Ian D. Kirby

The appellant's representative, a non-lawyer acting for an assessment facility, pursued an appeal of an arbitration decision regarding unpaid assessment accounts without the appellant's specific knowledge.

The appeal was dismissed.

The insurer sought its appeal expenses.

The Director of Arbitrations held that while the representative's conduct was disgraceful, the tribunal lacked jurisdiction to order costs against a non-party.

As the named party who had signed broad authorizations allowing the facility to act as her agent, the appellant was held responsible for the insurer's appeal expenses, fixed at $1,500.

Following a finding that the parties had reached a binding settlement of all claims arising from a motor vehicle accident, the insurer sought its arbitration expenses.

The arbitrator found that the insurer was fully successful and that the arbitration was unnecessarily prolonged by the insured's manifestly unfounded attempt to resile from the settlement.

The insured was ordered to pay the insurer's arbitration expenses in the amount of $2,004.65.

Following an arbitration where the insured was largely unsuccessful in claiming income replacement and non-earner benefits, the insurer sought its expenses.

The arbitrator found that the insured's claim for income replacement benefits was manifestly unfounded and that his representative's conduct prolonged and hindered the proceeding.

The insured was ordered to pay two-thirds of the insurer's arbitration expenses, fixed at $6,428.10.

The applicant was partially successful in her claim for statutory accident benefits, recovering less than the insurer's pre-hearing settlement offer.

The insurer argued it should be awarded its expenses because its offer exceeded the recovery.

The arbitrator rejected a strict results-based approach but noted the applicant had sufficient guidance from prior decisions to evaluate the offer.

The arbitrator exercised discretion to award the applicant half of her arbitration expenses, totaling $1,500.

The applicant sought income replacement benefits, non-earner benefits, and medical expenses following a motor vehicle accident.

The arbitrator found that the applicant fabricated his pre-accident employment and was therefore not entitled to income replacement benefits.

The claim for non-earner benefits was dismissed as the applicant failed to prove a complete inability to carry on a normal life.

The arbitrator also held that the applicant's failure to attend a Designated Assessment Centre (DAC) barred him from recovering medical expenses incurred after the scheduled assessment date, but he was entitled to reasonable and necessary expenses incurred prior to that date.

The applicant, a pedestrian injured in a motor vehicle accident, sought statutory accident benefits including a non-earner benefit, medical benefits for physiotherapy, transportation expenses, and prescription costs.

The arbitrator dismissed the claim for a non-earner benefit, finding that the applicant was not continuously prevented from engaging in substantially all of her pre-accident activities beyond six months post-accident.

The claim for physiotherapy and transportation expenses was partially granted, with the arbitrator finding that treatment up to the date of the DAC assessment and an additional six weeks of therapy were reasonable and necessary for pain relief and functional improvement.

The claim for prescription expenses was dismissed due to a lack of evidence.

Interest was awarded on the amounts found owing.

The applicant was injured in a rear-end motor vehicle accident and sought payment for 99 active rehabilitation treatment sessions and four treatment plans.

The insurer denied the treatment plans, arguing the duration and cost were excessive.

The arbitrator found that the applicant required supervised active rehabilitation to return to his pre-accident heavy labour job and that the duration of the program was reasonable.

However, the arbitrator reduced the hourly rate from the claimed $150 to $60 per session, noting the treatment was provided in a group setting rather than one-on-one.

The arbitrator also awarded interest on overdue payments and a $1,000 special award, finding the insurer unreasonably withheld payments by unilaterally reducing the rate for approved treatment without a valid basis.

The appellant abandoned his appeal before the Financial Services Commission of Ontario after his representative was excluded from the proceeding for obstructive conduct during a bias motion.

The Director's Delegate dismissed the appeal and confirmed the arbitrator's order.

The appellant was ordered to pay the respondent's appeal expenses of $1,507.50 due to the frivolous and vexatious nature of the bias motion and the representative's conduct.

The insured suffered catastrophic injuries in a motor vehicle accident and was placed in a long-term care facility.

A dispute arose over whether her automobile insurer was required to pay her chronic care accommodation co-payments under the SABS-1994.

The arbitrator ordered the insurer to pay the full co-payments and awarded a $10,000 special award.

On appeal, the Director's Delegate varied the order, finding that while the insurer is responsible for the co-payments, the SABS secondary payer rule requires the insured to apply for reasonably available partial or full exemptions under the Health Insurance Act to reduce the amount payable.

The special award was revoked because the insurer's delay was not unreasonable given the insured's failure to pursue these exemptions.

The Delegate also revoked the arbitrator's award for past attendant care and support worker services that were never actually incurred.

In a pre-hearing decision regarding a claim for statutory accident benefits, the insurer sought a remedy for the applicant's repeated failure to comply with undertakings and orders to produce medical and financial records.

The arbitrator declined to dismiss the proceeding but found that the applicant's non-compliance warranted a cost consequence.

The applicant was denied her expenses for the pre-hearing process and ordered to pay the insurer $500 in expenses, payable as an offset against any future award.

Following an arbitration where the insured was unsuccessful in claiming a medical benefit, the insurer sought its expenses.

The arbitrator considered the criteria under the Dispute Resolution Practice Code, including the insurer's offer to settle and the insured's lack of success and credibility issues.

Balancing these factors with the need to maintain accessibility to the dispute resolution system for individuals of modest means, the arbitrator awarded the insurer one-third of its assessed expenses, totaling $3,179.55 plus GST.

The appellant appealed an arbitration decision regarding statutory accident benefits.

During the appeal, the appellant's non-lawyer agent brought a motion alleging institutional bias against the Financial Services Commission of Ontario.

The agent repeatedly failed to comply with procedural orders, made incoherent submissions, and demonstrated open contempt for the tribunal.

The Director's Delegate ordered the agent excluded from the proceeding pursuant to section 23(3) of the Statutory Powers Procedure Act, finding him incompetent to properly represent the appellant and failing to comply with the duties of an advocate.

Allstate appealed an arbitration order awarding the respondent $3,655.41 for rehabilitation expenses at a clinic.

Allstate argued the arbitrator erred in law by classifying the kinesiology treatment as 'one-to-one' and allowing an $80 hourly rate, and by finding the clinic's assessment fees were not recoverable from OHIP.

The Director's Delegate dismissed the appeal, finding no error of law in the arbitrator's conclusion that the $80 hourly fee was a reasonable and necessary expense given the respondent's age and complex medical history.

The Delegate also upheld the finding that the specific assessment fees were payable by the insurer, as the arbitrator was entitled to accept evidence that the clinic could not bill OHIP for them.

The applicant was struck by a vehicle and sustained a fractured tibia.

She sought statutory accident benefits for chiropractic and active rehabilitation therapy.

The insurer disputed the reasonableness of the treatment and the fees charged by the clinics.

The arbitrator found that the treatment was reasonable and necessary to assist in the applicant's recovery, but determined that the frequency and duration of the treatments, as well as the fees charged by the clinics, were excessive.

The arbitrator reduced the compensable sessions and the hourly rates, awarding $1,080.50 for chiropractic expenses and $635 for rehabilitation expenses, plus interest.

Following an arbitration award for chiropractic and rehabilitation expenses, the applicants sought assessment of their arbitration expenses totaling $50,791.66.

The insurer disputed the amount, arguing the legal fees and expert disbursements were excessive.

The arbitrator assessed the expenses at $42,493.76, applying a 4:1 ratio for preparation to hearing time but reducing the fees due to the applicants' minimal success and the self-serving involvement of the rehabilitation clinic.

The arbitrator also determined that interest on the awarded benefits was payable to the husband from the date of the arbitration award (due to his failure to attend a DAC assessment) and to the wife from 14 days after the DAC assessment report.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the insurer.

After two years, the insurer transitioned the applicant to loss of earning capacity benefits (LECBs).

The insurer later attempted to argue that the applicant's disability was unrelated to the accident.

The arbitrator held that the insurer was precluded from raising a causation defence because it had paid IRBs to the 104-week mark without protest and had already begun paying LECBs.

The arbitrator determined the applicant's residual earning capacity at various stages, awarding LECBs based on a 30-hour work week initially, and a 20-hour work week after the three-year review.

The arbitrator also awarded supplementary medical expenses and a $3,000 special award for the insurer's unreasonable refusal to fund psychological counselling.

Allstate sought to appeal an arbitrator's preliminary decision that collateral benefits were not available to the respondent, Mr. Torok, because his application to the collateral insurer was out of time.

The Director's Delegate rejected the appeal pursuant to Rule 46.2 of the Dispute Resolution Practice Code, which generally prohibits appeals of preliminary orders until all issues are finally decided.

The Delegate found that the appeal was not compelling on its face, involved factual disputes, and would likely delay the scheduled entitlement hearing, causing prejudice to the respondent.

The applicant was injured in a motor vehicle accident and sought payment for exercise therapy under the Statutory Accident Benefits Schedule.

The insurer denied the claim, arguing the treatment was not reasonable and necessary.

The arbitrator found that the applicant had pre-existing shoulder issues and lacked credibility regarding his medical history.

Relying on expert medical assessments, the arbitrator concluded the applicant had regained almost full mobility prior to the disputed therapy and did not have an impairment requiring the treatment.

The claims for medical benefits and a special award were dismissed.

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

Prior to the arbitration hearing, the parties engaged in settlement discussions.

The insurer argued that a binding oral agreement was reached to fully and finally settle all claims, which was confirmed in writing the next day.

The applicant's paralegal representative argued the amount discussed was merely a proposal and no binding agreement was formed.

The arbitrator found the insurer's evidence more credible, concluding that an unconditional oral agreement was reached and confirmed in writing in compliance with the Settlement Regulation.

As the applicant failed to rescind the agreement within the statutory two-day cooling-off period, the settlement was binding and the arbitration was dismissed.

The applicant was injured in a motor vehicle accident and sought payment from her insurer for a multidisciplinary assessment, including a medical assessment and a Functional Abilities Evaluation (FAE), after the insurer denied further treatment based on a prior Designated Assessment Centre (DAC) report.

The arbitrator found that the medical assessment was a reasonable expense as it provided necessary treatment recommendations that the DAC report lacked.

However, the FAE was deemed unreasonable as it duplicated a recent assessment without justification.

The arbitrator dismissed the applicant's claim for a special award, finding the insurer's conduct did not amount to unreasonably withholding benefits.

Due to the applicant's representative's unfounded allegations of bias and obstructive conduct, no expenses were awarded to the applicant despite her partial success.