Jean Claude Rioux

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

The insurer denied certain medical and rehabilitation benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the applicant's physical injuries were predominantly minor, his psychological impairments, including depression and post-traumatic stress symptoms, justified removal from the MIG.

The Tribunal ordered the insurer to pay for a psychological assessment but denied the claims for physiotherapy treatment, finding them not reasonable and necessary.

The appellant sought income replacement benefits (IRBs) and medical benefits following a motor vehicle accident.

The insurer terminated IRBs on the basis that the appellant no longer suffered a substantial inability to perform the essential tasks of her employment.

The Tribunal found that the appellant failed to prove she was substantially unable to perform her pre-accident employment tasks after the termination date, noting her subsequent employment history and an intervening hand injury.

A claim for physiotherapy was denied because the treatment plan was not entered into evidence.

However, the Tribunal ordered the insurer to pay for an occupational therapy in-home assessment because the insurer failed to provide proper medical reasons for denying the treatment plan, making it payable if incurred.

The Applicant sought accident benefits following a rear-end collision, claiming entitlement to attendant care benefits and the cost of an attendant care needs assessment.

The Insurer argued the Applicant's injuries fell within the Minor Injury Guideline (MIG).

The Arbitrator found that the Applicant failed to meet the burden of proving his injuries fell outside the MIG, relying on the Insurer's expert medical evidence.

Consequently, the Applicant was not entitled to attendant care benefits or the cost of the assessment.

The Applicant's claims were dismissed, and he was ordered to pay the Insurer's arbitration expenses.

The applicant applied for statutory accident benefits following an alleged motor vehicle accident.

The insurer disputed the claim, alleging it was fraudulent and that the applicant was not in the vehicle.

The applicant failed to attend the preliminary issue hearing.

Based on the uncontested evidence of an independent witness who testified that the applicant was not in the vehicle, the arbitrator found the applicant was not involved in the accident.

The application for arbitration was dismissed without costs.

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer denied the claim on May 9, 2012.

The applicant submitted a second application for the same benefits, which was denied on May 9, 2013.

The applicant filed for arbitration on August 13, 2014.

The arbitrator held that the initial denial on May 9, 2012, was a clear and unequivocal refusal that triggered the two-year limitation period.

Submitting a new application did not restart the limitation clock.

Therefore, the application for arbitration was statute-barred.

The applicants were injured in a motor vehicle accident and sought statutory accident benefits.

The insurer capped their medical benefits under the Minor Injury Guideline (MIG) and terminated the husband's income replacement benefits (IRB).

The arbitrator found that both applicants developed chronic pain, which is an aberrant physiology not contemplated by the MIG, thus removing them from the $3,500 cap.

However, the claims for specific medical benefits were dismissed for lack of evidence proving they were reasonable and necessary.

The husband was awarded his claimed IRB as his injuries caused a substantial inability to perform his pre-accident employment as a truck driver.

Expenses were awarded to the applicants.

The appellant sought to appeal an arbitrator's preliminary decision finding that the parties had not reached a settlement, and requested a stay of the upcoming arbitration hearing.

The Director's Delegate declined to exercise discretion to hear the interlocutory appeal, finding that it did not finally decide all issues in dispute and that hearing it would not facilitate the most cost-effective resolution.

The Delegate also refused to stay the arbitration hearing, noting the absence of special circumstances to take control of the process away from the hearing arbitrator.

The appeal was rejected without prejudice to renewing it after all issues are finally determined.

The insurer appealed an arbitrator's decision allowing the insured to claim income replacement and housekeeping benefits despite driving with an expired driver's licence at the time of the accident.

The arbitrator had applied the due diligence defence, finding the insured reasonably believed his licence was valid because he had not received a renewal notice.

On appeal, the Director's Delegate applied the Supreme Court of Canada's decision in Lévis (City) v. Tétreault, holding that passive ignorance and reliance on administrative practices like renewal notices do not constitute due diligence.

The appeal was allowed, and the insured was precluded from claiming the benefits.

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

The insurer denied income replacement and housekeeping benefits under s. 30(1)(b) of the Statutory Accident Benefits Schedule, arguing the applicant was driving with an expired licence.

The arbitrator held that the exclusion for driving without a valid licence is subject to a due diligence defence.

Finding that the applicant reasonably relied on the Ministry of Transportation to send a renewal notice, which was delayed due to a public service strike, the arbitrator concluded the applicant reasonably believed his licence was valid.

The exclusion did not apply, and the applicant was permitted to proceed to arbitration.

The insurer brought a motion to stay the arbitration until the applicant attended an examination under oath pursuant to section 33(1.1) of the Statutory Accident Benefits Schedule.

The arbitrator found that while section 33 provides a remedy for non-compliance (potential disentitlement to benefits), it does not grant the arbitrator authority to stay the arbitration proceedings.

The arbitrator distinguished this from a failure to attend a section 42 medical examination, where a stay may be granted to prevent unfairness or abuse of process.

The motion for a stay was dismissed.

The applicant was injured in a motor vehicle accident and sought arbitration after the insurer denied his claims for income replacement, attendant care, and housekeeping benefits.

The arbitrator dismissed the claim for income replacement benefits, finding the applicant's evidence regarding his self-employment as an artist and a purported employment contract to be unreliable and contradicted by his tax returns.

The claims for attendant care and housekeeping benefits were also dismissed due to a lack of supporting evidence, including the absence of a recommendation from a qualified health practitioner and no proof that outside housekeeping services were actually engaged.

All claims were dismissed.

In a pre-hearing decision regarding a claim for statutory accident benefits, the insurer sought production of the applicant's bank statements from one year prior to the accident to date to verify post-accident income.

The arbitrator dismissed the request, finding that the amount of the weekly income replacement benefit was not in dispute and the insurer had no evidentiary basis to suspect the applicant was employed during the disputed period.

The arbitrator concluded that ordering production based on speculation alone would be unnecessarily intrusive and contrary to the Dispute Resolution Practice Code.

The insurer brought a motion to compel the insured to attend an independent medical examination by a psychiatrist under section 42 of the Statutory Accident Benefits Schedule.

The insured refused to attend, arguing the examination was for medical-legal purposes rather than determining entitlement to a benefit.

The arbitrator dismissed the motion, finding that arbitrators at the Financial Services Commission of Ontario lack jurisdiction to order an insured to attend a medical examination.

The arbitrator also noted that the insurer's delay in requesting the examination until the eve of the hearing would cause significant prejudice to the insured.

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

The insurer terminated the benefits and sought to compel the applicant to attend examinations by an orthopaedic surgeon, a physiatrist, and a psychologist.

The insurer argued the applicant was precluded from proceeding to arbitration for failing to attend.

The arbitrator held that the insurer's notice of examination was deficient because it listed benefits not in dispute, and thus could not be relied upon to preclude arbitration.

The arbitrator further held that examinations by an orthopaedic surgeon and a physiatrist were reasonable and necessary, but a psychological examination was not, given the passage of time since any psychological issues were reported.