Mouna Hanna

The applicant failed to attend his scheduled arbitration hearing for statutory accident benefits.

At the commencement of the hearing, the applicant's counsel successfully moved to be removed from the record due to a breakdown in the solicitor-client relationship.

The arbitrator proceeded in the applicant's absence and dismissed the application for arbitration because the applicant failed to meet his burden of proof.

The insurer was awarded expenses for the proceeding, while the applicant was awarded expenses for a previous motion on which he was successful.

Following an arbitration where the insurer was completely successful in defending against the applicant's claims for statutory accident benefits, the insurer requested an expense hearing.

The arbitrator reviewed the insurer's claimed expenses of $18,251.15, considering factors such as the degree of success, offers to settle, and the applicant's failure to comply with undertakings.

Finding the insurer's hours and disbursements reasonable, the arbitrator ordered the applicant to pay the full claimed amount of $18,251.15.

The appellants, minors injured in a motor vehicle accident, appealed an Arbitrator's decision dismissing their claim for a special award and ordering them to pay the insurer's expenses.

The Director's Delegate found that the Arbitrator breached natural justice by failing to provide reasons for the expenses award, rescinding that portion of the order and remitting it for a re-hearing.

However, the Delegate upheld the dismissal of the special award claim, finding the Arbitrator correctly concluded there was insufficient evidence that the insurer unreasonably withheld or delayed payments.

The Delegate also held that while the Arbitrator may have erred in applying witness notice rules to a party, the exclusion of the appellant's testimony had no bearing on the outcome.

The insurer brought a motion arguing that the applicant's claim for a non-earner benefit was statute-barred because he failed to apply for mediation within two years of the insurer's refusal to pay.

The arbitrator found that the applicant had not actually applied for the non-earner benefit when the insurer issued its initial denial in 2013.

Therefore, the insurer could not validly refuse a benefit that had not been claimed.

The limitation period did not begin to run until the insurer's subsequent denial in 2015, making the applicant's mediation request timely.

The motion was dismissed.

The appellant was injured in a motor vehicle accident and sought payment for an in-home assessment under the Statutory Accident Benefits Schedule.

The insurer failed to respond to the treatment plan within the required 10 business days.

The appellant argued this failure required the insurer to pay for the assessment regardless of its merits.

The Director's Delegate affirmed the Arbitrator's decision, holding that the mandatory payment provision was not raised at arbitration and, in any event, assessments remain subject to a reasonableness and necessity test.

The applicants, two minors injured in a motor vehicle accident, sought a special award under s. 282(10) of the Insurance Act, alleging the insurer unreasonably withheld or delayed payment of statutory accident benefits.

Prior to the hearing, all substantive issues regarding medical benefits and interest were settled.

The arbitrator dismissed the claim for a special award, finding no evidence that the insurer mishandled the file or acted in bad faith.

The insurer had relied on independent medical examinations that differed from the applicants' family doctor's recommendations, which constituted a mere difference of opinion rather than unreasonable withholding of benefits.

The insurer was awarded its expenses for the arbitration hearing.

The applicant applied for statutory accident benefits following two motor vehicle accidents.

The parties were unable to resolve their disputes through mediation, and the applicant applied for arbitration.

At the scheduled arbitration hearing, the applicant failed to appear, although his representative was present.

The insurer brought a motion to dismiss the applications.

The arbitrator found that the applicant had been notified of the proceedings and failed to meet his onus of proof by not attending.

The applications for arbitration were dismissed, and the insurer was awarded $500 in expenses for each application.

The applicant sought payment for a family and social assessment and custom orthotics following a motor vehicle accident.

The applicant argued that the insurer failed to respond to the treatment plans within the required time, resulting in deemed approval under the Statutory Accident Benefits Schedule.

The arbitrator held that the deemed approval provisions relate to the timing of interim payments pending dispute resolution and do not override the substantive requirement that expenses be reasonable and necessary.

The arbitrator found insufficient evidence to prove the treatment plans were properly submitted or that the claimed expenses were reasonable and necessary.

The claims were dismissed.

The applicants sought statutory accident benefits following a 2007 motor vehicle accident.

After filing the applications for arbitration, the applicants' legal representative lost contact with them, and they failed to appear at scheduled pre-hearings or provide productions.

The representative moved to be removed from the record, and the insurer moved to dismiss the applications and sought costs against both the applicants and their representative.

The arbitrator granted the representative's motion to be removed due to a breakdown in the solicitor-client relationship.

The applications were dismissed as frivolous or vexatious under Rule 68 of the Dispute Resolution Practice Code due to the applicants' failure to participate.

The arbitrator awarded the insurer $500 in expenses against each applicant but declined to award costs against the representative, finding insufficient evidence on the record to conclude that the claims were entirely time-barred when filed.

The Applicant was injured in a motor vehicle accident and received Non-Earner Benefits until the Insurer terminated them on November 30, 2011, issuing an Explanation of Benefits (OCF-9) on November 23, 2011.

The Applicant applied for mediation on March 13, 2014, beyond the two-year limitation period.

The Applicant argued the OCF-9 was invalid because it cited the wrong section of the Statutory Accident Benefits Schedule.

The Arbitrator held that the refusal was clear, unequivocal, and sufficient to trigger the limitation period, as perfection is not required.

The Applicant is therefore statute-barred from proceeding to arbitration for further Non-Earner Benefits.

The defendant insurer brought a motion for summary judgment to dismiss the plaintiff's claim for unidentified motorist coverage.

The plaintiff alleged she was involved in a hit-and-run accident but failed to report it to the police or the insurer within the statutory timeframes, relying on alleged advice from an insurance broker's employee.

The court found the plaintiff failed to comply with the strict reporting requirements under the Insurance Act and the Uninsured Automobile Coverage schedule.

Applying the test for relief from forfeiture, the court held the plaintiff's conduct was unreasonable and the insurer suffered actual and potential prejudice by losing the opportunity to investigate.

The motion for summary judgment was granted and the action dismissed.

The applicant was involved in a motor vehicle accident and her application for statutory accident benefits was dismissed in a prior decision, with the insurer entitled to its expenses.

The insurer claimed $7,591.67 in expenses.

The self-represented applicant submitted she lacked familiarity with the process and could not afford the claimed amount.

The arbitrator fixed the expenses payable by the applicant to the insurer at $1,500 inclusive of disbursements and HST.