Jonathan Schrieder

The respondent insurer raised preliminary issues arguing that the applicant was barred from proceeding with her Licence Appeal Tribunal application due to her failure to attend Insurer's Examinations (IEs) and failure to produce requested documents under s. 33 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant was not barred from proceeding, as she provided a credible medical explanation (opioid withdrawal symptoms) for missing the IEs, but ordered her to attend rescheduled IEs before the claim could proceed.

The Tribunal also found the applicant was compliant with s. 33, noting that the insurer's requests for documents were vague, lacked timelines, and failed to state the consequences of non-compliance.

The applicant was involved in a motor vehicle accident and received $3,700 in medical and rehabilitation benefits from the respondent insurer.

The insurer subsequently alleged that the applicant was not a passenger in the vehicle, that the accident was staged, and sought repayment of the benefits under s. 52 of the Statutory Accident Benefits Schedule due to wilful misrepresentation.

The Tribunal found the applicant to be a credible witness, noting that her vague recollection of the accident was explained by documented cognitive dysfunction related to multiple sclerosis.

The Tribunal concluded that the applicant was indeed in the accident and did not make a wilful misrepresentation.

The insurer's claim for repayment was dismissed.

Following the dismissal of the appellant's appeal of an arbitration order, the successful respondent sought its legal appeal expenses.

The Director's Delegate found that the respondent was completely successful and entitled to its expenses based on the outcome of the proceeding.

Noting that the appeal was neither long nor complex and was conducted jointly with the appellant's spouse's appeal, the Director's Delegate ordered the appellant to pay the respondent $2,500 inclusive of HST and disbursements.

Following the dismissal of the appellant's appeal of an arbitration order, the respondent sought its legal appeal expenses.

The Director's Delegate found that the respondent was completely successful in resisting the appeal and was therefore entitled to its expenses based on the degree of success.

The respondent was awarded $2,500 inclusive of HST and disbursements.

The applicant sought expenses following an arbitration regarding statutory accident benefits arising from three motor vehicle accidents.

The arbitrator found that the applicant was more successful overall, having been deemed catastrophically impaired and awarded housekeeping benefits, despite mixed success on other issues.

The arbitrator awarded the applicant his expenses, applying a 3:1 ratio for preparation to hearing time, reduced by 20% to reflect the mixed success.

The insurer was ordered to pay $46,890.88 inclusive of fees, disbursements, and HST.

Following an arbitration where the insurer was entirely successful in dismissing the applicant's claims for statutory accident benefits, the insurer sought its expenses.

The arbitrator considered the criteria under Ontario Regulation 664, noting the insurer's complete success and the applicant's rejection of a $2,500 settlement offer.

The arbitrator awarded the insurer its expenses, reducing the claimed preparation time to a 2:1 ratio relative to the 25 hours of hearing time, and disallowing the cost of a court reporter.

The applicant was ordered to pay the insurer $10,082.68 in expenses.

The applicant, who was self-represented, requested an adjournment at the start of a catastrophic impairment hearing after his former counsel disengaged shortly before the hearing.

During the preliminary matters, the applicant suffered a medical emergency (seizure) in the hearing room.

The adjudicator granted the adjournment, finding that the applicant needed time to retain new counsel and that proceeding would not permit an adequate hearing and could negatively impact the applicant's health.

Following a successful partial appeal that reduced an arbitration expense award by one third, the appellant sought legal expenses for the appeal.

The respondent argued each party should bear their own costs due to mixed results.

The Director's Delegate found the reduction substantial, constituting a success, and awarded the appellant $1,000 in legal appeal expenses.

The appellants appealed an arbitrator's decision dismissing their applications for accident benefits after they failed to attend the arbitration hearing.

The appellants argued they had not received proper notice of the hearing.

The Director's Delegate dismissed the appeal, finding that the arbitrator's determination regarding notice was a finding of fact supported by evidence from the appellants' former counsel.

As appeals under Rule 50.1 of the Dispute Resolution Practice Code are limited to questions of law, and there was evidence to support the arbitrator's finding, no error of law was made in dismissing the applications pursuant to Rule 37.9.

The appellant sought $2,534.90 in legal expenses and disbursements following a successful appeal of an arbitrator's decision that had dismissed her proceeding without a hearing.

The respondent insurer disputed the disbursements for lack of supporting documentation and argued the hours claimed were excessive.

The Director's Delegate found the disbursements and the 12 hours claimed to be reasonable, noting the Commission does not engage in line-by-line analysis of expenses.

The appellant was awarded $2,650, which included an additional hour for preparing the reply.

The appellant appealed an arbitrator's expense decision awarding the insurer $16,115.96 in costs.

The Director's Delegate upheld the arbitrator's discretionary award of law clerk fees but found that the arbitrator erred in awarding $5,303.99 for transcript expenses, as transcripts are generally not recoverable under the Expenses Regulation.

The appeal was allowed in part, and the costs award was reduced to $10,811.97.

The appellant sought legal expenses following a successful appeal that overturned an arbitrator's decision denying a special award.

The Director's Delegate found the appellant was entirely successful and entitled to reasonable expenses.

Applying a global assessment and deducting unsubstantiated disbursements, the Delegate ordered the respondent to pay $2,250.00 for legal fees, inclusive of disbursements and HST.

The appellant sought to reopen her arbitration file to claim further housekeeping benefits.

The Arbitrator dismissed the proceeding without a hearing, finding that the Commission was functus based on previous minutes of settlement.

On appeal, the Director's Delegate found that the Arbitrator erred in law by failing to provide notice or an opportunity for the appellant to make submissions before dismissing the proceeding, contrary to the Statutory Powers Procedure Act and the Dispute Resolution Practice Code.

The appeal was allowed and the matter returned to arbitration.

Following the dismissal of the appellant's statutory accident benefits appeal, the respondent requested an assessment of appeal expenses.

The Director's Delegate directed the parties to file written submissions regarding expenses.

Neither party provided submissions.

Consequently, the request for an assessment was dismissed and no award of expenses was made.

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

In a previous arbitration, the arbitrator found the appellant was entitled to treatment plans but denied a special award.

On appeal, the denial of the special award was rescinded and returned to a new arbitrator for redetermination.

The second arbitrator also denied the special award.

The appellant appealed again.

The Director's Delegate found that the second arbitrator committed errors of law by making factual findings based on speculation, unsupported by evidence, and contradicting the binding factual findings of the first arbitrator.

The decision was rescinded and the issue of the special award was returned to a different arbitrator for redetermination.

Following a successful defence of an application for statutory accident benefits, the insurer sought its expenses for the arbitration hearing.

The arbitrator reviewed the insurer's bill of costs, noting that the rules for insurer's costs differ significantly from those for an insured.

The arbitrator reduced the claimed hourly rates to align with the Legal Aid Tariff and adjusted the ratio of preparation time to hearing time from 5:1 to 3:1.

Certain disbursements, including fees for a witness who did not testify and court reporter fees, were disallowed.

The insured was ordered to pay the insurer $16,115.96 for its expenses.

Following an arbitration where the insurer was completely successful in defending all claims for statutory accident benefits, the insurer requested an expense hearing.

The insurer claimed $54,029.63 in total expenses.

The arbitrator found the insurer's claimed hours excessive and reduced the fees to match the applicant's own legal costs of $24,423.47 plus HST.

Disbursements for two expert witnesses were also reduced to the maximum amounts permitted under the Expense Regulation.

The applicant was ordered to pay the insurer's expenses fixed at $29,798.52 inclusive of fees, disbursements, and HST.

The insurer requested an expense hearing after successfully defending against the applicant's claims for statutory accident benefits.

The arbitrator found the applicant's evidence wholly lacking in credibility and that his conduct prolonged and obstructed the hearing.

The arbitrator ordered the applicant to pay the insurer's expenses in the amount of $14,988.86, comprising disbursements and legal fees.

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

The insurer raised a preliminary issue arguing the applicant was precluded from arbitrating his claim for a non-earner benefit because he had previously elected to receive an income replacement benefit.

The arbitrator found that the insurer failed to demonstrate it had complied with the mandatory notice provisions under section 35 of the Schedule, which are required for an election to be valid and binding.

As a result, the applicant was not precluded from proceeding to arbitration on his claim for a non-earner benefit.

The applicant sought accident benefits following a motor vehicle accident, claiming her injuries were catastrophic.

The arbitrator found the applicant lacked credibility, noting she had returned to work shortly after the accident, retrained for a more physically demanding job, and was observed on surveillance performing activities she claimed she could not do.

The arbitrator preferred the insurer's expert evidence over the applicant's, concluding the applicant failed to prove her injuries were catastrophic or that the claimed attendant care and medical benefits were reasonable, necessary, and directly caused by the accident.

All claims were dismissed.