Derek Greenside

The applicant sought to arbitrate her entitlement to Non-earner and Attendant Care benefits following a motor vehicle accident.

The insurer raised a preliminary issue that the arbitration was barred by the two-year limitation period under the Insurance Act.

The applicant argued the refusals were invalid because she lacked a full understanding of written English.

The arbitrator applied an objective test, finding the insurer provided clear and unequivocal refusals with the required dispute resolution information.

The preliminary issue was resolved in favour of the insurer, and the applicant was precluded from proceeding to arbitration.

The insurer requested a preliminary issues hearing to determine if the applicant was precluded from arbitrating her claims for treatment expenses and a higher income replacement benefit (IRB) due to the expiry of the two-year limitation period under s. 281.1(1) of the Insurance Act.

The applicant withdrew her claim for treatment expenses.

For the IRB claim, the arbitrator found that the insurer's provision of an accounting report and payment of a lump sum did not constitute a clear and unequivocal refusal of a higher benefit level.

Therefore, the limitation period was not triggered, and the applicant was permitted to proceed to arbitration on the quantum of her IRB.

The insurer brought a motion to have issues regarding the applicant's compliance with sections 34, 55, and 56 of the Statutory Accident Benefits Schedule heard as preliminary issues.

The arbitrator found that hearing these issues preliminarily would not serve judicial economy, as they would require extensive evidence that would likely be duplicated at a substantive hearing.

The motion was dismissed, and the issues were ordered to be determined at the main arbitration hearing.

The insurer brought a motion for an order compelling Maritime Life Assurance Company to produce a copy of its complete disability file with respect to the applicant.

The applicant objected to the production of the entire file on the grounds of relevance, but consented to production from September 1999 onwards.

The arbitrator ordered Maritime Life Assurance Company to produce a copy of the contents of its disability file with respect to the applicant from September 1999 to date.

The applicant filed an application for arbitration in error regarding claims that had not yet been mediated.

The insurer brought a motion to dismiss the application, seeking a return of its $3,000 assessment fee and its arbitration expenses.

The arbitrator dismissed the application for arbitration but found no jurisdiction to order the return of the assessment fee, as the relevant provision of the Insurance Act had been repealed.

However, the arbitrator ordered the applicant's representative to personally pay $150 in expenses to the insurer, as the representative's administrative error caused the application to be filed without reasonable cause.

The applicant sought payment of the balance of an arbitration award and his expenses for the arbitration.

The insurer claimed an overpayment of interest as a setoff, arguing the pre-hearing arbitrator had suspended interest.

The arbitrator found he had jurisdiction to decide the interest issue and declined to suspend interest, ordering the insurer to pay the $302.92 balance.

The arbitrator also assessed the applicant's arbitration expenses, allowing legal fees, agent fees at a law clerk rate, and disbursements, awarding a total of $5,033.66 in expenses.

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

The insurer had terminated benefits a few months after the accident, arguing the applicant's ongoing symptoms were due to pre-existing conditions.

The arbitrator found the applicant to be an unreliable historian regarding his pre-accident health, relying instead on the clinical notes of his family physician which documented extensive pre-existing chronic pain and depression.

However, the arbitrator accepted that the accident exacerbated the applicant's neck pain and anxiety, causing a substantial inability to perform his pre-accident job as a snowplow operator for a limited period.

The applicant was awarded income replacement benefits until December 1, 1994, but his claim for ongoing benefits and treatment expenses was dismissed.

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 appellant appealed an arbitration decision denying her claim for spousal death benefits following the death of the insured in a motor vehicle accident.

The appellant claimed she was the deceased's common-law spouse, despite the deceased being married and continuing to live with his wife at the time of his death.

The Director's Delegate upheld the arbitrator's finding that the appellant failed to establish a conjugal relationship of sufficient permanence, noting the lack of financial interdependence and the deceased's ongoing cohabitation with his wife.

The appeal was dismissed.

The applicant, the former spouse of an insured person who died in a motor vehicle accident, applied for death benefits under paragraphs 2 and 4 of subsection 25(2) of the Statutory Accident Benefits Schedule.

The parties' separation agreement explicitly waived spousal support but provided for child support.

The applicant argued that the child support payments constituted "support" under the Schedule because she received an indirect economic benefit from them.

The arbitrator rejected this argument, finding that "support" in the context of a former spouse refers to spousal support.

As the insured had no obligation to provide spousal support at the time of the accident, the applicant was not entitled to death benefits.

However, the arbitrator awarded the applicant her arbitration expenses due to the novel issue of interpretation presented.