Eric Grossman

The respondent insurer filed a request for reconsideration of a preliminary decision more than 12 months after the 21-day deadline, arguing that its timely appeal to the Divisional Court demonstrated its intention to pursue a review.

The Tribunal declined to extend the deadline under section 7 of the Licence Appeal Tribunal Act or Rule 3, finding that allowing the late reconsideration would not promote an efficient or timely resolution and would prejudice the applicant who had already responded to the unsuccessful court appeal.

The request for reconsideration was dismissed.

The insurer applied to vary an appeal order that required the insured to repay interim benefits but failed to specify the quantum.

The insured argued the Director's Delegate lacked jurisdiction as the omission was not a mere typographical error.

The Director's Delegate held that issuing an unenforceable order without a quantum was an 'error in the order' under Rule 61.1(c) of the Dispute Resolution Practice Code.

The order was varied to require the insured to repay $41,919.18 in interim benefits.

However, the insurer's request to include benefits paid after a subsequent arbitration order was dismissed, as there was no error in the original appeal order regarding those payments.

The appellant insurer appealed an arbitrator's decision that the denial of the respondent's caregiver benefit was invalid and that she was entitled to elect her preferred weekly benefit.

The insurer argued that the OCF-1 application form constituted an application for all weekly benefits, allowing it to deny all benefits without an election, relying on recent case law.

The Director's Delegate dismissed the appeal, finding that the arbitrator correctly distinguished the case law because the insurer had actual knowledge that the respondent might qualify for more than one benefit, triggering the election requirement under section 36(2) of the Statutory Accident Benefits Schedule.

Because the insurer failed to provide the required election form, the limitation period did not commence, and the respondent could still make her election.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and two treatment plans.

The respondent insurer denied the benefits, arguing the applicant did not meet the test for IRBs and failed to attend scheduled independent medical examinations (IEs).

The Tribunal found the applicant's credibility lacking due to her failure to produce documents explaining her non-attendance at the IEs and drew an adverse inference.

However, relying on the applicant's psychological expert, the Tribunal concluded she suffered severe psychological impairments rendering her substantially unable to perform the essential tasks of her pre-accident employment as a personal support worker.

The Tribunal awarded ongoing IRBs, excluding the period of non-attendance at the IEs, but denied the disputed treatment plans as duplicative or unproven.

The applicant was injured in an ATV accident in British Columbia and sought statutory accident benefits under his Ontario automobile insurance policy.

The insurer denied the claim on the basis that an ATV is not an 'automobile' under the SABS.

The arbitrator applied the lex loci delicti principle, finding that British Columbia law governed the incident.

Under British Columbia law, the ATV was not required to be insured under a motor vehicle liability policy.

Consequently, the ATV did not meet the definition of an automobile under the ordinary parlance test, and the incident was not an 'accident' under the SABS.

The application was dismissed.

The insured was injured in a motor vehicle accident and submitted an Application for Accident Benefits (OCF-1) indicating she was retired.

The insurer denied income replacement benefits (IRBs) and non-earner benefits based on the application.

Over two years later, the insured sought mediation for IRBs, arguing the initial denial was invalid because she had not explicitly claimed IRBs.

The Director's Delegate allowed the insurer's appeal, holding that an OCF-1 constitutes a claim for all weekly benefits.

The insurer's denial was valid and triggered the two-year limitation period, rendering the insured's claim statute-barred.

The insurer appealed an arbitrator's decision allowing the insured to proceed to arbitration regarding the stoppage of income replacement benefits despite the expiry of the two-year limitation period.

The Director's Delegate upheld the arbitrator's finding that the Notice of Stoppage (OCF-17) was invalid because it misleadingly indicated that requesting a Designated Assessment Centre (DAC) assessment was a mandatory prerequisite to disputing the stoppage.

Because the notice failed to properly inform the insured of the dispute resolution process, it did not constitute a clear and unequivocal refusal, and the limitation period was never triggered.

The Insurer brought a motion to stay the arbitration proceedings in this and fourteen other cases, arguing that it had commenced a civil action against several rehabilitation facilities for alleged fraud and unjust enrichment.

The Insurer sought a stay pending the outcome of the court action to avoid a multiplicity of proceedings and inconsistent findings.

The Arbitrator applied the RJR-MacDonald test and found that the Insurer failed to establish irreparable harm or that proceeding would constitute an abuse of process.

The motion for a stay was dismissed.

The Insurer brought a motion to stay the applicant's arbitration for statutory accident benefits, along with 14 other similar cases, pending the resolution of a civil action it commenced against several assessment facilities for alleged fraud and unjust enrichment.

The Insurer argued that proceeding with the arbitrations would result in a multiplicity of proceedings and potential inconsistent findings.

The Arbitrator applied the RJR-MacDonald test for a stay of proceedings and found that the Insurer failed to establish that it would suffer irreparable harm or that allowing the cases to proceed would constitute an abuse of process.

The motion for a stay was dismissed.

The Insurer brought a motion to stay the Applicant's arbitration proceeding, along with 14 other similar cases, pending the resolution of a Superior Court action it commenced against several assessment facilities for alleged fraud and unjust enrichment.

The Insurer argued that proceeding at FSCO would result in a multiplicity of proceedings and potential inconsistent findings.

The Arbitrator applied the RJR-MacDonald test and dismissed the motion, finding that the Insurer failed to establish that it would suffer irreparable harm or that proceeding would constitute an abuse of process.

The Arbitrator noted that the court action could take years and the Applicant would be prejudiced by the delay.

The Insurer brought a motion to stay the applicant's arbitration proceeding, along with 14 other similar cases, pending the resolution of a civil action it commenced against several treatment facilities for alleged fraud and unjust enrichment.

The Insurer argued that proceeding with the arbitrations would result in a multiplicity of proceedings and inconsistent findings.

The Arbitrator applied the RJR-MacDonald test and dismissed the motion, finding that the Insurer failed to establish that it would suffer irreparable harm or that allowing the cases to proceed would constitute an abuse of process.

The Arbitrator noted that the civil action could take years to resolve and that the applicant would be prejudiced by the delay.

The Insurer brought a motion to stay the Applicant's claim for statutory accident benefits at FSCO, along with 14 other similar cases.

The Insurer argued that a stay was necessary because it had commenced a civil action against several rehabilitation facilities for alleged fraud and unjust enrichment, and the Applicant's claims relied on services from those facilities.

The Arbitrator dismissed the motion, finding that the Insurer failed to meet the RJR-MacDonald test for a stay.

Specifically, the Insurer did not establish that it would suffer irreparable harm or that allowing the FSCO proceedings to continue would constitute an abuse of process.

The Insurer brought a motion for a stay of proceedings in this and fourteen other cases, arguing that it had commenced a court action against several rehabilitation facilities for alleged fraud and unjust enrichment.

The Insurer sought to stay the FSCO proceedings until the conclusion of its court action to avoid a multiplicity of proceedings and inconsistent findings.

The Arbitrator applied the RJR-MacDonald test and found that the Insurer failed to establish irreparable harm or that proceeding would constitute an abuse of process.

The motion for a stay was dismissed.

The Insurer brought a motion to stay the arbitration proceeding, along with 14 other related cases, pending the resolution of a civil action it commenced against several rehabilitation facilities for alleged fraud and unjust enrichment.

The Insurer argued that a stay was necessary to prevent a multiplicity of proceedings and an abuse of process.

The Arbitrator applied the RJR-MacDonald test and dismissed the motion, finding that the Insurer failed to establish that it would suffer irreparable harm or that allowing the arbitration to proceed would constitute an abuse of process.

The Arbitrator noted that the civil action involved different parties and issues, and that the Insurer could still challenge the credibility of the facilities' evidence in the arbitration.

The Insurer brought a motion to stay the applicant's arbitration for statutory accident benefits, along with 14 other similar cases, pending the resolution of a civil action it commenced against several treatment facilities for alleged fraud and unjust enrichment.

The Insurer argued that proceeding with the arbitrations would result in a multiplicity of proceedings and potential inconsistent findings.

The Arbitrator applied the RJR-MacDonald test and dismissed the motion, finding that the Insurer failed to establish that it would suffer irreparable harm or that allowing the cases to proceed would constitute an abuse of process.

The Arbitrator noted that the civil action could take years to resolve and that the insured persons were not named as defendants in that action.

The insurer brought a motion to stay the FSCO arbitration proceedings of the applicant and fourteen others, arguing that it had commenced a civil action against several rehabilitation facilities for alleged fraud and unjust enrichment.

The insurer sought the stay to avoid a multiplicity of proceedings and inconsistent findings.

The arbitrator applied the RJR-MacDonald test and found that the insurer failed to establish irreparable harm or that proceeding would constitute an abuse of process.

The motion for a stay was dismissed.

The Insurer brought a motion to stay the Applicant's arbitration proceeding, along with 14 other similar cases, pending the resolution of a civil action it commenced against several rehabilitation facilities for alleged fraud and unjust enrichment.

The Insurer argued that proceeding with the arbitrations would result in a multiplicity of proceedings and potential inconsistent findings.

The Arbitrator applied the RJR-MacDonald test and dismissed the motion, finding that the Insurer failed to establish that it would suffer irreparable harm or that proceeding with the arbitrations would constitute an abuse of process.

The Arbitrator noted that the civil action could take years to resolve and that the Applicant would be prejudiced by the delay.

The insurer brought a motion to stay the applicant's claim for statutory accident benefits, along with 14 other similar claims, pending the resolution of a civil action it commenced against several rehabilitation facilities for alleged fraud and unjust enrichment.

The insurer argued that proceeding at FSCO would result in a multiplicity of proceedings and inconsistent findings.

The arbitrator applied the RJR-MacDonald test and dismissed the motion, finding that the insurer failed to establish that it would suffer irreparable harm or that allowing the case to proceed would constitute an abuse of process.

The arbitrator noted that the applicant was not a party to the civil action and would be prejudiced by a delay.

The insurer brought a motion to stay the applicant's arbitration proceeding for statutory accident benefits, along with 14 other similar cases.

The insurer argued that a stay was necessary because it had commenced a civil action against the treatment facilities involved in the claims, alleging fraud and unjust enrichment.

The arbitrator applied the RJR-MacDonald test for a stay of proceedings and found that the insurer failed to establish that it would suffer irreparable harm or that allowing the arbitration to proceed would constitute an abuse of process.

The motion for a stay was dismissed.

The Insurer brought a motion to stay 15 FSCO arbitration proceedings, including this one, pending the resolution of a Superior Court action it commenced against several assessment facilities for alleged fraud and unjust enrichment.

The Insurer argued that proceeding at FSCO would result in a multiplicity of proceedings and inconsistent findings.

The Arbitrator applied the RJR-MacDonald test and dismissed the motion, finding that the Insurer failed to establish that it would suffer irreparable harm or that proceeding at FSCO would constitute an abuse of process.

The Arbitrator noted that the insured persons were not named as defendants in the court action and that staying their accident benefits claims would cause presumed prejudice.