Linda Matthews

The insurer brought a motion to stay the arbitration proceeding until the applicant attended a section 42 assessment with a physiatrist.

The applicant had previously attended multiple insurer examinations and the insurer had consistently denied his claim for non-earner benefits.

The arbitrator found that the insurer's request, made almost a year after learning of the applicant's physiatrist treatment and only five months before the hearing, was primarily to bolster its case rather than adjust the claim.

The motion was denied as the proposed assessment was not reasonable and necessary at this time.

The appellant appealed an order refusing to extend the time for service of the statement of claim.

The Court of Appeal found that the motion judge erred by allowing his frustration with plaintiff's counsel to displace the assessment of prejudice to the defendant, and by improperly concluding the plaintiff had no case.

Finding little to no prejudice to the defendant, the Court allowed the appeal and extended the time for service, but awarded no costs due to the conduct of plaintiff's counsel.

The insurer brought a motion for production of the transcript of the applicant's examination for discovery from a related tort action.

The applicant opposed the motion, arguing the transcript was not relevant to the specific period of housekeeping benefits in dispute.

The arbitrator denied the motion, finding that ordering production would give the insurer an unfair advantage by effectively importing the discovery process into the FSCO proceeding, which is not permitted under the Insurance Act.

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

The insurer refused to pay, arguing the applicant failed to provide necessary financial information to assess the claim, as required by section 33 of the Statutory Accident Benefits Schedule.

At the arbitration hearing, the applicant's newly retained counsel requested an adjournment to produce tax returns that had been requested for over two years.

The arbitrator denied the adjournment and refused to admit the late-produced documents into evidence, finding the delay was avoidable and the applicant had engaged in tactical brinkmanship.

The claim for income replacement benefits was dismissed, and the applicant was ordered to pay the insurer's arbitration expenses.

The applicant was injured in a motor vehicle accident and claimed housekeeping expenses under the Statutory Accident Benefits Schedule.

The insurer denied the benefits based on an in-home assessment.

The arbitrator found the applicant suffered a substantial inability to perform his pre-accident housekeeping activities for a limited period and awarded $315 in housekeeping benefits.

The arbitrator also granted a $40 special award because the insurer unreasonably withheld benefits for a four-week period prior to the assessment.

The insurer's claim that the arbitration was frivolous or vexatious was dismissed.

The insurer appealed an arbitration order awarding the insured person ongoing income replacement benefits, attendant care benefits, medical benefits, and a special award following a motor vehicle accident.

The Director's Delegate upheld the award of income replacement benefits, finding no error in the arbitrator's conclusion that the insured person suffered a complete inability to engage in suitable employment due to chronic pain.

However, the Delegate reversed the award of attendant care benefits beyond the 104-week mark, holding that the transitional provisions of the SABS-1996 did not suspend the temporal limit.

The Delegate also reversed the award of medical benefits for a specific clinic, finding the arbitrator erred in ordering benefits solely because of a delay in obtaining a DAC report.

The special award was consequently reduced to reflect only those benefits that were unreasonably delayed and actually payable.