Jane Cvijan

The applicant was injured in a motor vehicle accident when she hit her head on a streetcar.

She applied for non-earner benefits, attendant care benefits, housekeeping benefits, and the cost of medical assessments.

The arbitrator found that the applicant did not suffer a complete inability to carry on a normal life, as she continued to travel, live independently, and engage in social activities, and therefore denied the non-earner benefits.

The arbitrator awarded $1,560.97 for attendant care services (hair and foot care) and granted the withheld housekeeping benefits, accepting her explanation for the delayed disability certificates.

The claims for the cost of medical assessments were dismissed for lack of evidence.

The appellant insurer sought to appeal a preliminary arbitration order that found the respondent insured was not precluded from proceeding with her claim for non-earner benefits.

The Director's Delegate rejected the appeal pursuant to Rules 50.2 and 51.2(c) of the Dispute Resolution Practice Code, noting that the main arbitration hearing on the merits had already concluded and a final decision was pending.

The appeal file was administratively closed, to be reopened at the appellant's request once the final arbitration decision is issued.

The appellant's request for a stay of the arbitrator's order was denied.

The applicant was injured in a motor vehicle accident and claimed non-earner benefits.

The insurer argued she was precluded from proceeding to arbitration because she did not submit a disability certificate stating a complete inability to carry on a normal life within 104 weeks.

The arbitrator found that the applicant provided sufficient information to trigger the insurer's duty to adjust the claim, and that the insurer failed to respond properly, delaying the crystallization of the dispute.

Furthermore, the arbitrator held that the insurer breached its duty of good faith by failing to arrange a neuropsychological insurer examination as part of a proper investigation into the applicant's head injury.

The applicant was permitted to proceed to arbitration with her claim.

The insurer appealed an arbitrator's decision that the insured's application for arbitration was not barred by the limitation period.

The Director's Delegate upheld the arbitrator's findings that the insurer's denial of housekeeping and treatment plan benefits was not clear and unequivocal.

The Delegate also held that the 90-day limitation extension under the Insurance Act runs from the date the mediator's report is received, not sent.

Finally, the Delegate waived a technical defect where the insured filed the arbitration application on the wrong floor of the Commission, finding the proceeding was commenced in time.

The appeal was dismissed.

The appellant insurer sought to appeal a preliminary decision of an arbitrator which held that the respondent insured was not precluded from proceeding to arbitration by the limitation period.

The arbitrator had found that the 90-day extension under s. 281.1(2)(b) of the Insurance Act commenced when the mediator's report was received, not when it was dated.

The Director's Delegate declined to reject the appeal under Rule 50.2 of the Dispute Resolution Practice Code, finding that clarification of the law on this limitation issue was important given inconsistent case law.

The appeal was allowed to proceed and timelines for written submissions were set.

The applicant sought arbitration for medical, attendant care, and housekeeping benefits following a motor vehicle accident.

The insurer argued the application was filed beyond the two-year limitation period.

The arbitrator found that the insurer's initial refusals were either not clear and unequivocal or failed to properly inform the applicant of the dispute resolution process as required by the Schedule and the rule in Smith v. Co-operators.

Consequently, the limitation period was not triggered or had not expired, and the applicant was not precluded from proceeding to arbitration.

In a pre-hearing motion at the Financial Services Commission of Ontario, the insurer sought production of the applicant's 2002 income tax return.

The applicant argued the document was irrelevant because her claim for income replacement benefits was based on her earnings in the four weeks prior to the motor vehicle accident.

The arbitrator ordered the production of the tax return, finding it relevant to establishing the applicant's level of remuneration for the purpose of determining suitable employment under the post-104-week disability test.

The Applicant sought to withdraw her claim for medical benefits shortly before a scheduled preliminary issue hearing.

The Insurer opposed the withdrawal without an order for costs, arguing the late withdrawal caused unnecessary expenses.

The Arbitrator permitted the withdrawal of the claim and awarded the Insurer its reasonable expenses for preparing for the preliminary issue hearing, capped at Legal Aid rates, totaling $334.59.

The applicant sought an early arbitration hearing date for her claim for income replacement benefits following a motor vehicle accident.

The insurer requested that the hearing be delayed until 2009, pending the outcome of a motion before the Workplace Safety and Insurance Appeals Tribunal (WSIAT) regarding the applicant's entitlement to claim benefits under the Schedule.

The arbitrator found that the balance of prejudice favoured the applicant, noting the legislative intent for timely payments and dispute resolution.

The arbitrator scheduled the hearing for April 2008, rejecting the insurer's request for a delay.

The applicant brought a motion for a third-party production order for cell phone records and an adjournment of the arbitration hearing due to a recent ankle injury.

The arbitrator dismissed the request for third-party production because the applicant failed to comply with the mandatory procedural requirements under Rule 67 of the Dispute Resolution Practice Code.

However, the arbitrator granted the adjournment request on a peremptory basis, subject to conditions including the payment of $150 in fixed costs to the insurer for the last-minute motion.