Richard Horst

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them, arguing his ongoing back pain was caused by post-accident weight gain rather than the accident.

The Tribunal found that the applicant's rapid weight gain and chronic pain were a result of the accident.

Relying on the applicant's medical experts, the Tribunal concluded the applicant met both the pre-104 week test of substantial inability to perform his pre-accident employment and the post-104 week test of complete inability to engage in suitable employment.

The applicant was awarded ongoing IRBs with interest, and the insurer's claim for repayment of benefits was dismissed.

The applicant requested a reconsideration of a Tribunal decision that denied his application for income replacement benefits following a motor vehicle accident.

The applicant alleged the Tribunal denied him natural justice and procedural fairness by ignoring or mischaracterizing his medical evidence.

The Associate Chair granted the reconsideration, finding that the original adjudicator committed significant errors of law and fact by failing to consider the applicant's evidence regarding his weight and by substantially mischaracterizing the medical reports of several doctors.

The application was ordered to be reheard by a different adjudicator.

The applicant sought dispute resolution for various denied statutory accident benefits following a motor vehicle accident, including attendant care, medical benefits, and out-of-pocket expenses.

The Licence Appeal Tribunal found the applicant was entitled to $297.00 for attendant care provided by a qualified personal support worker.

The Tribunal also awarded $200.00 for the completion of an OCF-18 and $360.00 for a psychological progress report, finding the respondent's denials unreasonable.

The remaining claims for treatment plans, assistive devices, and transportation expenses were dismissed for lack of evidence or failure to meet statutory requirements.

Interest was awarded on the overdue amounts.

The applicant sought ongoing income replacement benefits following a motor vehicle accident.

The respondent had paid benefits until November 2014 but denied further entitlement.

The Tribunal found that the applicant's ongoing back pain was related to pre-existing mild degenerative changes and obesity, not the accident.

Medical evidence also suggested symptom embellishment.

The Tribunal concluded the applicant failed to prove a substantial inability to perform his pre-accident employment or a complete inability to engage in any suitable employment.

The application for ongoing benefits was dismissed.

The respondent's request for repayment of an overpayment was also dismissed as it was not properly raised at the case conference.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident, claiming catastrophic impairment, attendant care, housekeeping, and non-earner benefits.

The insurer argued the applicant's impairments were solely due to pre-existing rheumatoid arthritis.

The arbitrator found the accident was a material contributing factor to the applicant's catastrophic impairment, relying on expert medical and psychological evidence.

However, the claims for attendant care and housekeeping benefits were dismissed because the applicant failed to provide documentary evidence that her service providers suffered an economic loss.

The claim for non-earner benefits was also dismissed due to insufficient evidence comparing pre- and post-accident activities.

The applicant was awarded $3,100 for the cost of examinations.

The insurer appealed an arbitrator's preliminary decision that allowed the insured to proceed with her claim for non-earner benefits despite missing the two-year limitation period to add the issue to arbitration.

The Director's Delegate allowed the appeal, finding that while the insured validly added the non-earner benefits issue to mediation within the two-year period, she failed to add the issue to her application for arbitration before the limitation period expired.

Applying the Court of Appeal's decision in Cornie, the limitation period continued to run despite the lack of a mediator's report, precluding the claim from proceeding to arbitration.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which were denied by the insurer.

After mediation failed, the applicant applied for arbitration but subsequently failed to attend pre-hearings and the scheduled arbitration hearing.

The arbitrator dismissed the application for arbitration due to the applicant's failure to pursue her claims and present evidence.

The insurer was awarded its expenses fixed at $1,500.

The applicant sought non-earner benefits following a motor vehicle accident.

The insurer denied the benefits based on an independent chiropractic examination.

The insurer argued that the applicant failed to commence a mediation proceeding within the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The applicant had requested to add the issue to an existing mediation via letter before the limitation period expired, which was common practice, but did not file a formal Application for Mediation until after the deadline.

The Arbitrator applied the Dispute Resolution Practice Code's rules on broad interpretation and defects in form, finding that the letter validly commenced the mediation proceeding.

The applicant was not barred from proceeding with her claim.

The defendants brought a motion under rule 21.01(1)(b) of the Rules of Civil Procedure to strike portions of the statement of claim alleging conspiracy, fraudulent misrepresentation, negligent misrepresentation, negligence, and unjust enrichment arising from allegedly false insurance assessment claims.

The court applied the “plain and obvious” test for striking pleadings and held that the conspiracy claim was redundant under the merger doctrine where the same damages were claimed for fraudulent misrepresentation.

Claims against the individual defendants were also struck due to insufficient pleaded facts establishing personal tortious conduct separate from the corporate defendants.

However, the court found the pleadings sufficiently disclosed causes of action for fraudulent misrepresentation, negligent misrepresentation, negligence, and unjust enrichment when read generously.

Leave was granted to amend the statement of claim.

Following the dismissal of the applicant's claims for statutory accident benefits, the insurer sought its expenses for the arbitration proceeding.

The arbitrator found that the insurer was completely successful and the applicant was completely unsuccessful, largely due to adverse credibility findings and grossly exaggerated claims.

The arbitrator ordered the applicant to pay the insurer's expenses, fixed at $5,000 inclusive of fees and disbursements.

The applicant sought statutory accident benefits following a motor vehicle accident, including medical, attendant care, and housekeeping benefits.

The arbitrator found the applicant's credibility severely compromised due to material misrepresentations, inflated claims, and failure to provide accurate medical histories to his assessors.

The applicant admitted to submitting claims for periods when he had no symptoms and required no assistance.

The arbitrator gave little weight to the applicant's medical expert due to incomplete information and bias against the Pre-approved Framework (PAF).

Preferring the insurer's assessments, the arbitrator dismissed all of the applicant's claims for accident benefits.

The appellant appealed from a jury trial decision, arguing that the respondent's counsel made a misstatement of law during the opening statement.

The Court of Appeal dismissed the appeal, finding that the trial judge's immediate correction and explicit jury charge were sufficient to cure the error and ensure a fair trial.

Other complaints regarding the opening statement were also dismissed as not serious enough to warrant striking the jury.

The appeal was dismissed with costs fixed at $5,000.

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

The insurer initially denied certain medical benefits and examination expenses, leading the applicant to apply for arbitration.

At a pre-hearing discussion, the applicant brought a motion to withdraw his application because the insurer had paid the service provider and assessor directly, leaving no issues in dispute.

The insurer consented to the motion.

The arbitrator granted the motion to withdraw the application pursuant to Rule 70 of the Dispute Resolution Practice Code and closed the file.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for ongoing acupuncture, physiotherapy, prescription medications, and transportation expenses.

The insurer denied the claims based on independent medical examinations suggesting the applicant had plateaued and that certain medications were experimental.

The arbitrator found that the acupuncture and physiotherapy treatments were reasonable and necessary for pain management and maintaining the applicant's functionality, despite her having reached a plateau.

The arbitrator also approved the claim for Tylenol #4 and transportation expenses.

However, the claims for topical Ketamine/DMSO and Flexeril were denied as experimental and inappropriate for long-term use.

The applicant's request for a special award due to the insurer's administrative errors was dismissed, as the errors did not cause an unreasonable delay in the payment of benefits.

The applicant sought expenses following an arbitration for statutory accident benefits where he was awarded $9,258.33.

The insurer argued it was entitled to expenses for a successful preliminary issue hearing and an unnecessary recusal motion brought by the applicant.

The arbitrator found the applicant was substantially successful overall and had made a reasonable offer to settle.

However, the insurer was entitled to set off its expenses for the preliminary issue hearing, the recusal motion, and the applicant resiling from an agreement.

The arbitrator awarded the applicant net expenses of $7,670.22.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for medical treatments and housekeeping.

The insurer denied the claims.

The arbitrator found that the applicant suffered injuries outside the WAD II PAF Guideline, specifically radiculopathy, and awarded medical benefits for chiropractic, physiotherapy, and acupuncture treatments.

The arbitrator also awarded partial housekeeping benefits for the initial four weeks post-accident, finding the applicant's evidence of ongoing need unreliable.

The third treatment plan was denied as not reasonable or necessary.

The applicant brought a motion requesting that the arbitrator recuse himself on the basis of a reasonable apprehension of bias.

The applicant argued that a prior letter from the arbitrator, which recorded a procedural agreement between the parties, lacked an evidentiary foundation and therefore indicated bias.

The arbitrator dismissed the motion, finding that the letter itself was the record of the agreement reached during a telephone conference, and an informed person would not conclude that the arbitrator would not decide the issues fairly.

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

The insurer requested an examination under oath pursuant to section 33(1.1) of the Statutory Accident Benefits Schedule.

The applicant failed to attend the scheduled examination, arguing that notice was improperly sent to his counsel rather than to him personally, and that the insurer failed to reasonably accommodate his schedule.

The arbitrator found that notice to the applicant's solicitor was sufficient under section 68(2)(a) of the Schedule and that the applicant's counsel failed to respond to scheduling attempts.

Consequently, the insurer is not liable to pay benefits from the date of the missed examination until the applicant complies.

The applicant sought statutory accident benefits following a motor vehicle accident.

After his representatives withdrew from the record, the applicant failed to attend the scheduled arbitration hearing.

As no evidence was adduced in support of the application, the arbitrator dismissed the application as abandoned.

The applicant was ordered to pay the insurer's expenses of the arbitration, fixed at $587.28, due to his conduct which prolonged and hindered the proceeding.

The applicant applied for arbitration at the Financial Services Commission of Ontario after the insurer refused to pay various statutory accident benefits following a motor vehicle accident.

The applicant's representatives withdrew from the record due to an inability to communicate with her.

The applicant failed to attend the pre-hearings, a motion, and the scheduled arbitration hearing.

As no evidence was adduced in support of the application, the arbitrator dismissed the application as abandoned and ordered the applicant to pay the insurer's expenses of the proceeding, fixed at $587.28.