Emma Kirsten Duggan

The applicant sought accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

She also claimed entitlement to a non-earner benefit and a physiotherapy treatment plan.

The Tribunal found that the applicant's injuries were predominantly minor sprains and strains, and she failed to prove that pre-existing conditions precluded her recovery within the MIG.

Furthermore, the applicant did not demonstrate a complete inability to carry on a normal life, as required for the non-earner benefit.

All claims were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit and a physiotherapy treatment plan outside the Minor Injury Guideline (MIG).

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove her soft tissue injuries warranted removal from the MIG, noting she had returned to her pre-accident activities in a reduced capacity.

The Tribunal also dismissed the claim for a non-earner benefit, finding no complete inability to carry on a normal life.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a catastrophic impairment assessment.

The Tribunal scheduled a written hearing, but the applicant failed to file any submissions or evidence.

Finding that proper notice was given, the Tribunal proceeded in the applicant's absence under the Statutory Powers Procedure Act.

The application was dismissed as the applicant failed to meet their burden of proof.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The applicant disputed the denial of three treatment plans (OCF-18s) for psychological services, a pre-screen assessment, and chiropractic/massage/acupuncture services.

The Tribunal found that the respondent's denial of the psychological and pre-screen OCF-18s was non-compliant with s. 38(8) of the Schedule, entitling the applicant to the incurred amounts starting on the 11th business day after receipt.

However, the Tribunal declined to deem the expenses incurred under s. 3(8), finding the applicant contributed significantly to the delay.

The Tribunal also dismissed the claim for the chiropractic/massage/acupuncture OCF-18, finding the applicant failed to prove it was reasonable and necessary.

Peter Ekstein was catastrophically injured as a pedestrian.

He had a personal auto policy with Chubb and was the owner/CEO of a company with an auto policy (including optional enhanced benefits and OPCF-47 endorsement) with Continental Casualty Company (CNA).

Chubb began paying statutory accident benefits (SABS) but served a priority notice on CNA.

An arbitrator found CNA to be the priority insurer, deeming Ekstein a "named insured" under the CNA policy due to "regular use" provisions.

CNA appealed.

The Superior Court found the arbitrator erred in deeming Ekstein a "named insured" under the CNA policy, as he never actually used company vehicles.

However, due to the OPCF-47 endorsement, CNA was still obligated to pay both mandatory and optional SABS benefits to Ekstein.

The court clarified that the OPCF-47 endorsement does not alter priority rules between insurers, entitling CNA to reimbursement from Chubb for the mandatory SABS benefits and associated administration costs.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) after initially returning to work but claiming he could not continue due to accident-related back pain.

The insurer denied the benefit, arguing the applicant lacked credibility and was terminated from his employment for other reasons.

The adjudicator found the applicant's testimony regarding his medical history and prior injuries to be highly inconsistent and lacking credibility.

Relying on the respondent's orthopedic expert who found no objective impairment, the adjudicator concluded the applicant did not suffer a substantial inability to perform his employment and dismissed the appeal.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG) and upheld the insurer's denial of two treatment plans.

Prior to the reconsideration decision, the insurer revised its position, approved full payment for both treatment plans, and removed the applicant from the MIG.

The only remaining issue was whether the applicant was entitled to interest on the outstanding benefits.

The Executive Chair granted the reconsideration in part, ordering the insurer to pay interest on the overdue payments in accordance with the Statutory Accident Benefits Schedule.

The applicant sought payment for a neurological assessment and the disputed balance of a driving evaluation assessment following a motor vehicle accident.

The Tribunal found the neurological assessment was not reasonable and necessary, as the insurer's examination concluded injuries were soft tissue in nature and the applicant provided no corroborating expert evidence.

For the driving evaluation assessment, the Tribunal allowed the cost of preparation services but denied the costs for mental health counselling (which duplicated an earlier psychological assessment) and the treatment provider's mileage (which is not payable under the Schedule).

The applicant sought accident benefits following a motor vehicle accident and applied for arbitration.

The applicant failed to attend the scheduled arbitration hearing.

The insurer brought a motion to dismiss the application.

The arbitrator proceeded in the applicant's absence pursuant to Rule 37.9 of the Dispute Resolution Practice Code.

As the applicant bore the onus of proving entitlement and presented no evidence, the application was dismissed.

The arbitrator awarded $1,000 in expenses to the insurer due to the applicant's failure to prove his claim and attend the hearing.

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

The parties reached a settlement agreement, but the applicant failed to sign the release and ceased communicating with her counsel and the Commission.

Her counsel withdrew.

The applicant failed to attend the scheduled arbitration hearing.

The arbitrator dismissed the applicant's claims for failing to prove entitlement and awarded the insurer $1,130.90 in expenses, finding that the applicant's failure to participate prolonged the proceedings.

The applicant claimed statutory accident benefits following a motor vehicle accident.

After the insurer terminated certain benefits, the applicant applied for arbitration.

The applicant's representative was removed from the record due to a breakdown in the relationship and an inability to receive instructions.

The applicant subsequently failed to participate in the proceedings or respond to communications from the arbitrator.

The insurer brought a motion to dismiss the application.

The arbitrator dismissed the application as frivolous or vexatious under Rule 68 of the Dispute Resolution Practice Code due to the applicant's non-participation, and ordered the applicant to pay $1,500 in expenses to the insurer.

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

Disputes arose and the applicant applied for arbitration at the Financial Services Commission of Ontario.

The applicant failed to attend the hearing and failed to instruct his representative.

The arbitrator granted the representative's motion to be removed from the record due to a breakdown in the relationship.

As the applicant bore the onus of proving entitlement to the claimed benefits and presented no evidence, the arbitration was dismissed.

The applicant failed to attend his scheduled arbitration hearing for statutory accident benefits.

At the hearing, the applicant's counsel successfully moved to be removed from the record due to a breakdown in the solicitor-client relationship.

The arbitrator then proceeded in the applicant's absence pursuant to the Statutory Powers Procedure Act and the Dispute Resolution Practice Code.

As the applicant presented no evidence to prove his claims, the application for arbitration was dismissed.