Eric K. Grossman

The applicant was injured in a motor vehicle accident and claimed income replacement and rehabilitation benefits.

The insurer terminated benefits, arguing the applicant could perform his pre-accident work as a masonry apprentice.

The arbitrator found that the applicant suffered a substantial inability to perform his essential tasks due to chronic pain resulting from the accident.

The arbitrator awarded ongoing income replacement benefits, rehabilitation benefits for retraining, and a $7,500 special award against the insurer for unreasonably withholding benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for ongoing chiropractic, physiotherapy, and massage treatments, as well as the costs of various assessments.

The insurer disputed the ongoing treatments and assessments.

The arbitrator found that the initial treatments were reasonable and necessary, but denied ongoing treatments due to a lack of medical evidence supporting their therapeutic benefit.

The arbitrator allowed the costs of some assessments but reduced the amounts claimed.

The arbitrator denied the applicant's request for a special award, finding the insurer's actions reasonable given the applicant's lack of cooperation.

Due to the poor conduct of the applicant's representative, the applicant was ordered to pay the insurer's expenses for a half-day of an expert witness's attendance.

The applicant sought payment for various medical and rehabilitation expenses following a motor vehicle accident.

The insurer denied the claims, arguing in part that the referring physician had an undisclosed conflict of interest regarding one of the treatment centres.

The arbitrator found that while the physician failed to disclose his ownership of the centre, the insurer had not previously approved the treatment plan, meaning the automatic exclusion under section 38(20) of the Schedule did not apply.

However, the arbitrator scrutinized the medical necessity of the treatments, awarding partial costs for acupuncture, the family physician's accident-related services, and certain diagnostic testing, while denying costs for structured physiotherapy.

The arbitrator also awarded overdue interest and dismissed the insurer's claim for repayment of disability benefits due to lack of proper notice.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated them.

The applicant applied for arbitration.

Prior to the hearing, the applicant advised he had been laid off due to his injuries, prompting the insurer to request an Insurer's Examination (IE) with a new doctor.

The applicant refused to attend, arguing the request was unjustified and prejudicial.

On a preliminary motion, the arbitrator held that the insurer's request was reasonably necessary given the significant change in the applicant's employment status.

The arbitration was adjourned pending the applicant's attendance at the IE.

The applicant sought statutory accident benefits following two motor vehicle accidents in June 1995 and July 1996.

The insurers disputed his claims for income replacement benefits, supplementary medical expenses, rehabilitation expenses, attendant care benefits, other pecuniary losses, and housekeeping expenses.

The first insurer also sought repayment of benefits.

The arbitrator found that the applicant was entitled to income replacement benefits from the second insurer for a specific period, as well as certain supplementary medical expenses, attendant care benefits, and other pecuniary losses.

The claims for rehabilitation and housekeeping expenses were dismissed.

The arbitrator also ordered the applicant to repay the first insurer for a period of income replacement benefits due to misrepresentation regarding his pre-accident abilities and receipt of short-term disability benefits.

The applicant sought ongoing statutory accident benefits following a motor vehicle accident, claiming physical and psychological disabilities prevented him from working as a superintendent.

The arbitrator found that the applicant suffered from chronic fatigue and psychological issues prior to the accident, stemming from previous torture in Turkey, which had already impaired his job performance.

Medical opinions supporting the applicant's claim were rejected because the experts were unaware of his pre-accident condition.

The arbitrator concluded the accident did not significantly contribute to the applicant's disability, denying further weekly benefits and the insurer's claim for repayment, but awarded reimbursement for a medical report.

The applicant was injured in two motor vehicle accidents in 1996 and sought statutory accident benefits for caregiver, housekeeping, and attendant care expenses.

The insurer terminated caregiver benefits and denied attendant care, alleging the applicant was malingering and exaggerating her symptoms, pointing to a pre-existing slip-and-fall injury and substance abuse issues.

The arbitrator found that the applicant sustained psychological and physical injuries in the accidents, leading to disabling psychological and chronic pain conditions.

The arbitrator rejected the insurer's malingering argument, finding the applicant's substance abuse was a misguided effort to control pain.

The applicant was awarded caregiver benefits from February 4, 1997, and attendant care benefits for a limited period, but her claim for additional housekeeping benefits was denied.

The insurer appealed an arbitrator's interim order requiring it to produce all adjuster's notes prior to June 1, 1999, except for those made during a prior mediation.

The insured argued the notes were relevant because she was claiming a special award for unreasonable denial of benefits.

The Director's Delegate allowed the appeal in part, finding that a claim for a special award does not automatically entitle an insured to the complete file.

The production order was narrowed to the period between when the insurer first received notice of the disputed claims and the commencement of the mediation.

The appellant appealed an arbitration order that dismissed his claims for income replacement benefits and ordered him to repay benefits previously received due to misrepresentation.

The arbitrator found that the appellant had lied about his pre-accident employment and medical history.

The Director's Delegate dismissed the appeal, finding no error in the arbitrator's assessment of the evidence and concluding that the appeal lacked merit.

The appellant was injured in a motor vehicle accident and claimed weekly income benefits for a period of disability related to a shoulder injury.

The arbitrator awarded benefits for a portion of the claimed period but denied benefits from February 2, 1994 to July 21, 1994, finding the appellant was not disabled during that time.

On appeal, the Director's Delegate found that the arbitrator erred in his assessment of the evidence, including the appellant's work duties, his receipt of unemployment insurance benefits, and the medical reports from treating specialists.

The Director's Delegate substituted her own decision, finding the appellant was disabled during the disputed period and entitled to weekly income benefits.

The applicant sought income replacement benefits following two motor vehicle accidents.

The insurer had paid some benefits but terminated them after discovering the applicant was not disabled.

At the hearing, evidence revealed the applicant had been working continuously and earning more than the benefit amount, and had wilfully misrepresented his employment status.

The arbitrator dismissed the claim for benefits.

The insurer's claim for repayment of benefits was denied because it failed to provide the required statutory notice under section 47 of the Schedule.

However, the arbitrator found the application frivolous and an abuse of process, ordering the applicant to pay a $3,000 assessment to the insurer under section 282(11.2) of the Insurance Act, plus the expenses of the arbitration.

The applicant sought income replacement benefits (IRBs) and other expenses following a 1995 motor vehicle accident.

The insurer reduced and then terminated the IRBs, and sought repayment of all benefits paid, alleging fraud.

The arbitrator found that the applicant had fabricated his employment history, concealed a previous disabling car accident, and grossly exaggerated his injuries, with medical evidence suggesting malingering.

The applicant's claims were dismissed in their entirety.

The arbitrator ordered the applicant to repay $37,879 in IRBs and rehabilitation expenses obtained through fraudulent misrepresentation, and awarded the insurer its arbitration expenses and assessment fee, finding the application frivolous and an abuse of process.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until they were terminated by the insurer.

The applicant alleged that an application for arbitration was mailed within the two-year limitation period but was lost by the postal service or the Commission.

The arbitrator found that the applicant failed to provide documentation proving the Commission received the application before the limitation period expired.

As arbitrators have no jurisdiction to extend the limitation period, the application was dismissed as out of time.

The applicant sought interim income replacement benefits, a Loss of Earning Capacity offer, and a special award following a motor vehicle accident.

The insurer had terminated benefits after the applicant was convicted of driving without insurance.

Although the applicant's conviction was stayed pending an arbitration to determine if he had a valid insurance policy with another insurer, the arbitrator found that the stay alone did not entitle him to interim benefits.

The arbitrator concluded that the exclusion clause for driving without insurance remained applicable until the appeal of the conviction was concluded.

The motion for interim benefits and other relief was dismissed.

The insurer appealed an arbitration decision awarding the respondent additional weekly income benefits and a special award.

The insurer argued the arbitrator erred in law by admitting oral testimony from the respondent's medical expert that went beyond his written reports, causing unfair surprise.

The Director's Delegate dismissed the appeal, finding that the expert's testimony regarding the respondent's medication and physical limitations was a reasonable amplification of his reports and the medical record.

Furthermore, the insurer's counsel did not object to the testimony at the hearing, chose to cross-examine the expert, and did not request an adjournment to call responding evidence, thereby waiving the right to claim procedural unfairness.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from Kingsway, which denied coverage claiming the policy was cancelled.

The applicant then applied to Pafco, which paid some benefits but asserted Kingsway was the responsible insurer.

The applicant commenced arbitration against Kingsway at the Financial Services Commission of Ontario (FSCO).

Kingsway brought a motion to dismiss the arbitration, arguing that the dispute was essentially a priority dispute between insurers governed by O. Reg. 283/95, which must be resolved through private arbitration.

The arbitrator agreed, finding that the core issue was which insurer was responsible for paying benefits, not the applicant's entitlement to specific benefits.

Therefore, the issue of whether a valid policy existed between the applicant and Kingsway was outside the jurisdiction of a FSCO arbitrator.

The applicant sought ongoing weekly income benefits and medical-rehabilitation expenses following a 1991 motor vehicle accident.

The insurer had terminated benefits in 1995 and sought repayment of overpaid amounts.

The arbitrator found that the applicant, with the assistance of his doctor, had shifted responsibility for a pre-existing back condition to the minor 1991 accident.

Video surveillance demonstrated the applicant engaging in vigorous exercise inconsistent with his claimed disability.

The arbitrator dismissed the claims for ongoing benefits and expenses, determined the correct quantum of weekly benefits based on pre-accident income, and ordered the applicant to repay $66,967.56 in overpaid benefits plus interest, finding he had deliberately misled the insurer.

The appellant insurer appealed an arbitration decision finding it responsible for paying accident benefits to the injured respondent.

The injured respondent was a passenger in a vehicle insured by the respondent insurer, but was the spouse of a named insured under the appellant's policy.

The Director's Delegate held that the injured respondent qualified as an 'insured person' under the appellant's policy because she was an occupant of 'any other automobile'.

Under the priority rules, she was required to claim benefits from her spouse's insurer.

The appeal was dismissed.

The Director's Delegate also held there was no jurisdiction to award appeal expenses between insurers.

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

The insurer terminated benefits and the applicant applied for arbitration.

The insurer moved to dismiss or stay the proceeding because the applicant failed to comply with pre-hearing production orders and failed to participate in pre-hearing discussions.

The arbitrator found that the applicant abused the Commission's process and constructively withdrew his application.

The applicant was ordered to pay the insurer's $2,000 arbitration assessment as a precondition to proceeding with the hearing, failing which the application would be deemed withdrawn.

The applicant claimed statutory accident benefits for income replacement following two motor vehicle accidents in 1995 and 1996.

The insurer paid benefits for a period but subsequently terminated them.

The arbitrator found the applicant to be an unreliable historian who concealed prior workplace and motor vehicle injuries from his medical assessors.

Preferring the objective medical evidence of the insurer's experts, the arbitrator concluded that the applicant's ongoing shoulder and back problems were chronic pre-existing conditions and that he was no longer disabled as a result of the motor vehicle accidents.

The claim for further income replacement benefits was dismissed, but the applicant was awarded one-half of his arbitration expenses.