John D. Dean

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

The insurer terminated and later reinstated the benefits with arrears.

A dispute arose over whether the insurer could set-off a deductible lump sum payment of collateral benefits against the benefit arrears, or if it had to recover the deduction through 20 per cent reductions in the reinstated benefits.

The arbitrator held that the insurer was entitled to set-off the deduction against the benefit arrears, as this prevented over-compensation and aligned with the purpose of the Schedule.

The insurer was also ordered to pay the applicant's hearing expenses.

Allstate appealed an Arbitrator's order that included the insured's accrued vacation pay in her pre-accident income for calculating income replacement benefits (IRBs) and established her ongoing entitlement to IRBs.

The Director's Delegate allowed the appeal, finding that the Arbitrator erred in law on both issues.

First, the Arbitrator lacked jurisdiction to make an entitlement order without a full hearing on the merits, as the insurer had only agreed to reinstate benefits without waiving its right to contest entitlement later.

Second, accrued vacation pay is deferred income and should not be included in pre-accident income unless it was actually paid or available to the insured prior to the accident.

The Applicant sought to recover GST on disbursements for medical reports as part of her hearing expenses.

The Insurer argued that the medical reports were GST-exempt.

The Arbitrator found that while the reports may be exempt when billed to the lawyer, CCRA policy requires the lawyer to charge GST when billing the client, making the GST recoverable.

The Insurer also argued that the disbursements should be reduced because they were partially recovered in a related tort settlement.

The Arbitrator held he had no jurisdiction to alter his previous costs order based on the subsequent tort settlement.

Following earlier decisions regarding statutory accident benefits, the parties disputed the applicant's entitlement to interest on reinstated income replacement benefits and the quantum of hearing expenses.

The insurer argued the interest claim was res judicata because a special award had already been granted.

The arbitrator held that the applicant was entitled to interest under section 46 of the Schedule, finding the special award did not preclude a separate claim for interest.

The arbitrator also assessed the applicant's bill of costs, allowing deductions for premature motion expenses while denying other requested reductions, and remained seized of any remaining disputes.

The applicant was injured in a motor vehicle accident and sought income replacement benefits, housekeeping expenses, and the cost of a gym membership.

The arbitrator found that the medical evidence did not support a substantial inability to perform the essential tasks of his employment during the claimed period.

The claims for housekeeping and the gym membership were also dismissed due to lack of credible evidence and medical necessity.

The applicant was ordered to repay the insurer for an overpayment of benefits received while he was also receiving long-term disability benefits.

The plaintiffs, Ontario residents, were involved in a motor vehicle accident in New York with the defendants, who were New York residents.

The plaintiffs commenced an action in Ontario against the New York defendants and their own insurer.

The New York defendants successfully moved to stay the action for lack of jurisdiction.

On appeal, the Court of Appeal applied the real and substantial connection test and the eight factors from Muscutt v. Courcelles.

The court concluded that assuming jurisdiction over the out-of-province defendants for a foreign accident would violate principles of order and fairness, and dismissed the appeal.

The applicants, husband and wife, were injured in a motor vehicle accident and filed separate applications for arbitration regarding statutory accident benefits.

A Commission case administrator purported to combine the applications without following the notice and consent requirements of the Dispute Resolution Practice Code and the Statutory Powers Procedure Act.

At a pre-hearing discussion, the arbitrator found the administrative combination invalid but, exercising adjudicative discretion and with the consent of both parties, formally ordered the proceedings combined to avoid inconsistent results, save costs, and promote efficiency given the overlapping facts and witnesses.

The applicant was injured in a motor vehicle accident and sought income replacement benefits for work performed at an equine centre in exchange for boarding her horses.

The insurer denied the claim, arguing the arrangement was not employment or, alternatively, was self-employment.

The arbitrator found that the applicant was an employee, not self-employed, and that her income included the value of the payment in kind (horse boarding).

The applicant was awarded $1,639.90 in income replacement benefits.

Claims for a special award and for a frivolous arbitration penalty were dismissed.

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

The insurer terminated benefits based on an orthopaedic surgeon's report that the applicant's ongoing disability was psychological and caused by a prior accident.

The applicant also received a temporary supplement from another insurer for the prior accident.

The arbitrator held that the insurer was entitled to deduct the temporary supplement from the income replacement benefits, as the applicant's inability to work was partly due to the prior accident.

However, the arbitrator also found that the insurer unreasonably delayed reinstating the income replacement benefits by relying on an orthopaedic surgeon's opinion regarding a psychological disability, and ordered the insurer to pay a special award of $2,060.67.

The appellant was injured in a motor vehicle accident and sought payment for a multidisciplinary assessment under s. 24 of the SABS-1996.

The arbitrator allowed the costs for the physiotherapy and functional abilities assessments but denied the cost of the orthopaedic assessment.

Both parties appealed.

The Director's Delegate dismissed the appeal and cross-appeal, finding that the arbitrator correctly applied a flexible, contemporaneous reasonableness test to determine whether the assessments were obtained for the purpose of the regulation.

The Delegate also declined to admit fresh evidence on appeal and dismissed a motion alleging institutional bias.

The applicant was injured in a motor vehicle accident and received income replacement benefits, which the insurer later terminated.

The applicant applied for arbitration.

Prior to the hearing, the insurer reinstated the benefits and did not contest entitlement at the hearing.

The applicant sought an order establishing her entitlement to benefits to gain procedural protection under section 287 of the Insurance Act.

The arbitrator held he had jurisdiction to issue the order and granted it.

The arbitrator also held that the applicant's accrued vacation pay must be included in the calculation of her income replacement benefit, distinguishing previous case law based on the applicant's history of taking vacation pay as contributions to a vacation account rather than as paid time off.

The applicant sought statutory accident benefits, including non-earner disability benefits and income replacement benefits, following a motor vehicle accident.

The applicant failed to attend the arbitration hearing and his subsequent request for an adjournment was denied.

The arbitrator dismissed the claims for benefits, finding that the applicant's medical evidence was unsupported by diagnostic imaging and contradicted by surveillance video showing him working and moving freely.

Claims for interest and arbitration expenses by both parties were also dismissed.