8 total
Successful appellants awarded $4,200 in appeal expenses; transcript costs denied as unrecoverable.
The Appellants sought their legal appeal expenses following a successful appeal regarding their housekeeping and home maintenance claims.
The Director's Delegate awarded the Appellants their appeal expenses, allowing paralegal fees at $70 per hour rather than the claimed $150 per hour.
The claim for transcript costs was denied, as transcript costs are not recoverable under the Expense Regulation.
The total amount awarded was $4,200, inclusive of disbursements and HST.
Limitation period did not begin to run because insurer used an unapproved, invalid denial form.
The appellants were injured in a motor vehicle accident and claimed housekeeping and home maintenance benefits.
The insurer stopped paying benefits after the appellants failed to attend insurer examinations, sending them OCF-9 Explanation of Benefits forms.
The appellants filed for mediation more than two years later.
The Director's Delegate found that the OCF-9 forms used by the insurer were no longer approved by the Superintendent and referred to a nonexistent rebuttal process.
Therefore, the denial notices were invalid, the limitation period had not started to run, and the appellants' claims were not statute-barred.
Application for accident benefits dismissed as abuse of process after applicant failed to file submissions.
The applicant sought statutory accident benefits following a motor vehicle accident.
After a case conference, the applicant was ordered to file written submissions but failed to do so and did not request an extension.
The respondent brought a motion to dismiss the application as an abuse of process.
The adjudicator found the applicant's failure to comply with the order and communicate with the respondent constituted an abuse of process.
The motion was granted and the application was dismissed without costs, as awarding costs against the applicant would render any potential recovery moot.
Appeal allowed; arbitrator erred in denying adjournment to seek counsel and finding abandonment of claim.
The appellant appealed an arbitrator's decision dismissing her claims for statutory accident benefits.
The arbitrator had denied her request for an adjournment to seek new counsel after her previous counsel withdrew shortly before the hearing, and dismissed her claims when she left the hearing room.
The Director's Delegate allowed the appeal, finding that the late delivery of surveillance evidence and the recent withdrawal of counsel meant an adjournment should have been granted.
Furthermore, the appellant's ongoing efforts to retain counsel even after leaving the hearing room demonstrated she had not abandoned her claim.
The matter was remitted to arbitration for a new hearing.
Applicant awarded $67,688.74 in arbitration expenses; claim for solicitor/client costs and additional interest dismissed.
Following an arbitration decision awarding the applicant attendant care and housekeeping benefits, the parties disputed the entitlement to and quantum of expenses.
The arbitrator found the applicant achieved a sufficient degree of success to warrant an award of expenses.
The applicant's request for full indemnity costs on a solicitor/client scale or a special award was rejected, as the arbitrator's discretion is constrained by the Insurance Act and the Dispute Resolution Practice Code.
The arbitrator awarded the applicant $67,688.74 in expenses, applying an enhanced hourly rate of $150.00.
The applicant's claim for interest on overdue payments was dismissed, as the insurer was not required to pay until 10 business days after receiving a Form 1 assessment.
Priority scheme for accident benefits only applies if multiple policies actually provide coverage for the incident.
The appellant insurer appealed an arbitration decision regarding a priority dispute over statutory accident benefits for a claimant injured on an all-terrain vehicle (ATV).
The arbitrator found that the respondent's policy, which specifically insured the ATV, met the definition of an 'accident' under the Statutory Accident Benefits Schedule (SABS).
However, the arbitrator erred by concluding that the appellant's general automobile policy, which did not cover the ATV, was still subject to the priority scheme in s. 268(2) of the Insurance Act.
The Superior Court of Justice held that the threshold for statutory accident benefits must be met under each specific policy before the priority scheme is engaged.
Since only the respondent's policy provided coverage, the priority scheme did not apply, and the appeal was granted.
Insurer ordered to pay $5,850 in expenses following pre-hearing settlement of accident benefits dispute.
The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.
The parties settled all issues except expenses shortly before the arbitration hearing.
The arbitrator determined that the applicant was entitled to expenses under section 282(11) of the Insurance Act.
The arbitrator awarded $1,200 for legal fees, $3,500 for expert reports (allowing the reports of Dr. Jha and Dr. Braganza but rejecting a second report by Dr. Waxer as duplicative), and $1,150 for disbursements, for a total expense award of $5,850.
Leave to appeal granted in priority dispute over whether an ATV incident constitutes an accident.
The applicant insurer sought leave to appeal an arbitrator's preliminary ruling in a priority dispute.
The arbitrator had found that an ATV incident on private property constituted an 'accident' under the Statutory Accident Benefits Schedule, making the applicant responsible for paying benefits.
The court granted leave to appeal, finding that the interpretation of 'accident' and 'automobile' under the legislation raised a question of law, and that the determination of this question would significantly affect the rights of the parties and resolve the mediation.
