts were identical to those considered in the prior decision.

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

The insurer delayed payment for several months and failed to pay benefits pending a disability DAC assessment.

On a motion for interim benefits, the insurer agreed to pay $21,841.32 in arrears and $300 per week ongoing.

The arbitrator found the insurer's conduct in delaying and withholding benefits to be unreasonable and ordered a special award of $6,500 under section 282(10) of the Insurance Act.

The appellant appealed an arbitrator's decision denying her arbitration expenses following an unsuccessful claim for full death benefits.

The arbitrator had found that the appellant's claim to be the sole spouse was without merit and that her conduct, along with her counsel's, unreasonably prolonged the hearing.

The Director's Delegate dismissed the appeal, holding that the arbitrator has broad discretion regarding expenses and did not err in her cumulative assessment that the appellant's unreasonable conduct warranted a denial of expenses.

The insured was involved in two separate motor vehicle accidents and commenced multiple court actions against different insurers and tortfeasors.

She subsequently applied for arbitration at the Financial Services Commission of Ontario to claim specific chiropractic and dental expenses from her first insurer, Royal & SunAlliance.

The insurer appealed an arbitrator's preliminary order that allowed the arbitration to proceed and awarded interim benefits.

The Director's Delegate allowed the appeal, finding that the arbitration and court proceedings involved overlapping factual and legal issues, particularly regarding causation.

The arbitration was stayed pending the outcome of the court action to avoid duplicitous proceedings and inconsistent results.

The applicant sought her expenses following an arbitration decision regarding statutory accident benefits.

The insurer agreed the applicant was entitled to expenses but disputed the number of hours claimed by her counsel.

The arbitrator reviewed the bill of costs, noting the complexity and significance of the issues, as well as the multiple hearings and written submissions required.

The arbitrator reduced the claimed 144.85 hours to 120 hours, awarding $18,000 in legal fees and $1,688 in disbursements, plus applicable GST.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them at the 104-week mark, offering a loss of earning capacity benefit of zero.

The arbitrator found that the insurer failed to follow the proper termination procedures under the Statutory Accident Benefits Schedule and did not arrange a residual earning capacity assessment in a timely manner.

The arbitrator ordered that the benefits payable after the termination date be characterized as income replacement benefits until 14 days after the receipt of a valid residual earning capacity assessment, after which loss of earning capacity benefits could commence.

A special award of 10 percent was granted due to the insurer's unreasonable withholding of benefits.

The applicant sought interim payment of dental and chiropractic accounts under the 'pay pending dispute' provisions of the Statutory Accident Benefits Schedule following a 1993 motor vehicle accident.

The insurer moved to dismiss the arbitration as duplicitous with the applicant's civil action and sought to introduce defence medical reports obtained in that action.

The arbitrator admitted the medical reports, finding the interests of justice outweighed the deemed undertaking rule, but refused to dismiss the arbitration, holding the claims were distinct.

The arbitrator ordered the insurer to pay the medical accounts on an interim basis, finding the applicant had established the requisite de minimis connection between the accident and the treatment.

The applicant sought her expenses for an arbitration proceeding regarding statutory accident benefits following the death of her common-law spouse.

The arbitrator denied the applicant's request for expenses, finding that her claim to be the sole spouse was without merit given overwhelming evidence of the deceased's prior undissolved marriage, and that her conduct and that of her counsel unreasonably prolonged the hearing.

The insurer's request for its assessment fee under subsection 282(11.2) of the Insurance Act was also dismissed because the applicant's claim was not entirely frivolous, as she had succeeded on a claim for interest.

The applicant sought full death benefits and an additional dependant benefit following the death of her common-law spouse in a motor vehicle accident.

The insurer paid only half the death benefit, arguing the deceased was legally married to another woman in China in 1941.

The arbitrator found that a valid traditional Chinese marriage had occurred, meaning the deceased had two spouses at the time of the accident, and the applicant was therefore only entitled to half the death benefit.

The arbitrator also dismissed the claim for the dependant benefit, finding the applicant was not principally dependent on the deceased for financial support.

However, the insurer was ordered to pay statutory interest on the overdue benefit payments.

The applicant sought interim income replacement and medical-rehabilitation benefits following a motor vehicle accident.

The insurer had terminated benefits, and the parties were unable to resolve their disputes through mediation.

The arbitrator found that the applicant established a probable case for entitlement to income replacement benefits and demonstrated financial urgency, awarding partial interim income replacement benefits at $235.74 per week.

The arbitrator also awarded interim benefits for housekeeping and transportation to medical appointments, but denied other requested medical and rehabilitation expenses, finding they were either past expenses or not urgently required.

The issue of a special award was reserved for the main arbitration hearing.

The appellant appealed an arbitration decision denying his claim for statutory accident benefits.

The arbitrator had found that an agreement reached at mediation was based on a misunderstanding regarding the Workers' Compensation Board's decision on the appellant's claim, and that the appellant was precluded from receiving accident benefits under section 20 of the Statutory Accident Benefits Schedule because he was entitled to workers' compensation benefits.

The Director's Delegate dismissed the appeal, holding that the arbitrator did not exceed her jurisdiction in considering the validity of the mediation agreement.

The Delegate also confirmed that the appellant's entitlement to workers' compensation benefits, even if his claim for lost time was rejected, triggered section 20 of the Schedule and precluded his claim for accident benefits.