David S. Wilson

Following a successful partial appeal that reduced an arbitration expense award by one third, the appellant sought legal expenses for the appeal.

The respondent argued each party should bear their own costs due to mixed results.

The Director's Delegate found the reduction substantial, constituting a success, and awarded the appellant $1,000 in legal appeal expenses.

The appellant sought $2,534.90 in legal expenses and disbursements following a successful appeal of an arbitrator's decision that had dismissed her proceeding without a hearing.

The respondent insurer disputed the disbursements for lack of supporting documentation and argued the hours claimed were excessive.

The Director's Delegate found the disbursements and the 12 hours claimed to be reasonable, noting the Commission does not engage in line-by-line analysis of expenses.

The appellant was awarded $2,650, which included an additional hour for preparing the reply.

The appellant insurer sought a variation of an earlier order requiring it to pay ongoing income replacement benefits, which was granted but the contested issues were resolved in favour of the respondent insured.

The respondent sought expenses for the variation proceeding.

The Director's Delegate found the respondent was entirely successful on the contested issues and awarded $2,500.00 for legal fees, inclusive of disbursements and HST, after deducting disbursements for parking and mileage.

The appellant appealed an arbitrator's expense decision awarding the insurer $16,115.96 in costs.

The Director's Delegate upheld the arbitrator's discretionary award of law clerk fees but found that the arbitrator erred in awarding $5,303.99 for transcript expenses, as transcripts are generally not recoverable under the Expenses Regulation.

The appeal was allowed in part, and the costs award was reduced to $10,811.97.

The appellant sought legal expenses following a successful appeal that overturned an arbitrator's decision denying a special award.

The Director's Delegate found the appellant was entirely successful and entitled to reasonable expenses.

Applying a global assessment and deducting unsubstantiated disbursements, the Delegate ordered the respondent to pay $2,250.00 for legal fees, inclusive of disbursements and HST.

The appellant sought to reopen her arbitration file to claim further housekeeping benefits.

The Arbitrator dismissed the proceeding without a hearing, finding that the Commission was functus based on previous minutes of settlement.

On appeal, the Director's Delegate found that the Arbitrator erred in law by failing to provide notice or an opportunity for the appellant to make submissions before dismissing the proceeding, contrary to the Statutory Powers Procedure Act and the Dispute Resolution Practice Code.

The appeal was allowed and the matter returned to arbitration.

This endorsement concerns the determination of costs following a settlement of a tort action for $200,000.

The plaintiff sought $190,605.74 in costs, including fees for accident benefit arbitration.

The court fixed costs at $145,605.75, reducing the tort claim costs due to proportionality and allowing a portion of accident benefit legal costs to be recovered from the tort defendant, as the defendant benefited from the plaintiff's efforts in securing those benefits.

The court also rejected the defendant's argument to limit costs based on an earlier Rule 49 offer, finding the settlement agreement for costs was unrestricted.

Zurich brought a preliminary motion to stay the insured's variation/revocation proceeding, arguing the insured failed to submit to an insurer's in-home occupational therapy examination and failed to produce medical documents.

The Director's Delegate dismissed the motion.

The parties reached an agreement on document production during the hearing.

Regarding the examination, the Delegate found that the insured had sufficiently submitted to the assessment by participating for over three hours, and that the assessor had gathered enough information through formal and informal observations to provide an opinion once the outstanding documents were produced.

Procedural fairness did not require a further examination.

The appellant insurer filed an appeal from an arbitrator's order, which the Director's Delegate declined to hear on the basis that it was an appeal of an interim or preliminary order.

The respondent subsequently sought expenses for the appeal proceeding.

The Director's Delegate rejected the insurer's argument that expenses should be deferred until a hypothetical future hearing on the merits, and awarded the respondent $700 inclusive of disbursements and HST for the written proceeding.

State Farm appealed an arbitration order to vary the quantum of Income Replacement Benefits (IRBs) payable to the insured, who began receiving CPP disability benefits after the original order.

The Director's Delegate allowed the variation, reducing the ongoing IRB rate to account for the CPP deduction.

However, State Farm's request for repayment of past overpayments was denied because its notices under section 52 of the Statutory Accident Benefits Schedule were defective, claiming periods longer than the permitted 12 months and miscalculating the maximum allowable deduction.

Consequently, State Farm was ordered to repay the insured all amounts it had already collected through weekly deductions, with interest.

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

In a previous arbitration, the arbitrator found the appellant was entitled to treatment plans but denied a special award.

On appeal, the denial of the special award was rescinded and returned to a new arbitrator for redetermination.

The second arbitrator also denied the special award.

The appellant appealed again.

The Director's Delegate found that the second arbitrator committed errors of law by making factual findings based on speculation, unsupported by evidence, and contradicting the binding factual findings of the first arbitrator.

The decision was rescinded and the issue of the special award was returned to a different arbitrator for redetermination.

Following a finding that the insurer unreasonably delayed payment of attendant care and medical benefits, the arbitrator determined the quantum of the Special Award and expenses.

The arbitrator awarded a Special Award of $52,000, finding the insurer's conduct blameworthy and noting the vulnerability of the insured.

The arbitrator also awarded the applicant $35,360.45 for arbitration expenses and $4,279.88 for the costs of the written hearing on these issues.

Following an appeal decision that partially allowed the insured's appeal regarding attendant care benefits but dismissed the claim for Botox injections, the parties were unable to agree on the expenses of the appeal.

The Director's Delegate found that the insured had the greater degree of success, as the monthly attendant care benefits were significantly increased.

The insurer was ordered to pay the insured $3,500.00 in appeal legal expenses, inclusive of disbursements and HST.

Following a successful defence of an application for statutory accident benefits, the insurer sought its expenses for the arbitration hearing.

The arbitrator reviewed the insurer's bill of costs, noting that the rules for insurer's costs differ significantly from those for an insured.

The arbitrator reduced the claimed hourly rates to align with the Legal Aid Tariff and adjusted the ratio of preparation time to hearing time from 5:1 to 3:1.

Certain disbursements, including fees for a witness who did not testify and court reporter fees, were disallowed.

The insured was ordered to pay the insurer $16,115.96 for its expenses.

The applicant was involved in two motor vehicle accidents and sought statutory accident benefits.

The arbitrator found that the applicant suffered a catastrophic impairment as a result of the second accident, primarily due to psychiatric impairments including major depressive disorder, which resulted in a marked impairment in work adaptation.

The claims for attendant care and housekeeping benefits were dismissed as statute-barred because the applicant failed to provide timely notice and an assessment of attendant care needs prior to mediation.

Various medical and rehabilitation benefits were found to be reasonable and necessary and were awarded.

The claim for a special award was dismissed as the insurer acted reasonably in adjudicating the complex claims.

The appellant appealed an arbitration order regarding the calculation of her income replacement benefits (IRBs) and the deduction of long-term disability (LTD) benefits.

The Director's Delegate held that the matter must be returned to arbitration to determine the correct IRB calculation and whether the insurer gave proper notice for repayment of alleged overpayments.

However, the Delegate upheld the arbitrator's finding that the appellant could not deduct the legal expenses incurred in obtaining the LTD benefits from the amount of LTD benefits subtracted from her IRBs, as section 7(3) of the SABS only permits deductions for income tax.

The applicant was injured in a motor vehicle accident when the bus he was on collided with a train, resulting in catastrophic impairments.

He sought ongoing attendant care benefits and a Special Award for the insurer's unreasonable delay in paying benefits.

The arbitrator found that the applicant was entitled to ongoing attendant care benefits at $6,000 per month, rejecting the insurer's argument that the applicant must continually prove the expenses were 'incurred' each month.

The arbitrator also awarded a Special Award, finding that the insurer acted unreasonably, imprudently, and inflexibly in delaying payments for attendant care and medical benefits despite having sufficient evidence of the applicant's economic loss and catastrophic impairments.

The applicant sought expenses following a successful arbitration for statutory accident benefits.

The parties agreed on most costs but disputed the allowability of three expert reports totaling $4,000.

The arbitrator found that the reports from an exercise physiologist and a physician were necessary for the conduct of the arbitration, as they established the continuity of the applicant's disability and chronic pain syndrome.

The arbitrator awarded the applicant $29,589.48 in total expenses, plus $209.50 for the costs of the expense hearing.

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

The arbitrator applied the criteria under section 12(2) of Ontario Regulation 664 and the principle of global assessment based on reasonableness.

Finding that the insurer unnecessarily prolonged the proceedings by relying on insufficient medical assessments and acting unreasonably, the arbitrator awarded the applicant her full claimed expenses of $13,369.99, inclusive of fees, disbursements, and taxes.

The appellant rescinded a 2005 full and final settlement of his accident benefits claims after a 2012 decision found the Settlement Disclosure Notice defective.

The insurer subsequently paid the claimed benefits with interest calculated from the date of rescission.

The appellant sought further interest from the dates the benefits originally became overdue, as well as a special award.

The Director's Delegate allowed the appeal in part, finding the Arbitrator erred in concluding that the appellant's conduct or the settlement itself constituted unusual circumstances precluding interest.

The Delegate ordered interest on housekeeping, caregiver, and non-earner benefits from the dates they became overdue, but denied further interest on attendant care and medical/rehabilitation benefits due to the lack of prior applications.

The issues of a special award and arbitration expenses were remitted for re-hearing.