Derek Ross Greenside

The appellant sought judicial review of an arbitrator's decision that found the appellant in higher priority to pay accident benefits to an injured non-occupant.

The core issue was the interpretation of "spouse" under the Insurance Act, specifically whether the injured party and the appellant's insured had "lived together in a conjugal relationship" for the requisite three years.

The court applied a reasonableness standard of review to the arbitrator's interpretation, which had relied on family law definitions of "spouse" and a holistic approach.

The court found the arbitrator's decision unreasonable for failing to distinguish the policy context of the Insurance Act from the Family Law Act, and for applying a non-literal interpretation of "live together" without proper justification in the insurance context.

The appeal was allowed, the arbitrator's decision quashed, and the respondent declared in priority.

Following an arbitration decision regarding statutory accident benefits, the parties were unable to resolve the issue of expenses.

The insurer claimed success on the post-104-week income replacement benefit issue and three of six medical issues, seeking $22,912.12 in fees and $8,351.16 in disbursements.

The applicant also claimed partial success.

The arbitrator found the insurer was entitled to its expenses but reduced the amount to reflect the applicant's degree of success, principles of reasonableness, consumer protection, and access to justice.

The insurer was awarded $5,000 inclusive of fees, disbursements, and HST.

Following an arbitration where the insurer successfully defended all issues in dispute, the insurer requested an expense hearing.

The applicant failed to submit any materials or respond to the insurer's cost submissions.

The arbitrator found that the applicant's claim for income replacement benefits was improper and vexatious, as she was operating a business while claiming benefits.

The arbitrator awarded the insurer its full claimed expenses of $30,967.21, noting the amounts were within the maximum limits permitted under the Expense Regulation and billed at the Legal Aid rate.

The Applicant sought a determination that he suffered a catastrophic impairment following a motor vehicle accident.

In a previous decision, the arbitrator found the Applicant's Whole Person Impairment (WPI) was 50%, falling short of the 55% threshold.

On appeal, the Director's Delegate remitted the matter back to arbitration to determine the impairment rating under Chapter 4, Table 3 of the AMA Guides and to assign a rating for medication use.

Upon reassessment, the arbitrator assigned a 15% WPI for the nervous system impairment (after applying a 2% discount for double counting) and a 2% WPI for medication use.

Combining these with the previously confirmed ratings resulted in a 54% WPI, which rounds to 55%.

Consequently, the arbitrator concluded the Applicant sustained a catastrophic impairment.

The applicant was injured in a motor vehicle accident when she was struck by a car while crossing a street.

She applied for statutory accident benefits, including post-104 week income replacement benefits and various medical and rehabilitation benefits.

The arbitrator found that the applicant suffered from chronic pain but failed to prove a complete inability to engage in suitable employment, dismissing the claim for income replacement benefits.

The arbitrator granted entitlement to an occupational therapy re-assessment, a portion of physical rehabilitation, and a vocational assessment, finding the insurer's denials improper or the treatments reasonable and necessary.

Claims for further physical rehabilitation and orthotics were dismissed.

The arbitrator awarded interest on overdue payments but declined to order a special award against the insurer.

The applicant insurer sought judicial review of a Director's Delegate's appeal decision regarding a catastrophic impairment determination under the Statutory Accident Benefits Schedule.

The Delegate had overturned an arbitrator's finding that combining impairment ratings for a physical brain injury and a separate psychological disorder constituted impermissible 'double counting'.

The Delegate also remitted the issue of medication impairment back to arbitration and upheld a 4% rating for scarring.

The Divisional Court applied the reasonableness standard of review and dismissed the application, finding the Delegate's interpretation of the AMA Guides and the Schedule fell within the range of acceptable outcomes.

The applicant sought post-104 income replacement benefits following a motor vehicle accident, claiming a complete inability to work due to physical and psychological injuries.

The insurer denied the benefits and presented surveillance and social media evidence showing the applicant actively operating a holistic business, working as a life coach, and giving motivational speeches.

The arbitrator found the applicant lacked credibility and preferred the evidence of the insurer's neuropsychologist over the applicant's experts, who were unaware of her business activities.

The application for income replacement benefits, a special award, and interest was dismissed, with expenses awarded to the insurer.

The appellant appealed an Arbitrator's order dismissing her arbitration for Non-Earner Benefits on the basis that she failed to complete an insurer examination under s. 44 of the Statutory Accident Benefits Schedule.

The Director's Delegate allowed the appeal, finding that the Arbitrator erred by ruling that the circumstances leading to the examination were irrelevant and by failing to consider whether the examination was reasonably necessary.

The issues of entitlement to Non-Earner Benefits and a special award were remitted for a de novo re-hearing before a different Arbitrator.

The appellant, Unifund Assurance Company, sought judicial review of an arbitration award that found its vehicle to be the "striking vehicle" under the "transmission of force" doctrine, making it responsible for a pedestrian's accident benefits.

The Superior Court reviewed the arbitrator's application of the legal principle of transmission of force, particularly in the context of two moving vehicles.

The court found that the arbitrator erred by not applying the reasoning from Trahan v Royal Insurance Co. of Canada, concluding that the ACE vehicle, despite being deflected, maintained its own independent force and propulsion.

Consequently, the court set aside the arbitration decision, finding ACE INA Insurance Company to be in highest priority and responsible for the claimant's statutory accident benefits, and ordered ACE to reimburse The Personal Insurance Group.

The Applicant sought statutory accident benefits following a motor vehicle accident.

The Insurer argued that a prior settlement was binding, but the Arbitrator found the Applicant's rescission letter valid despite lacking a fax cover page.

The Arbitrator declined to recuse himself after viewing the settlement documents.

The Applicant was precluded from arbitrating her claim for non-earner benefits because she failed to attend a mandatory section 44 medical examination.

The Arbitrator also found that the Applicant's injuries fell within the Minor Injury Guideline (MIG), as there was no compelling evidence linking her seizures to the accident, and multiple medical assessors concluded her injuries were minor.

Claims for a special award and interest were dismissed, and the Applicant was ordered to pay the Insurer's reasonable expenses.

The appellant appealed an order adding it as a party to the proceeding.

The Court of Appeal questioned its jurisdiction to hear the appeal, considering whether the order was final or interlocutory.

The appellant argued the order was final due to preconditions in the Insurance Act regarding mediation and arbitration for statutory accident benefits.

The Court held that the order adding the party was interlocutory, as it did not finally determine the questions of law raised by the appellant.

Consequently, the appeal was quashed for lack of jurisdiction, with costs awarded to the respondents.

Following an earlier ruling on the merits of an appeal, the court addressed the issue of costs.

The responding party argued that costs of the appeal should be deferred to the arbitrator.

The court rejected that submission and held that the moving party had succeeded on the appeal, even though the remedy granted differed from what had been proposed.

Costs were therefore awarded to the successful party.

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.