Joseph Claude Alphonse Blouin

The appellant appealed an Arbitrator's variation order that allowed the insurer to deduct Canada Pension Plan disability benefits from his income replacement benefits.

The Director's Delegate allowed the appeal, finding that the Arbitrator breached procedural fairness by deciding the variation application on the record without issuing a Notice of Hearing.

Furthermore, the Director's Delegate found no legal basis for the variation, as the evidence of the CPP disability benefits was known to both parties before the end of the original arbitration hearing and therefore was not 'evidence not available on the arbitration' under section 284(3) of the Insurance Act.

The variation order was rescinded and the application for variation dismissed.

This was a costs ruling following an appeal involving the Motor Vehicle Accident Claims Fund and an insurer.

The successful responding party sought partial indemnity costs of $7,500 from total accounts of $10,072.45, while the unsuccessful party argued the appeal was not complex and proposed $5,000.

The court applied Rule 57.01 and the principle of indemnity, emphasizing the importance of the issue to both the parties and the motor vehicle insurance industry, the time spent by senior counsel, and the quality of the materials and submissions.

The court held that $7,500 inclusive of GST and disbursements was fair and reasonable.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the non-catastrophic policy limits were exhausted.

The applicant brought a motion for interim attendant care and medical/rehabilitation benefits in excess of the non-catastrophic limits, pending a determination of whether he suffered a catastrophic impairment.

The arbitrator dismissed the motion, finding no jurisdiction to order payments over the statutory non-catastrophic limits prior to a finding of catastrophic impairment.

Furthermore, the arbitrator held that the applicant did not meet the threshold test for interim benefits, as the conflicting medical evidence resulted in an ambiguous case strength.

The Respondent brought a motion during a preliminary appeal conference to compel the Appellant to order and pay for the transcript of his own testimony from the arbitration hearing.

The Appellant argued he could not afford the transcripts and did not intend to rely on them.

The Director's Delegate dismissed the motion, finding that the onus is on the moving party to establish that further portions of the transcript should be ordered, and that there is nothing preventing the Respondent from ordering the transcripts itself if it believes they are necessary for a full and fair appeal hearing.

The appellant insurer sought to appeal an arbitrator's preliminary decision which found there was a 'genuine issue for hearing' regarding whether the respondent's injuries from police rubber bullets constituted an 'accident' under the Schedule.

The Director's Delegate held that the arbitrator erred by applying a summary judgment test rather than deciding the preliminary issue.

However, the Delegate rejected the appeal under the Dispute Resolution Practice Code to avoid piecemeal litigation, instead remitting the matter to the Arbitration Unit for an expedited rehearing of the preliminary issue.

The applicant was injured in a motor vehicle accident while driving a tractor trailer and sustained a catastrophic impairment.

He sought various statutory accident benefits, including caregiver, income replacement, housekeeping, attendant care, and medical benefits.

The arbitrator dismissed the majority of the claims, citing significant credibility issues, surveillance evidence showing the applicant performing demanding physical activities, and a failure to provide documentation regarding post-accident employment and income.

The insurer was ordered to pay for one specific treatment plan at the catastrophic impairment rate, but the claim for a special award was denied.

The insurer brought an application to vary an arbitration order to permit the deduction of Canada Pension Plan (CPP) disability benefits received by the insured from the income replacement benefits to which he was entitled.

The insured had begun receiving CPP disability benefits part-way through the original arbitration hearing but failed to disclose this to the insurer or the arbitrator.

The arbitrator found that the undisclosed receipt of CPP disability benefits constituted evidence that was not available on the arbitration but had since become available.

The application was granted, and the previous order was varied to allow the insurer to deduct the CPP disability benefits previously received by the insured.

Following a jury trial where the plaintiffs recovered damages for general damages and future care but failed on claims for wage loss, the court determined the appropriate costs award.

The plaintiffs sought substantial indemnity costs exceeding $247,000, while the defendants argued for partial indemnity costs around $105,300.

Applying the principles of reasonableness under s.131 of the Courts of Justice Act and Rule 57.01 of the Rules of Civil Procedure, the court held that substantial indemnity was not justified because there was no reprehensible conduct by the defendants.

The court emphasized that costs must be fair and proportionate to the result achieved.

Partial indemnity fees of $100,000 and disbursements of $50,000 inclusive of HST were awarded.

In a motor vehicle personal injury jury trial, the defendants brought a threshold motion under s. 267.5(5) of the Insurance Act seeking to bar the plaintiff’s claim for non‑pecuniary damages.

Liability had been admitted and the jury awarded $125,000 in general damages and $150,000 for future care costs.

The court considered whether the plaintiff sustained a permanent serious impairment of an important physical, mental or psychological function within the meaning of the statutory threshold under Bill 198 (Regulation 381/03).

Evidence showed the plaintiff suffered ongoing ankle and neck problems and an exacerbation of pre‑existing clinical depression that significantly limited his daily functioning.

The court held that the combined physical and psychological impairments met the statutory threshold and substantially interfered with the plaintiff’s usual activities of daily living.

The defendants’ threshold motion was dismissed and the plaintiff was entitled to judgment in accordance with the jury’s verdict.

The applicant sought judicial review of a decision by the Director's Delegate of FSCO, which found she was not involved in an 'accident' under the Statutory Accident Benefits Schedule.

The applicant was injured while driving a pocket bike on the property of the bike's owner.

The Divisional Court upheld the Delegate's decision, finding that under the Off-Road Vehicles Act, the pocket bike was not required to be insured while operated on the owner's property.

Consequently, it did not qualify as an 'automobile' at the time of the collision, and the application for judicial review was dismissed.

The applicant sought expenses following an arbitration hearing where he achieved partial success, primarily on the issue of income replacement benefits.

The insurer argued for a reduction in expenses to reflect this partial success and challenged certain witness fees.

The arbitrator allowed the witness fees as prudent preparation and found the preparation time reasonable.

However, recognizing that the applicant was unsuccessful on several other claims that consumed hearing time, the arbitrator reduced the recoverable counsel fees by 30% and disbursements by 10%.

The applicant was awarded total expenses of $35,084.75, including the costs of the expense hearing.

Two priority disputes arose between insurers regarding the payment of statutory accident benefits to independent contractors injured while operating commercial vehicles.

The contractors operated as sole proprietorships and were named insureds under their personal-use vehicle policies, but not under the commercial fleet policies.

The Court of Appeal held that under s. 66(1)(a) of the Statutory Accident Benefits Schedule, an insured vehicle can be made available for an individual's regular use by their own sole proprietorship.

Consequently, the contractors were deemed named insureds under the commercial fleet policies, making the commercial insurers responsible for paying the accident benefits.

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

The arbitrator found that the applicant's left knee impairment was caused by the accident, despite pre-existing arthritis, and that his ongoing impairments rendered him completely unable to engage in any suitable employment, entitling him to ongoing income replacement benefits.

Claims for attendant care and medical benefits were dismissed as the applicant was independent in self-care and the proposed treatments were not reasonable and necessary.

Housekeeping benefits were granted in part.

The arbitrator also awarded interest at the rate of 2% per month under the Old SABS, finding that the transitional provisions of the New SABS did not erode the right to the old interest rate for benefits that became overdue.

The appellant insurer appealed an arbitrator's decision finding that a pocket bike operated by the respondent on private property was an automobile, entitling her to statutory accident benefits.

The Director's Delegate allowed the appeal, holding that under the Off-Road Vehicles Act, an off-road vehicle driven on land occupied by its owner is not required to be insured.

Applying the 'time and circumstances' analysis from Copley v. Kerr Farms Ltd., the pocket bike did not require insurance at the time of the incident and was therefore not an automobile within the meaning of the Statutory Accident Benefits Schedule.

The appellant appealed an arbitration order that allocated 50% of the post-accident net income from her family business to her for the purpose of calculating her income replacement benefits.

The appellant argued that only 5% should be allocated to her, reflecting her reduced active participation and tax filings.

The Director's Delegate upheld the Arbitrator's decision, finding that the 50/50 split fairly reflected her true financial situation, as the business continued to operate at pre-accident levels due to a replacement worker whose salary was deducted from the post-accident income.

The applicant was injured while riding a gas-powered 'pocket bike' on private property and applied for statutory accident benefits.

The insurer denied the claim, arguing the pocket bike was not an 'automobile' and therefore no 'accident' occurred.

The arbitrator found that the pocket bike met the definition of an off-road vehicle under the Off-Road Vehicles Act.

Because the owner had previously driven it on lands they did not occupy, it was required to be insured under that Act.

Consequently, it fell within the expanded definition of 'automobile' under section 224(1)(a) of the Insurance Act, meaning the applicant was involved in an accident and entitled to claim benefits.

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

During the arbitration process, the insurer requested the production of the applicant's OHIP records and family doctor's clinical notes dating back to prior motor vehicle accidents alleged to have occurred in 2000, 2001, and 2002.

The applicant opposed the expanded production, arguing there was no reliable evidence of inconsistencies in his reporting.

The arbitrator found that references to earlier accidents in medical reports provided a foundation for the insurer's request, as the information was relevant to assessing causation and quantum.

The arbitrator ordered the applicant to produce the requested records dating back to 2000.

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

Prior to the accident, she and her husband were equal partners in a trucking business.

Following the accident, she could no longer drive, and a replacement worker was hired.

The applicant argued her post-accident income should be calculated based on a 5% allocation of the business's net income, reflecting her diminished contribution.

The insurer argued for a 50% allocation, consistent with the pre-accident split.

The arbitrator agreed with the insurer, finding that a 50% allocation fairly reflected her true financial situation and avoided over-compensation.

However, the arbitrator found the insurer unreasonably withheld IRB payments for a period in 2008 after receiving requested documentation, and ordered a special award of $750.

The applicant, a six-year-old catastrophically impaired by a brain injury sustained when struck by a motor vehicle, sought increased attendant care benefits for continuous supervision provided by his mother.

The insurer argued that much of the supervision was regular parenting.

The arbitrator found that the applicant's impulsivity, unpredictability, and behavioural issues required continuous and vigilant supervision beyond regular parenting, and awarded the increased benefits.

The arbitrator dismissed the applicant's claims for the higher attendant care rates introduced in the 2006 Schedule amendments, as the accident occurred in 2001, and for the cost of a vocational assessment.

The appellant's personal injury action arising from a motor vehicle accident was dismissed by the motion judge due to her failure to fulfill undertakings given during examinations for discovery while self-represented.

The Court of Appeal allowed the appeal and reinstated the action, finding that the motion judge failed to balance the prejudice to the appellant against any prejudice to the respondents, who provided no evidence of prejudice.

The court emphasized that a potentially meritorious claim should not be dismissed on procedural grounds unless the defendant demonstrates prejudice to their ability to defend the claim.