Dr. Doxey

The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits (IRBs) after the insurer terminated them.

The arbitrator found the applicant lacked credibility, noting inconsistencies between her testimony, her reported pain, and the extensive medical imaging which showed no abnormalities.

Multiple independent medical examinations concluded there was no physical or psychological barrier preventing her return to work.

The arbitrator held that the applicant failed to prove she suffered a substantial inability to perform her pre-accident employment as a personal support worker, nor did she meet the post-104 week test of a complete inability to engage in suitable employment.

The claims for IRBs and interest were dismissed, and the insurer was awarded its expenses.

Following a jury verdict in a pedestrian–motor vehicle accident action, the court was asked to determine the quantum and apportionment of the successful plaintiff’s costs.

The uninsured driver was found 70 per cent liable, a commercial host 5 per cent liable, and the plaintiff 25 per cent contributorily negligent.

The plaintiff’s insurer defended the action under uninsured and underinsured coverage.

The court exercised its discretion under s. 131 of the Courts of Justice Act and rule 57.01 of the Rules of Civil Procedure to fix costs at $635,500 on a partial indemnity basis and ordered that the costs be borne equally by the commercial host and the insurer.

The court held that strict apportionment based on liability percentages was inappropriate in the circumstances and that fairness justified an equal allocation.

During jury deliberations in a motor vehicle accident trial, the defendant brought a motion to determine whether the plaintiff's claims were barred by the statutory threshold under Bill 59 of the Insurance Act.

The court reviewed the medical evidence and the plaintiff's testimony regarding her chronic pain, fatigue, and psychological impairments.

Applying the test from Meyer v. Bright, the court found that the plaintiff had sustained a permanent serious impairment of an important physical, mental, or psychological function.

The defendant's motion was dismissed.

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

An arbitrator initially found the termination improper under section 37 of the SABS and ordered interim benefits paid until proper notice was given.

After the insurer complied, the arbitrator found the applicant did not meet the substantive test for disability and dismissed her claim for ongoing benefits, but also ruled she was not required to repay the interim benefits paid prior to the proper termination notice.

Both parties appealed.

The Director's Delegate dismissed both appeals, finding the arbitrator was not functus officio after the interim order, did not err in rejecting the applicant's medical evidence, and correctly concluded that requiring repayment of benefits paid before a proper termination notice would render the stoppage provisions meaningless.

The plaintiff was injured in two separate motor vehicle accidents and brought actions against both drivers.

The trial judge struck the jury due to the complexity of the plaintiff's medical history and found the plaintiff 100% liable for the first accident, but the defendant Hayik 100% liable for the second.

The trial judge awarded damages and made a Sanderson order requiring Hayik to pay the successful first defendant's costs.

On appeal, the Court of Appeal upheld the trial judge's decisions on striking the jury, liability, and damages, but set aside the Sanderson order, finding that the two actions were independent and the plaintiff had the ability to pay the costs of the unsuccessful action.

The applicant was injured in a rear-end motor vehicle collision and claimed income replacement benefits for fibromyalgia and psychological impairments.

The insurer terminated benefits after June 24, 2003.

The arbitrator found that the applicant's physical complaints were not objectively verifiable and preferred the insurer's psychological assessment, which concluded she was not substantially disabled from performing the essential tasks of her employment as a computer sales representative.

The application for arbitration was dismissed.

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

The insurer subsequently terminated his weekly income replacement benefits.

The arbitrator found that the insurer unreasonably withheld benefits by ignoring overwhelming medical evidence of the applicant's ongoing cognitive impairment and relying on flawed reports that supported termination.

The arbitrator characterized the insurer's conduct as wilful blindness.

The applicant was awarded $64,177 in arrears of income replacement benefits, $48,096 in interest, a special award of $39,295 under s. 282(10) of the Insurance Act, and $42,908 in arbitration expenses.

The applicant was seriously injured in a motor vehicle accident and subsequently developed a severe addiction to crack cocaine.

He applied for catastrophic impairment status, attendant care benefits, and income replacement benefits.

The insurer argued the addiction pre-dated the accident and was not causally linked.

The arbitrator found that the applicant was a recreational user prior to the accident but the severe addiction was a direct result of the accident, likely due to a mild traumatic brain injury and an attempt to self-medicate.

The arbitrator concluded the applicant suffered a Class 4 marked impairment under the AMA Guides, meeting the definition of catastrophic impairment.

The applicant was awarded ongoing attendant care benefits of $5,056.80 per month and income replacement benefits of $256 per week.

The applicant was severely traumatized in a motor vehicle accident and received extensive psychological treatment for post-traumatic stress disorder.

The insurer terminated payments for the treatments, arguing they were no longer reasonable in frequency or duration.

The arbitrator found that while ongoing psychotherapy was appropriate, the frequency of two to three visits per week over several years was excessive.

The insurer was ordered to pay 50 per cent of the outstanding accounts.

Additionally, the arbitrator granted a special award of $2,500 because the insurer violated the 'pay pending dispute' provision by withholding payments while the dispute was ongoing.