Jonathan B. Schrieder

Following a preliminary issue hearing where the arbitrator found the applicant was not injured in an 'accident' as defined in the Schedule, the insurer sought its expenses.

The arbitrator awarded the insurer its expenses, noting it was entirely successful in the preliminary hearing and the applicant's delay in providing productions necessitated a resumption of the pre-hearing.

The arbitrator reduced the insurer's claimed hours, applying a 3:1 ratio for preparation to hearing time, and disallowed the cost of transcripts.

The applicant was ordered to pay the insurer's expenses fixed at $11,557.90.

The Applicant sought to withdraw his Application for Arbitration for accident benefits at the outset of the scheduled three-day hearing.

The Insurer agreed to the withdrawal on a with-prejudice basis, provided it was awarded expenses.

The Arbitrator permitted the withdrawal on a with-prejudice basis and awarded the Insurer expenses for one day of hearing and two days of preparation, noting the late notice of withdrawal resulted in time thrown away.

The Applicant was ordered to pay the Insurer $4,535.23 in expenses and disbursements.

The applicant was injured in a motor vehicle accident and sought payment for an occupational therapy assessment and treatment plan.

The insurer denied the plans and raised a late defence of double payment at the hearing.

The arbitrator rejected the late defence as trial by ambush and found no actual double payment occurred.

The arbitrator concluded the treatment plans were reasonable and necessary, noting the insurer's assessor admitted her recommendation might have differed had she received all relevant information.

The arbitrator ordered the insurer to pay for the plans, plus interest at 2% per month compounded monthly, and a special award of $5,500 for unreasonably withholding payment.

The applicant sought a special award under s. 282(10) of the Insurance Act, alleging that the insurer unreasonably denied two occupational therapy treatment plans.

In a previous hearing, an arbitrator found the treatment plans were reasonable and necessary but denied the special award.

On appeal, the special award issue was returned for redetermination.

The arbitrator found that the insurer did not act unreasonably in relying on its own assessors' reports to deny the benefits.

The insurer's reliance on the reports of its occupational therapist and psychologist was not immoderate or inflexible, especially given gaps in the applicant's medical evidence and questions regarding causation.

The claim for a special award was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, attendant care, and housekeeping benefits.

The insurer terminated these benefits based on insurer's examinations concluding the applicant did not suffer a substantial inability to perform her tasks and that further treatment was not reasonable or necessary.

The arbitrator dismissed all of the applicant's claims, finding her evidence highly unreliable and lacking credibility due to numerous inconsistencies, failure to produce medical records, and failure to disclose pre-accident medical history.

The arbitrator also accepted evidence from a doctor called by the insurer who testified that his name and signature were used on treatment plans without his knowledge or authorization.

The applicant was injured in a motor vehicle accident and sought various medical benefits and the cost of examinations from his insurer.

The insurer denied the claims, and the applicant applied for arbitration.

The arbitrator found that the insurer failed to respond to a treatment plan for a therapy ball within the required 10-day period under s. 38(8) of the Statutory Accident Benefits Schedule.

As a result, the insurer was ordered to pay for the therapy ball and was prohibited from taking the position that the Minor Injury Guideline applied to the applicant's impairment.

However, the arbitrator dismissed the remaining claims for medical benefits and assessments, finding that the applicant failed to establish causation between the accident and his symptoms years later, noting significant gaps in the medical records and the applicant's unreliability as a witness.

The applicant's request for a special award was denied.

The applicant was ordered to pay 75% of the insurer's arbitration expenses due to his conduct prolonging the proceedings.

The Insurer sought its expenses following an arbitration hearing where the Applicant's claims for statutory accident benefits were either withdrawn or dismissed.

The Applicant argued that the Insurer's conduct prolonged the proceeding and that the claimed costs were excessive.

The Arbitrator found that the Insurer was entirely successful and entitled to expenses.

Applying a 3:1 ratio for preparation to hearing time and reducing excessive disbursements, the Arbitrator fixed the Insurer's expenses at $12,070.91 and ordered the Applicant to pay this amount.

The appellant insurer appealed an arbitration decision awarding the respondent insured various statutory accident benefits, including attendant care, a hot tub, massage therapy, psychological counseling, and ergonomic equipment, as well as a special award and legal expenses.

The Director's Delegate dismissed most of the appeal, finding no errors of law in the Arbitrator's awards for the benefits, interest, and the special award, noting the insurer unreasonably withheld payments by relying on flawed medical assessments that applied incorrect legal tests.

The Delegate found the Arbitrator erred by failing to provide reasons for allowing an increased claim for ergonomic equipment and for awarding legal expenses.

With the parties' consent, the Delegate redetermined these issues, denying the increased equipment costs but awarding the original amount plus HST, and fixing the respondent's arbitration legal expenses at $95,633.79 and appeal legal expenses at $24,179.67.

The applicant sought statutory accident benefits following two motor vehicle accidents in 2007.

The insurer denied claims for chiropractic treatment and a psychological assessment.

At the arbitration hearing, the applicant was the sole witness.

The arbitrator found the applicant lacked credibility, noting he deliberately obscured his medical history, including previous accidents and pre-existing conditions, and exaggerated the severity of the subject accidents.

Consequently, the arbitrator concluded the applicant failed to prove the accidents materially contributed to his claimed impairments.

All claims for benefits, interest, and a special award were dismissed.

The applicant sought statutory accident benefits for chiropractic treatment plans and in-home assessments following a 2012 motor vehicle accident.

The insurer denied the claims based on its medical assessments indicating the injuries were minor and required no further treatment.

The arbitrator dismissed the application in its entirety, finding the applicant completely lacking in credibility due to numerous inconsistencies, evasions, and denials regarding his significant pre-accident medical history.

The arbitrator concluded that the applicant's lack of credibility fundamentally undermined the reliability of his treating practitioners' recommendations, and the applicant failed to establish that the claimed benefits were reasonable and necessary.

The appellant insurer appealed an arbitration decision awarding statutory accident benefits and a special award to the respondent.

The appellant failed to provide the required arbitration transcripts, ignored multiple communications from the appeals office, and abruptly attempted to withdraw the appeal without following proper procedures.

The Director's Delegate found that the appellant's course of conduct demonstrated a willful disregard for the appeal process and that the appeal was commenced in bad faith.

The appeal was dismissed without a hearing pursuant to Rule 68.1 of the Dispute Resolution Practice Code.

The Insurer sought its expenses following a successful defence of the Applicant's claims for statutory accident benefits.

The Arbitrator found that the Applicant's conduct prolonged the proceedings through late production of evidence, failure to properly summon witnesses, and pursuit of unnecessary procedural aspects.

The Insurer claimed approximately $51,900 in expenses.

The Arbitrator reduced the claimed legal fees and disbursements, noting the lack of complexity and excessive claims for process service and court reporters.

The Applicant was ordered to pay the Insurer's expenses fixed at $13,400.

The appellant was successful on her appeal and sought her legal appeal expenses.

The respondent insurer did not dispute entitlement but challenged some items on the bill of costs.

The Director's Delegate found the claimed amount reasonable and ordered the respondent to pay $2,500 inclusive of disbursements and HST, noting that a global assessment rather than a line-by-line assessment is appropriate.

The applicant sought statutory accident benefits following a 2008 motor vehicle accident, including costs for a psychiatric evaluation, an OCF-19, attendant care, and housekeeping benefits.

The arbitrator dismissed all claims, finding that the applicant failed to seek pre-approval for the psychiatric evaluation and that the charge for the OCF-19 was unreasonable.

Furthermore, the arbitrator found the applicant and his spouse lacked credibility, noting significant inconsistencies in their evidence and a failure to disclose relevant pre-existing medical conditions to assessors.

As the substantive claims were denied, claims for interest and a special award were also dismissed.

The appellant appealed an arbitrator's decision denying her a special award under s. 282(10) of the Insurance Act, despite finding she was entitled to two treatment plans.

The Director's Delegate found that the arbitrator's reasons for denying the special award were conclusory and failed to address the live issues and key arguments raised by the appellant.

The appeal was allowed, the denial of the special award was rescinded, and the issue was remitted for redetermination before a different arbitrator.

The applicant applied for arbitration after the insurer denied statutory accident benefits following a motor vehicle accident.

The applicant failed to attend the scheduled arbitration hearing on time.

The insurer moved to dismiss the application.

The arbitrator found no evidence that the applicant had made a positive effort to advance her claim and rejected her explanation for being late.

The application for arbitration was dismissed, and no costs were awarded to the insurer.

The applicant applied for arbitration after the insurer terminated certain statutory accident benefits following a motor vehicle accident.

The applicant failed to attend the scheduled arbitration hearing.

The insurer moved to dismiss the application.

The arbitrator dismissed the application due to the applicant's failure to attend and lack of evidence advancing her claim, rejecting her subsequent explanation for her absence.

The arbitrator declined to award costs to the insurer as no evidence of expenses was presented.

In a motor vehicle personal injury action, the plaintiff sought an order compelling the tortfeasor’s insurer, added as a statutory third party after denying coverage, to answer written interrogatories and deliver an affidavit of documents explaining the basis for its denial of coverage.

The information was sought to determine whether the insurer’s liability was reduced to the statutory minimum by operation of law, which would affect the plaintiff’s entitlement to underinsured coverage under the OPCF 44R endorsement from his own insurer.

The court held that the facts underlying the denial of coverage were relevant to the plaintiff’s claim for underinsured motorist coverage and fell within the rationale of Rule 31.06(4) concerning disclosure of insurance and conditions affecting its availability.

The statutory third party insurer could not refuse discovery wholesale on the basis of privity or potential prejudice, though it could raise privilege or prejudice objections on a question‑by‑question basis.

The court ordered the insurer to answer the interrogatories and produce a sworn affidavit of documents.

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

After the applicant failed to attend the arbitration hearing, his claims were dismissed and the insurer was awarded its expenses.

In this decision on expenses, the arbitrator assessed the insurer's bill of costs.

The arbitrator reduced the claimed hourly rate, noting that the enhanced rate under Rule 78.1 of the Dispute Resolution Practice Code applies only to insured persons, not insurers, and limited the rate to the prevailing legal aid tariff.

The applicant was ordered to pay $6,264.50 in fixed expenses to the insurer.

Following an arbitration where the insurer was largely successful in defending against claims for statutory accident benefits, the parties sought expenses.

The arbitrator found that the insurer was entitled to its expenses due to its overwhelming success, though the amount was slightly reduced because the applicant had marginal success on two treatment plans and the insurer had listed 36 witnesses it did not call.

The applicant was ordered to pay the insurer $6,400.00 in expenses.