Helen Donata Kohner Friedman

The insurer brought a motion to dismiss or stay the arbitration proceeding on the grounds that the applicant had commenced both an arbitration and a Superior Court action for different benefits arising from the same motor vehicle accident and the same failed mediation.

The arbitrator held that section 281 of the Insurance Act, consistent with the rule against multiple proceedings, requires an insured person to choose a single forum for all issues in dispute arising from a single mediation.

The arbitration was stayed pending the outcome of the court case, with leave for the applicant to amend her application to include all issues if she chooses to proceed in arbitration.

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

The parties settled the substantive issues, with the insurer agreeing to pay $5,350 for income replacement, attendant care, and housekeeping benefits.

The only remaining issue was entitlement to the expenses of the arbitration proceeding.

The arbitrator considered the criteria under section 12 of Ontario Regulation 664 and found that success was mixed and both parties could have avoided the proceeding by acting reasonably from the outset.

The arbitrator ordered that each party bear their own expenses.

The applicant sought to amend a pre-hearing report to remove the issues of quantum and repayment of income replacement benefits, arguing they were not part of her original application for arbitration.

The arbitrator dismissed the motion, holding that under section 282(3) of the Insurance Act, the arbitrator must determine all issues in dispute, whether raised by the insured or the insurer.

The issues of quantum and repayment were found to be genuine disputes that naturally flowed from the applicant's claim for entitlement, and their inclusion would prevent multiple proceedings.

The applicant was injured in a motor vehicle accident and applied for income replacement benefits (IRBs).

The insurer denied the claim, arguing the applicant was neither employed at the time of the accident nor employed for 26 of the 52 weeks preceding it.

The arbitrator found that while the applicant was not employed at the time of the accident, his ongoing relationship with his union's hiring hall constituted continuous employment for the requisite 26 weeks.

Alternatively, the arbitrator held that working part of a week counts as a full week of employment under the Schedule.

The applicant was awarded IRBs and interest, but his claim for a special award was dismissed as the insurer's denial was based on a novel legal interpretation rather than unreasonable conduct.

The applicant was injured in a motor vehicle accident and diagnosed with a Grade II Whiplash-Associated Disorder (WAD II).

The insurer terminated her income replacement benefits after 16 weeks, relying on section 5(2)(e) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant also suffered a psychological impairment resulting from the accident, which excluded her impairment from the Grade II Whiplash Guideline.

Consequently, section 5(2)(e) did not preclude her from receiving income replacement benefits beyond 16 weeks.

The applicant sought medical, caregiver, and housekeeping benefits following two motor vehicle accidents.

Her claims were dismissed at the main arbitration hearing.

The insurer sought its arbitration expenses based on its success.

The applicant argued that a preliminary issue was novel and that she had made an offer to settle on the eve of the hearing.

The arbitrator found that the offer to settle was open for only 17 minutes and gave it no weight.

The arbitrator also found that the applicant's claim raised fundamental questions from the outset that remained unanswered.

The applicant was ordered to pay the insurer's arbitration expenses, assessed at $13,864.45.

The applicant claimed caregiver and housekeeping benefits following two motor vehicle accidents.

The insurer disputed the claims, relying on surveillance evidence and inconsistencies in the applicant's statements regarding the identity of the service providers and the services rendered.

The arbitrator found significant unresolved conflicts in the evidence and noted the applicant's failure to call the alleged caregiver to testify.

The arbitrator concluded the applicant failed to establish on a balance of probabilities that she incurred the claimed expenses.

The claims for benefits and interest were dismissed.

The insurer's claim for an assessment award was also dismissed as the statutory authority for such awards had been repealed.

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

The insurer requested a Designated Assessment Centre (DAC) assessment and required the applicant to sign an OCF-14 form to release health information.

The applicant failed to provide the signed form for 28 months.

The arbitrator held that this unreasonable delay constituted a failure to make herself reasonably available for the assessment under s. 43(2) of the Statutory Accident Benefits Schedule.

Consequently, under s. 50(c), the Financial Services Commission of Ontario lacked jurisdiction to mediate or arbitrate the claim for the disputed medical benefits.

The applicant sought income replacement benefits, medical benefits for physiotherapy and massage therapy, and the cost of various assessments following a motor vehicle accident.

The arbitrator dismissed all claims, finding the applicant entirely lacking in credibility due to numerous contradictions regarding his pre-accident health, employment duties, living arrangements, and the accident itself.

Surveillance evidence and independent medical examinations demonstrated significant symptom magnification and inconsistent effort.

The arbitrator concluded the applicant did not suffer a substantial inability to perform his employment tasks and that the claimed medical treatments and assessments were not reasonable or necessary.