Jason Anand

The applicant sought an income replacement benefit following a motor vehicle accident.

After the application was filed, the respondent paid the arrears and conceded ongoing entitlement, subject to its right to conduct future medical examinations.

The respondent argued the Tribunal lost jurisdiction because there was no longer a dispute.

The Tribunal held it retained jurisdiction because a dispute existed when the application was filed.

However, the Tribunal dismissed the claim for the income replacement benefit as it had been conceded, and refused to issue a declaratory order of ongoing entitlement, finding it would be based on a hypothetical future denial.

The parties were directed to make submissions on interest.

Following a preliminary issue hearing where it was determined that the applicant was not involved in an 'accident' within the meaning of the Schedule, the successful insurer sought its expenses of the arbitration.

The insurer claimed $24,182.62 in costs.

The arbitrator considered the criteria under section 282(11) of the Insurance Act and the Dispute Resolution Practice Code.

Noting that the applicant was an ODSP recipient and that the insurer's claimed hours were excessive given the nature of the preliminary issue, the arbitrator reduced the legal fees to a 2:1 ratio based on the Legal Aid Tariff.

The applicant was ordered to pay $3,028.22 in expenses.

The applicant was injured in a single-vehicle accident and sought a determination of catastrophic impairment based on a Glasgow Coma Scale (GCS) score of 9 or less.

The adjudicator found that while the applicant's GCS score dropped to 8T and 9T following surgery, this was due to pharmacologic sedation and intubation rather than brain impairment.

The applicant's initial GCS scores were 13 to 15, indicating no brain impairment upon arrival at the trauma centre.

The application was dismissed.

The applicant claimed he was injured in a motor vehicle accident while riding his bicycle and sought statutory accident benefits.

The insurer denied the claim, arguing the injuries resulted from a physical altercation with the driver of an SUV, not from the use or operation of an automobile.

The arbitrator found the applicant's testimony inconsistent with the police and emergency room reports, which indicated no physical contact between the SUV and the bicycle.

The arbitrator concluded that the physical altercation was an intervening act that broke the chain of causation, meaning the injuries were not directly caused by the use or operation of a motor vehicle.

The application was dismissed as there was no 'accident' within the meaning of the Schedule.

The insured applied for statutory accident benefits following a motor vehicle accident.

The insurer initiated a Preliminary Issue Hearing to dismiss the application due to the insured's failure to attend insurer examinations.

Prior to the hearing, the insured attended the examination, rendering the preliminary issue moot.

The insurer sought its expenses for preparing for the hearing.

The Arbitrator reserved the issue of expenses to the arbitrator seized of the substantive arbitration, noting that the delay in attending the examination may be relevant to the final disposition.