Neil Colville-Reeves

The applicant's law firm brought a motion to be removed as solicitors of record after the applicant passed away and the firm was unable to obtain instructions from a representative of her estate.

The insurer and the solicitor acting on matters relating to the estate consented to the withdrawal.

The arbitrator granted the motion pursuant to Rule 9.8 of the Dispute Resolution Practice Code.

The applicant, a plasterer, was injured in a motor vehicle accident and claimed ongoing income replacement benefits (IRBs) and medical benefits for a chronic pain condition.

The insurer terminated IRBs, arguing the applicant's chronic pain lacked objective medical evidence and was driven by pre-existing psychological factors.

The arbitrator found that the applicant developed a bona fide chronic pain condition as a result of the accident, rendering him substantially unable to perform his essential tasks or any suitable employment.

The arbitrator awarded ongoing IRBs, various medical expenses, and assessment costs.

Furthermore, the arbitrator ordered a special award of $7,500 against the insurer for unreasonably withholding payments and failing to properly assess the applicant's chronic pain condition.

The applicant was injured when her bicycle was struck by a parked car's door.

She was later diagnosed with Multiple Sclerosis (MS) and claimed statutory accident benefits, arguing the trauma from the accident triggered her MS.

The arbitrator reviewed expert neurological evidence on the theory that trauma can disrupt the blood-brain barrier and trigger latent MS.

The arbitrator found the theory speculative and concluded the applicant failed to prove the accident triggered her MS, noting she had pre-accident neurological symptoms and lacked evidence of serious trauma.

The claims for income replacement benefits, medical benefits, and a special award were dismissed.

The appellant insurer appealed an arbitrator's decision awarding the respondent income replacement and housekeeping benefits following a motor vehicle accident.

The insurer argued the arbitrator failed to apply the proper causation test and failed to provide adequate reasons, particularly regarding the respondent's pre-existing depression and medical history.

The Director's Delegate dismissed the appeal, finding the arbitrator correctly applied the material contribution test and properly treated the respondent as a 'thin skull' rather than a 'crumbling skull' case.

The Delegate held that the arbitrator's factual findings were supported by the evidence and her reasons were adequate.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The insurer terminated benefits and sought repayment, arguing the applicant was not involved in the accident.

At a preliminary issue hearing, the arbitrator found the applicant's evidence lacked credibility due to inconsistencies with medical records and contradictory testimony from his mother and the occupants of the other vehicle, who testified he was not in the car.

The arbitrator concluded the applicant was not involved in an accident under section 2(1) of the Schedule and held that the insurer was entitled to pursue repayment of benefits paid.

The applicant was injured in a motor vehicle accident and successfully opposed the insurer's motion to compel her attendance at a medical examination.

In this subsequent hearing on expenses, the arbitrator applied the criteria under section 12(2) of Ontario Regulation 664.

Finding that the applicant was completely successful and that the insurer's motion was unnecessary, the arbitrator awarded the applicant her expenses of the motion, assessed at $2,998.61.

The insurer brought a motion for a preliminary issue seeking an order that the insured attend a medical examination under s. 42 of the Statutory Accident Benefits Schedule, and to stay the arbitration proceedings until she did so.

The arbitrator found that the requested examination was not reasonably necessary because the insurer had delayed its request for over a year after learning of the insured's multiple sclerosis, suggesting the examination was sought to bolster its case for arbitration rather than to adjust the claim.

Furthermore, the notice of examination was deficient.

The arbitrator also noted a lack of jurisdiction to order attendance at a medical examination.

The motion was dismissed and the arbitration was not stayed.

The insurer brought a motion for leave to amend its Response to an Application for Arbitration to include new issues, specifically whether the applicant was actually involved in the motor vehicle accident, whether the applicant must repay benefits received, and the quantum of income replacement benefits.

The motion was prompted by unsolicited witness statements suggesting the applicant was not in the accident.

The arbitrator granted the motion, finding that the issue of involvement goes to the heart of entitlement, the amendment was sought in a timely manner after the evidence surfaced, and the delay and prejudice did not outweigh the need to determine the core issue of entitlement.

The applicant's arbitration for statutory accident benefits was previously dismissed as frivolous and vexatious after he failed to attend the hearing.

The insurer subsequently sought its expenses under section 282(11) of the Insurance Act.

The arbitrator found that the insurer was completely successful in its application for dismissal and awarded $1,782.83 for legal fees and disbursements.

The arbitrator declined to award the $3,000 filing fee, noting that legislative amendments revoked the jurisdiction to order repayment of the assessment fee.

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

The insurer denied the claim for income replacement benefits, leading the applicant to apply for arbitration.

The insurer brought a motion to dismiss or stay the arbitration because the applicant had commenced a parallel court action against the insurer.

On consent of the parties, the arbitrator ordered that the arbitration be stayed pending the outcome of the court action and that the parties bear their own expenses of the motion.

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

After the insurer terminated benefits, the applicant applied for arbitration.

The applicant failed to communicate with his counsel, respond to production requests, or attend the pre-hearing, leading his counsel to withdraw.

The insurer brought a preliminary issue hearing to dismiss the arbitration as frivolous and vexatious.

The applicant failed to attend the hearing despite receiving proper notice.

The arbitrator found the applicant completely failed in his obligations to support his claim and dismissed the arbitration as frivolous and vexatious.

The applicant was injured in a motor vehicle accident and sought income replacement and housekeeping benefits, which the insurer terminated.

The arbitrator found that the accident materially contributed to the applicant's development of chronic pain syndrome, rendering her completely unable to engage in any employment for which she was reasonably suited.

The arbitrator awarded ongoing income replacement benefits and a closed period of housekeeping benefits, along with interest.

The claim for a special award was dismissed, as the insurer's actions, while mistaken, were not unreasonable given the complex medical history.

The Applicant sought an award of expenses following a pre-hearing motion in which the Insurer's request for production of defence medical reports was denied.

The Arbitrator held that interim expenses should only be awarded in exceptional circumstances, which were not present here.

The request for expenses was denied, with the issue left to be determined by the hearing arbitrator at the conclusion of the proceeding.

The applicants claimed statutory accident benefits following a motor vehicle accident.

During pre-hearings, their non-lawyer representative demonstrated incompetence, failed to understand the issues, and caused unnecessary delays.

The arbitrator held a preliminary hearing to determine whether the representative should be barred from the proceedings and ordered to pay costs personally.

The arbitrator found that the representative's conduct fell below minimum standards, caused wasted expenses, and amounted to an abuse of process.

The representative was barred from appearing as an agent under section 23(3) of the Statutory Powers Procedure Act and ordered to personally pay $400 in costs to the insurer under section 282(11.2) of the Insurance Act.

The insured person was injured in a motor vehicle accident and initially elected to receive caregiver benefits.

She later attempted to re-elect income replacement benefits, which the insurer refused on the basis that elections are irrevocable.

The Arbitrator found the initial election invalid because the insurer failed to provide sufficient information about the implications of the choice, specifically that the higher benefit might not be the longer-lasting one.

On appeal, the Director's Delegate upheld the Arbitrator's decision, finding that the insurer did not meet its obligations under s. 32(2)(d) of the SABS-1996.

The Delegate also held that s. 36 allows an insured person to re-elect benefits, subject to statutory time limits and the requirement to provide a reasonable explanation for any delay.

The applicant was struck by a car as a pedestrian and sustained soft tissue injuries that developed into chronic pain and psychological impairments.

She sought statutory accident benefits for prolonged passive chiropractic and acupuncture treatments, assistive devices, attendant care, and housekeeping expenses.

The arbitrator found that the applicant's failure to submit a treatment plan for chiropractic care disentitled her to those expenses, and that the prolonged passive chiropractic treatment was not reasonable or necessary.

However, the arbitrator allowed the expenses for acupuncture as a reasonable palliative measure, along with the cost of a TENS machine and partial housekeeping expenses.

Claims for attendant care and other assistive devices were dismissed.

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

The arbitrator reviewed the insurer's docketed time and reduced the hours claimed, finding that the issues were straightforward and the hearing was brief.

The arbitrator awarded the insurer $2,244.93 in fees and disbursements but declined to award the $3,000 arbitration assessment fee, as the insurer had not provided prior notice of a claim that the proceeding was frivolous, vexatious, or an abuse of process.

The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits and payment for treatment expenses after the insurer terminated them.

The applicant failed to attend the arbitration hearing.

The arbitrator reviewed the insurer's evidence, including medical opinions indicating the applicant was capable of returning to work as a manicurist.

The arbitrator found the applicant failed to meet the burden of proving a substantial inability to perform the essential tasks of his employment or that the disputed treatment was reasonable and necessary.

The claims were dismissed, and the insurer was awarded its expenses for the arbitration.

The applicant, an elderly pedestrian, sustained a closed head injury when struck by a vehicle.

She claimed statutory accident benefits for care-giving services provided by her daughter and travel expenses for her granddaughter.

The arbitrator found that the accident materially contributed to the applicant's cognitive impairments.

However, applying the Court of Appeal's decision in Monochino, the arbitrator held that the applicant was not entitled to care-giver benefits because her daughter did not lose income and did not qualify as a professional care-giver.

The claim for travel expenses was dismissed as the trip was not for the applicant's benefit.

The claim for a special award was also dismissed.

The applicant was injured in a rear-end motor vehicle accident and received statutory accident benefits from the insurer.

The insurer terminated his medical rehabilitation benefits based on a Designated Assessment Centre report and the discharge report of his own chiropractor.

The applicant sought payment for ongoing chiropractic treatments, a special award, and arbitration expenses.

The arbitrator dismissed the claim for medical expenses, finding the applicant failed to provide objective medical evidence that the ongoing treatment was reasonable and necessary.

The claim for a special award was also dismissed as the insurer's denial was not unreasonable.

However, the arbitrator awarded the applicant his arbitration expenses, concluding that his claim was legitimate, presented in a timely manner, and not frivolous.