Dr. Neville Doxey

The insurer appealed an Arbitrator's decision finding the insured catastrophically impaired, entitled to post-104 week income replacement benefits (IRBs), and awarding a special award of 35% for unreasonably withholding benefits.

The insurer argued the Arbitrator reversed the onus of proof and failed to properly consider causation, specifically the insured's pre-existing psychological issues stemming from childhood abuse.

The Director's Delegate dismissed the appeal, finding the Arbitrator properly applied the 'but for' test, correctly weighed the medical evidence, and reasonably concluded the insurer's reliance on flawed and inconclusive reports justified the special award.

The plaintiffs brought a motion to compel production of a defence vocational assessment report following an examination of the injured plaintiff conducted by a vocational rehabilitation expert retained by the defendant municipality.

The defendant refused production, arguing the assessor was not a "health practitioner" within the meaning of s.105 of the Courts of Justice Act and therefore Rule 33 of the Rules of Civil Procedure did not require disclosure.

The court held that examinations conducted on consent are analogous to court‑ordered examinations under Rule 33.08 and therefore trigger the mandatory disclosure obligation in Rule 33.06.

The court further held that a party cannot avoid production simply by asserting that the assessor is not a statutory health practitioner or by electing not to rely on the report at trial.

The defendant was ordered to produce the report forthwith in the interests of fairness and full disclosure.

The applicant was injured in a minor rear-end motor vehicle accident and received statutory accident benefits.

The insurer terminated her income replacement benefits 11 months post-accident based on incomplete and deficient insurer examination reports.

The applicant sought ongoing income replacement benefits, interest, and a special award.

The arbitrator found that the insurer's termination of benefits was premature and unreasonable, entitling the applicant to benefits up to the 104-week mark and a special award of $7,500.

However, the arbitrator found the applicant was not entitled to benefits beyond 104 weeks, as she exaggerated her physical and psychological impairments, failed to make reasonable efforts to return to work, and her pre-accident employer was willing to accommodate her return.

The insurer brought a motion to stay the arbitration proceeding until the applicant attended a psychiatric assessment scheduled under section 42 of the Statutory Accident Benefits Schedule.

The applicant had been injured in a motor vehicle accident and suffered from chronic pain.

The insurer requested the assessment to respond to a psycho-vocational report obtained by the applicant.

The arbitrator found that the insurer had ample opportunity to investigate the applicant's chronic pain earlier and that the late request was primarily for hearing preparation rather than adjusting the claim.

The motion was denied.

The applicant was injured in a motor vehicle accident while riding his bicycle.

The insurer paid income replacement benefits for 104 weeks but terminated them, arguing the applicant did not meet the more stringent test of complete inability to engage in suitable employment.

The arbitrator found the applicant, who was functionally illiterate in English and had a history of heavy physical labour, suffered from chronic pain and psychological impairments caused by the accident.

The arbitrator rejected the insurer's expert evidence that the applicant was malingering, finding instead that he was completely disabled from working.

The applicant was awarded ongoing income replacement benefits.

However, his claim for a multidisciplinary pain management program was dismissed as he failed to prove it was reasonable and necessary, given a previous similar program had not yielded further recovery.

The applicant, who was self-represented, sought the appointment of an amicus curiae and an order for interim benefits as conditions for adjourning her arbitration hearing for statutory accident benefits.

The insurer had requested the adjournment pending a judicial review on a related procedural issue.

The arbitrator granted the request to appoint a lawyer as a 'friend of the court' to assist the unrepresented applicant.

Furthermore, the arbitrator ordered the insurer to pay interim income replacement benefits of $231.81 per week as a condition of the adjournment, finding that the applicant had demonstrated a serious issue to be tried regarding her disability and that the interim benefits would address the prejudice caused by the delay.

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

The insurer terminated benefits based on independent medical examinations and a DAC report suggesting the applicant could work.

The arbitrator found the applicant suffered significant cognitive impairments rendering him competitively unemployable, characterizing his post-accident work at his brother's video store as a sheltered workshop.

The arbitrator ordered the reinstatement of income replacement benefits at $340.53 per week and found the insurer liable for a special award for unreasonably withholding benefits by relying on flawed reports that ignored the overwhelming evidence of the applicant's disability.

The appellant, who claimed to suffer from a traumatic brain injury following a motor vehicle accident, appealed an Arbitrator's preliminary order denying her request to have a friend act as a 'facilitator' during her accident benefits arbitration.

The Director of Arbitrations dismissed the appeal, finding no error of law in the Arbitrator's conclusion that the appellant had the mental capacity to conduct her own case.

The Director reviewed conflicting medical evidence and concluded that the proposed facilitator's role blurred the line between communication assistance and representation, which is restricted under the Insurance Act.

The applicant was injured in a motor vehicle accident and sought payment from her insurer for a catastrophic impairment assessment report and a psycho-vocational assessment.

The insurer denied payment, arguing the reports were not reasonable or necessary.

The arbitrator found that both assessments were reasonable and necessary under section 24 of the Statutory Accident Benefits Schedule.

The catastrophic impairment report was required to complete the application for determination of catastrophic impairment, and the psycho-vocational report was necessary to facilitate the applicant's reintegration into the labour market.

The insurer was ordered to pay the costs of both reports.

The applicant, who suffered a catastrophic brain injury when struck by a car as a pedestrian, applied for ongoing income replacement benefits beyond the 104-week mark.

The insurer terminated benefits based on a DAC assessment concluding the applicant could work.

The arbitrator found the DAC assessment inherently flawed and preferred the evidence of the applicant's treating practitioners, which demonstrated that despite numerous attempts to work, the applicant's cognitive, behavioural, and physical deficits rendered him completely unable to engage in suitable employment.

The arbitrator ordered the insurer to pay ongoing income replacement benefits with interest, declined to reopen the hearing for new evidence, and gave notice that a special award for unreasonably withholding benefits was being considered.

The applicant in a statutory accident benefits dispute served a late psychovocational assessment report shortly before the arbitration hearing.

The insurer brought a motion seeking an order that the applicant attend a psychovocational assessment by its own expert to respond to the late report.

The arbitrator granted the motion, holding that fairness and the arbitrator's duty to control the hearing process required that the insurer be given a reasonable opportunity to respond, which included an independent assessment of the applicant.

The applicant, a 47-year-old welder with limited education and functional illiteracy, was injured in a motor vehicle accident and could no longer perform his pre-accident job due to chronic neck and back pain.

He found alternative employment as a car jockey earning significantly less.

The insurer terminated his income replacement benefits at the 104-week mark, arguing he could perform other skilled trades or driving jobs.

The arbitrator found that the applicant suffered a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience, preferring the applicant's psycho-vocational evidence that he lacked the literacy and physical capacity for the insurer's suggested occupations.

The applicant was awarded ongoing income replacement benefits and costs for certain assessments, but claims for housekeeping, a spinal corset, and a special award were dismissed.