Neutral Citation: 2004 ONFSCDRS 7
FSCO A03-000753
FINANCIAL SERVICES COMMISSION OF ONTARIO
BETWEEN:
GARY WILKERSON
Applicant
and
ALLIANZ INSURANCE COMPANY OF CANADA
Insurer
PRE-HEARING DECISION
Before:
David Muir
Heard:
By telephone conference call on November 17, 20, 28, and December 2, 2003.
Appearances:
Richard Levin for Mr. Wilkerson
Joan Takahashi for Allianz Insurance Company of Canada
Issues:
Gary Wilkerson was injured in a motor vehicle accident on April 14, 1999. He applied for and received statutory accident benefits from Allianz Insurance Company of Canada ("Allianz"), payable under the Schedule.1
A number of disputes over statutory accident benefits have developed between the parties which they have been unable to resolve through mediation, and Mr. Wilkerson applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended.
The issues in dispute in the main arbitration hearing have been identified by the parties, as follows:
Non-earner benefit pursuant to section 12 of the Schedule.
Medical benefits for physiotherapy from Professional Physiotherapy Clinic ($7,660 to date of mediation and ongoing) claimed pursuant to section 14 of the Schedule.
Rehabilitation benefit for home modifications ($250,000) claimed pursuant to section 15 of the Schedule.
Attendant care benefits provided by Para Med ($39,308.93 to date of mediation and ongoing) pursuant to section 16 of the Schedule.
A special award pursuant to subsection 282(10) of the Insurance Act.
A determination that Mr. Wilkerson is catastrophically impaired as defined in subsection 2(1) of the Schedule.
In addition, Mr. Wilkerson is seeking interest on any amounts found to be owing, and each party is seeking their expenses of the arbitration.
Each party brought a motion subsequent to the initial pre-hearing in this case. The pre-hearing discussion was resumed on November 17, 20, 28 and December 2, 2003. Briefly, Mr. Wilkerson seeks production of material in the Insurer's file. Allianz seeks to have Mr. Wilkerson attend an insurer's medical assessment.
I will first deal with Mr. Wilkerson's motion and then consider the issue brought by Allianz.
MR. WILKERSON'S PRODUCTION MOTION:
Mr. Wilkerson seeks the production of the entire accident benefits file of Allianz to the date of the anticipated arbitration hearing in March 2004 and specifically, the production of all internal memoranda and adjusters' notes to the date of the arbitration hearing and any communications between Allianz and its solicitors, including any legal opinions.
Allianz refuses to produce its internal memoranda and adjusters' notes, claiming they are protected by litigation privilege or, alternatively, are not relevant to the issues in dispute in this proceeding. As for any legal opinions, Allianz relies on solicitor-client privilege which it claims it has not waived.
The issues raised by Mr. Wilkerson's requests can be described in the following issue statements:
- Is Mr. Wilkerson entitled to the production of Allianz's entire accident benefits file including adjusters' notes and internal memoranda to date and ongoing to the arbitration?
Result:
Mr. Wilkerson is entitled to the production of the entire accident benefits file including adjusters' notes and internal memoranda to the date of the relevant application for mediation.
- Is Allianz required to produce all legal opinions and other solicitor-client correspondence between it and its counsel, to date and ongoing to the arbitration.
Result:
Mr. Wilkerson is entitled to the production of the entire accident benefits file including any solicitor-client communications to the date of the relevant application for mediation.
There are two privileges at issue here - solicitor-client privilege and litigation privilege. The onus of establishing that either privilege applies to these circumstances rests, at least initially, with the party asserting it, in this case Allianz. I find for the reasons set out below that Allianz has not met its burdens, at least until Mr. Wilkerson submitted issues to mediation.
Solicitor-client privilege is "a fundamental protective principle of substantive law."2
Solicitor-client privilege describes the privilege that exists between a client and his or her lawyer. This privilege is fundamental to the justice system in Canada. The law is a complex web of interests, relationships and rules. The integrity of the administration of justice depends upon the unique role of the solicitor who provides legal advice to clients within this complex system. At the heart of this privilege lies the concept that people must be able to speak candidly with their lawyers and so enable their interests to be fully represented.3
However, not all communications between a solicitor and his or her client are privileged – "only those which arise between the lawyer and client where the latter has sought legal advice."4 Even where legal advice has been sought, the solicitor-client communication in question may no longer be privileged where the privilege was waived in fact or by operation of the law.
In order for Allianz to establish the application of solicitor-client privilege with respect to any particular document, it must show that it relates to or contains a communication between the client and their solicitor, seeking legal advice and, further, that the privilege has not been waived.
Litigation privilege is related to solicitor-client privilege, but different in that it is broader in its application:
Litigation privilege exists to protect from production a communication made or a document created for the dominant purpose of assisting the client in litigation, actual or contemplated. It applies to third party communications made in confidence and for purposes of preparing for trial.5
The rationale for this privilege is somewhat different than that justifying solicitor-client privilege. It is "based upon the need for a protected area to facilitate a process (namely, the adversary process), while solicitor-client privilege aims to protect a relationship (namely, the confidential relationship between a lawyer and a client)."6
In order to establish litigation privilege, Allianz must show that the document or documents in question were created for the dominant purpose of litigation with Mr. Wilkerson.7
The Facts:
The factual record as it relates to the production motion is quite limited. Allianz relies upon an affidavit of Barb Kuper, an employee of the Insurer with carriage of the file at present. Mr. Wilkerson relies upon the affidavit of Ms. Kuper as well. In addition, the adjusters' notes produced to date, i.e. up to and including November 7, 2001, and a number of medical reports were filed.8
Ms. Kuper was not handling the file at the time that the decision to retain counsel was made. It is not clear from her affidavit when she became involved in the file.
The parties also sought to rely upon their submissions, which included for the most part non-controversial assertions of fact. However, I have placed no reliance on those submissions as to facts where they are contested or relate to points of controversy.
Mr. Wilkerson is 65 years old. He was seriously injured in an automobile accident in April 1999. He was not in good health prior to the accident and suffered a number of maladies, notably diabetes and epilepsy. According to the affidavit of Ms. Kuper, Mr. Wilkerson initially claimed physiotherapy and medical expenses, transportation expenses, visitor expenses, as well as accommodation and attendant care expenses. Some of these benefits were paid, for example attendant care, but others were not.
At an undisclosed later date, a claim for non-earner benefits was made by Mr. Wilkerson. Allianz denied this benefit on April 23, 2001. By letter dated May 11, 2001, Mr. Wilkerson's representative questioned Allianz's reliance on an inconclusive Catastrophic DAC assessment (CAT DAC)9 to deny non-earner benefits and indicated that Mr. Wilkerson may seek to mediate this issue. The letter also notes the advice of an agent for Allianz that it would not pay attendant care beyond the two-year mark. A letter dated November 6, 2001 advised Mr. Wilkerson's representative that the monetary limits for attendant care, where there is no catastrophic injury, were approaching and by implication at least, benefits would be terminated at that point.
In July 2001, his counsel at the time wrote to Allianz requesting a determination of catastrophic impairment pursuant to section 40 of the Schedule. A further CAT DAC was conducted by the firm of Kaplan and Kaplan in March 2002. A key issue in dispute between the parties is whether or not Mr. Wilkerson has suffered a catastrophic impairment.
A settlement meeting was held on November 6, 2001 involving Allianz, Mr. Wilkerson's legal representatives and counsel for the tort defendant. Mr. Wilkerson's counsel, in a letter to Allianz dated October 15, 2001, outlined his positions and indicated that if the parties were unable to "resolve this matter ...we have been instructed to proceed to all necessary DAC's and/or mediations." The meeting was held for the purpose of attempting to fully settle both the accident benefits claim and the tort claims, regardless of whether or not items were then formally in dispute.
It appears that there was a significant gap between the parties at that time and the parties were unable to resolve the matter on a full and final basis. Ms. Kuper, in her affidavit, deposes that she believes that it was after the settlement meeting failed that counsel was retained by Allianz. She also deposes that it was her belief that counsel was retained because "Allianz was anticipating that litigation or arbitration was imminent, as it is a policy of Allianz to retain counsel only in such situations." The affidavit does not disclose who made the decision to retain counsel, or precisely when that decision was made.
On October 31, 2002, Mr. Wilkerson made an Application for Mediation. The issues referred to mediation at that time were non-earner benefits and the conclusion of the CAT DAC.10 The other issues now going to arbitration such as attendant care and medical benefits, were not formally in dispute at that time.11 At a later undisclosed date, another Application(s) for Mediation was made.
In May 2003, Mr. Levin requested a second CAT DAC. Counsel for Allianz asked for the statutory authority Mr. Wilkerson relied upon in requesting a further CAT DAC. Mr. Levin, in response, cited evidence of the deteriorating medical condition of Mr. Wilkerson and offered that there was nothing in the Schedule which precluded a second DAC assessment. In her affidavit at paragraph 18, Ms. Kuper asserts that "it was determined" by Allianz that it had no obligation to offer a second CAT DAC and instructed its counsel to relay this information to Mr. Wilkerson. In doing so, Ms. Kuper states Allianz was not waiving any privilege with respect to its communication with its lawyer. It is not clear how Ms. Kuper came to this understanding.
The positions of the parties:
Briefly, Mr. Levin says that the material Mr. Wilkerson seeks is relevant to his special award claim. As for the litigation privilege claims of Allianz, Mr. Levin submits that there is no evidence that the dominant purpose of the creation of the documents in question was for the purposes of litigation and therefore, if relevant, the documents in question are producible.
Mr. Levin also submits that the manner and timing of Allianz's retaining of counsel was highly unusual, coming as it did almost a full year before the first issues were referred to mediation. Mr. Levin submits that counsel was retained not for the dominant purpose of providing legal advice, but to assist in the adjusting of the accident benefits file. Mr. Levin further states that because counsel was retained before the arbitration and for the purposes of adjusting the file, Allianz cannot rely upon either privilege at any point in the process up to the date of the scheduled arbitration hearing.
Mr. Levin further claims that Allianz has waived privilege by placing its state of mind in issue in the manner in which it adjusted Mr. Wilkerson's claims file. Mr. Levin states that the correspondence between counsel about a second CAT DAC, described in Ms. Kuper's affidavit, places Allianz's state of mind in issue such that any legal advice is producible.
Allianz states the documents Mr. Wilkerson seeks are either irrelevant or are protected by litigation privilege or solicitor-client privilege. The claim of litigation privilege is based on the assertion that counsel was retained in November 2001 because Allianz considered that litigation with Mr. Wilkerson was imminent. Ms. Takahashi states it is a mischaracterization for Mr. Levin to claim that there were no issues in dispute in November 2001 and relies upon the October 15, 2001 letter from Applicant's counsel which indicates that, in the event that parties cannot resolve their disputes in a proposed settlement meeting, they were instructed to proceed to mediation. Allianz also relies on the fact that non-earner benefits were in dispute from April 2001, as well as its communication to Mr. Wilkerson's counsel that it would not be paying attendant care benefits beyond 104 weeks or the monetary maximums for an individual who had not suffered a catastrophic impairment.
In short, Allianz submits that, although no issues in dispute were referred to mediation until October 2002, Allianz's positions on each of the issues now in dispute had been taken already and were known to Mr. Wilkerson by November 2001.
In response to the submission that it had waived solicitor-client privilege by placing its state of mind in issue, Allianz submits that there is no basis for such a claim in this case. In its submission, there must be evidence of it having sought and relied upon legal advice. In this case, there is no such evidence and accordingly there is no basis for concluding that solicitor-client privilege has been waived.
ANALYSIS:
I find that the material being sought by Mr. Wilkerson is potentially relevant to the special award which Mr. Wilkerson is seeking. In this regard, I accept the analysis of Arbitrator Wilson in Nigro and State Farm Mutual Automobile Insurance Company12 In this case, Mr. Wilkerson's requests for internal correspondence, notes and memoranda including legal opinions is not a mere fishing expedition in support of a pro forma claim for a special award. There appears, based on an extremely limited record, some substantial basis to the claim.
Mr. Levin claims that Allianz has waived solicitor-client privilege by placing its state of mind in issue. The basis for this assertion is limited. Allianz does not state that it relied upon legal advice in making claims management decisions. Indeed, there is no evidence that any legal advice was sought by Allianz or provided to it prior to the referral of disputes to mediation. What we do know is that Allianz retained counsel well in advance of any issue in dispute being referred to mediation. Mr. Levin claims that this calls out for an explanation from Allianz and, in the absence of an explanation, asks that I draw the inference that counsel provided legal advice upon which Allianz relied in making claims management decisions. We also know that Mr. Wilkerson is seeking a special award.
I am not persuaded that waiver necessarily arises in this case. Rather, the difficulty is in establishing the existence of the privilege claimed by Allianz.
The limited record placed before me discloses almost no evidence to support solicitor-client privilege beyond the mere fact that counsel was retained at some point, presumably soon after the November 6, 2001 meeting. More to the point, there is no evidence that Allianz sought any legal advice and equally no evidence that such advice was provided. As noted above, not all communications between a solicitor and their client are privileged, "only those that which arise between the lawyer and client where the latter has sought legal advice."13
Moreover, there is evidence that counsel was not retained for the purpose of providing legal advice but for purpose of assisting in the adjusting of Mr. Wilkerson's claims. The report of Dr. G. Lloyd, dated September 26, 2002, is confined to the question of whether or not Mr. Wilkerson was catastrophically impaired and was made a few weeks prior to the first Application for Mediation. The report is addressed to Allianz's counsel, not to Allianz.
The only proper basis for an insurer's examination of a person claiming a benefit, is to determine that person's entitlement to the benefit under the Schedule.14 The determination of entitlement to a benefit is made by an insurer. I find that the report of Dr. Lloyd, addressed as it is to counsel and not to Allianz, establishes that counsel had stepped into the shoes of the adjuster at least until September 26, 2002, the date of the report in question.
Turning now to the claim of litigation privilege, the evidentiary burden on an insurer seeking to establish it is not insignificant, depending upon the period of time for which the claim is made. Motor vehicle accident benefits are first party claims. There is a systemic presumption, rebuttable for certain periods of time, that any particular document in an accident benefits file was created for the purpose of adjusting the claim and not for purpose of anticipated litigation. An insurer, even after arbitration has been requested, is still expected to be adjusting its file in a good faith, reasonable manner. In response to this fluidity of roles, arbitrators have often relied on the date the insured person refers the dispute to mediation - the first formal step in the dispute resolution process - to define a line between claims adjustment and litigation for purposes of determining whether internal insurer documentation is producible. This bright line only reflects a presump-tion, which is rebuttable, that before that date the insurer was primarily concerned with adjusting the file and that after that date its focus might have reasonably shifted to preparing for litigation.
Allianz's submissions assume that, if it establishes that litigation was imminent on November 7, 2001, that fact would insulate the entire file subsequent to that date. This is not the law.15
The affidavit of Ms. Kuper is insufficient to support the claim of litigation privilege for two primary reasons. First, it does not establish that litigation was contemplated - only that Ms. Kuper believed that Allianz must have considered that litigation was imminent, based on her understanding of company policy. This is not sufficient to establish that Allianz considered that litigation was imminent.
Further, the fact the parties were unable to resolve this case on a full and final basis does not necessarily require the inference that litigation is imminent. Parties might attempt to negotiate a lumping out of a claims file even where there are no issues in dispute and no litigation contemplated. Accordingly, the fact the settlement meeting on November 6, 2001 was not successful does not support Allianz's position that litigation was imminent.
The second problem with Allianz's position is more profound. Even if it is true that Allianz believed that litigation was imminent, that fact does not establish that every subsequent document was created for the dominant purpose of the litigation. Based on the material, there is no evidence that the dominant purpose for the creation of documents after November 6, 2001 was anticipated litigation.
A fair examination of the circumstances as they were in early November 2001 suggests that there were issues between the parties which had crystallized and that were likely to be referred to mediation. However, I am not persuaded that litigation was imminent in this case as of November 7, 2001, nor am I persuaded that each and every document thereafter was created for the dominant purpose of litigation. Accordingly, there is no privilege that attaches to the documents sought by Mr. Wilkerson and they ought to be produced.
Mr. Wilkerson also seeks the production of the entire file to date and ongoing to the arbitration. The basis for the request is that having retained counsel, not as counsel but for adjusting assistance, it could never again assert solicitor-client or litigation privilege in this matter.
This position as it relates to the production of documents that have yet to be produced is without merit, if no other reason than it is specifically prohibited by the Court in Davies v. American Home Insurance Co.16 Even if not strictly bound by that decision, I find that Allianz has not, by simply retaining counsel relatively early in the process, waived forever its ability to assert solicitor-client or litigation privilege.
There is also nothing before me which would require Allianz to produce its file beyond the date(s) the various issues were referred to mediation. Mr. Levin states that the exchange of correspondence related to a second CAT DAC in May and July 2003 places the state of mind of Allianz in issue and gives rise to a waiver of solicitor-client privilege. I do not agree. First, I note that the Court in Davies, supra, made clear that merely seeking legal advice does not give rise to a waiver of privilege. I also note that the issue raised in the correspondence between counsel occurred well after the parties were in litigation and related not to an issue in dispute, but to a procedural question somewhat tangentially related to disputes between the parties.
I find therefore that Mr. Levin is entitled to the production of the entire accident benefits file including adjusters' notes, internal memoranda, communications between Allianz and its counsel to the date(s) the issues in dispute in this matter were referred to mediation. In this regard, I note that there appears to have been more than one Application for Mediation in this case. Documents related to these various issues will be produced until the date each of them was referred to mediation.
ALLIANZ'S MOTION FOR AN INSURER'S MEDICAL ASSESSMENT:
Allianz seeks the following relief:
A determination that the requested assessment is reasonable and necessary pursuant to section 42 of the Schedule.
An order that the arbitration hearing currently scheduled to be held in March 2004 be adjourned in the event that the required assessment cannot be completed in a timely manner.
An order that the arbitration of Mr. Wilkerson be stayed pending an attendance at the requested assessment.
By letter dated December 3, 2003, I delivered my rulings on these requests as follows, with reasons to follow:
The requested assessment is not authorized by section 42 of the Schedule. Section 42 allows assessments for the "purpose of determining whether an insured person is entitled to a benefit for which an application is made". I find that the assessment sought in this case is not being undertaken for that purpose, but primarily to bolster Allianz's case at the arbitration.
Irrespective of the result above, an adjournment of the hearing at this juncture would not be appropriate and I so find.
It follows from my finding above that the arbitration hearing is not stayed pending Mr. Wilkerson's attendance at the instance of Allianz.
The assessment in question was formally requested by a notice sent to Mr. Wilkerson's representative on or about November 27, 2003. The notice provides as follows:
In accordance with Section 42 of the Statutory Accident Benefit Schedule, your client are [sic] required to submit to the following Insurer Examination to assess your disability and eligibility to the following benefits: Non earner, Attendant Care and Medial/Rehabilitation [sic].
The notice indicates that the assessment will take place in Toronto on December 8, 2003.
The notice continues:
Failure to attend this examination will effect your entitlement to all of the above noted benefits and any cancellation feels will be your responsibility.
Please do not hesitate to contact me with any questions or concerns at the number listed below.
Allianz states that the assessment in question is reasonable and necessary to allow it to assess Mr. Wilkerson's ongoing entitlement to the benefits in question. Allianz submits that the assessment becomes necessary at this juncture for two primary reasons:
Allianz has had only one prior assessment of Mr. Wilkerson being that of Dr. G. Lloyd in September 2002. Dr. Lloyd's opinion only dealt with the question of whether or not Mr. Wilkerson was catastrophically impaired.
There is significant indication that Mr. Wilkerson's condition has deteriorated over that time as noted in the reports of Dr. Ostrowski and Dr. Amies.
Mr. Levin submits that there are technical defects in the notice that was delivered to him by Allianz. Mr. Levin states that the notice failed to set out the benefits to which the assessment relates. Allianz also failed to take reasonable steps to schedule the assessment at a time and place convenient for Mr. Wilkerson, according to Mr. Levin.
Mr. Levin takes issue with the rationale and timing of this assessment. The substantive issues in dispute and the key underlying question of Mr. Wilkerson's catastrophic impairment have been known for some time. For reasons unknown, Allianz did not seek assessments of Mr. Wilkerson's entitlement to the benefits that he claimed. The fact that Mr. Wilkerson's condition has been deteriorating is also not new. Mr. Levin points to the equivocal results of the CAT DAC in March 2000 and April 2002, the questions in Dr. Lloyd's opinion in September 2002, all of which in his submission called out for a response from Allianz. Instead of seeking further clarification of these issues or exploring the effects of the accident on Mr. Wilkerson's pre-existing epilepsy and diabetes raised by a number of medical professionals including Dr. Lloyd, Allianz did nothing until now, shortly before the arbitration hearing.
In this regard, I note that the Notice was only delivered to Mr. Levin on November 27, 2003. While I accept counsel's submission that Allianz had been considering its need for assessments for some time and that there may have been discussions with Mr. Levin for some time, the fact remains that Allianz had not formally determined that it would be seeking a section 42 assessment as late as the date set for the hearing of this motion which had to be adjourned pending that decision.
Finally, Mr. Levin submitted that the key issue in this arbitration is whether Mr. Wilkerson is catastrophically impaired. Mr. Levin queried how a physiatrist can add to the understanding of these issues.
I find that the Notice does not adequately set out the reasons for the assessment and the benefits to which it relates. Although it does refer in a general way to some of the claims, it does so without sufficient particularity to adequately inform Mr. Wilkerson of the reasons for the assessment. For example, amongst the issues in dispute are physiotherapy, a claim made pursuant to section 14 of the Schedule, and a claim for housing modifications made pursuant to section 15. Neither of these issues in dispute are specifically identified in the Notice - instead, it refers to medical/rehabilitation [benefits]. This is not sufficiently precise to allow Mr. Wilkerson to know what issues were being assessed by the Insurer and, accordingly, the assessment would not be reasonable for this reason as well.
I also find that the assessment sought by Allianz is not authorized by section 42 of the Schedule.
The question of whether or not an insurer's assessment is reasonably required, particularly when an arbitration hearing looms, is a troubled one. As has been remarked on more than one occasion, the Schedule does not provide the insurer with a right to a so-called defence medical examination. The Schedule does provide insurer assessments for the purpose of determining whether or not an insured person is entitled to a benefit under the Schedule. This precise and demarcated entitlement has been expanded to include assessments where, in the arbitrator's view, an assessment is required in the interests of fairness between the parties in litigation.
There is no issue of fairness between the parties in this case. The arbitration hearing is scheduled to begin in March 2004. Those dates were tentatively set in late September 2003. The issues in dispute and the basis of Mr. Wilkerson's claims have been clear for some considerable period of time. Mr. Wilkerson has raised no new issues where fairness would require that Allianz be given some period of time to respond. Mr. Wilkerson has been alleging that his medical condition is worsening for some period of time. If not absolutely clear to Allianz earlier, it should have been unmistakable when counsel for Mr. Wilkerson wrote to Allianz in May 2003, requesting a second CAT DAC on the basis of a deteriorating medical condition. For whatever reason Allianz chose not to respond at that time. The impact of the motor vehicle accident on Mr. Wilkerson's pre-existing conditions as well as the impact of his pre-existing conditions on his catastrophic status are not new issues and were raised by Dr. Lloyd in his report to Allianz's counsel in September 2002. Allianz chose not to seek any assessments of that issue, although it should have been clear to it that other medical professionals were finding that the accident had aggravated those conditions.17
I find that this assessment is not being sought for the purposes of assessing Mr. Wilkerson's entitlement to a benefit. It is being sought primarily for the purpose of buttressing Allianz's position in the upcoming arbitration. If that were not so, why would Allianz seek a preemptive adjournment order in the event that the assessment and report could not be produced in time for the hearing?
Mr. Levin also stated that the Insurer made no efforts to schedule the assessment at a time convenient for the Applicant. Mr. Levin also complained about the location of the assessment in Toronto, and suggested that Allianz was aware that Mr. Wilkerson had difficulty travelling. In this regard, I note that Allianz indicated at the hearing of this motion that it would be flexible both in the timing of the assessment and its location, including having the doctor travel to Niagara Falls if necessary. In my view these concessions on Allianz's part would remedy these defects in the Notice as delivered to Mr. Wilkerson.
Having made these determinations, I make no finding about Allianz's choice of medical professional to conduct the assessment, although in light of the confusion about what benefits entitlement Allianz is investigating, it would be difficult to assess the choice that was made.
EXPENSES:
Each party seeks their expenses of this motion, but agreed that it should follow the event. I find therefore that Mr. Wilkerson was substantially more successful in these two motions than was Allianz and is entitled to his reasonable expenses of the motion.
January 13, 2004
David Muir Arbitrator
Date
Neutral Citation: 2004 ONFSCDRS 7
FSCO A03-000753
FINANCIAL SERVICES COMMISSION OF ONTARIO
BETWEEN:
GARY WILKERSON
Applicant
and
ALLIANZ INSURANCE COMPANY OF CANADA
Insurer
ARBITRATION ORDER
Under section 282 of the Insurance Act, R.S.O. 1990, c.I.8, as amended, it is ordered that:
- Allianz shall produce the entire accident benefits file including: adjusters' notes and internal memoranda; solicitor-client communications; and legal opinions to the date(s) the related issue(s) were referred to mediation.
January 13, 2004
David Muir Arbitrator
Date
Footnotes
- The Statutory Accident Benefits Schedule — Accidents on or after November 1, 1996, Ontario Regulation 403/96, as amended by Ontario Regulations 462/96, 505/96, 551/96, 303/98, 114/00 and 482/01.
- R. v. McClure, 2001 SCC 14, [2001] 1 S.C.R. 445, 195 D.L.R. (4th) 513, p.20, cited in Davies v. American Home Assurance Co., 2002 CanLII 62442 (ON SCDC), 60 O.R. (3d) 512, Ouicklaw version p. 5.
- Ibid, p. 6.
- Ibid, p. 6
- Ibid, p. 8-9
- Ibid, p. 9.
- Nelson and Liberty Mutual Insurance Company (FSCO A00-000253, February 16, 2001) and the cases cited therein.
- The medical reports were filed primarily for the purposes of Allianz's motion below. Only limited reference was made to these reports in Mr. Wilkerson's motion.
- The assessment report by the firm of Kaplan and Kaplan dated March 27, 2000 concluded that Mr. Wilkerson's injuries/medical condition were not stable and concluded the assessment on that basis - that is, no determination of his status was arrived at.
- As noted, a first CAT DAC assessment held in March 2000 was inconclusive as Mr. Wilkerson's medical condition was not yet stable. The DAC resumed with a second assessment in March 2002. It concluded that Mr. Wilkerson was not catastrophically impaired as a result of the accident. The conclusion was somewhat equivocal in that the assessors felt the need to state that while they concluded that Mr. Wilkerson was not catastrophic, others may disagree with their conclusions.
- The parties did not provide much in the way of reliable evidence, affidavit or otherwise, to support their assertions about the extent to which the issues in dispute had crystallized by November 2001. They did no more than trade unsubstantiated submissions about when benefits were terminated and when it ought to have been clear that a particular issue was in dispute.
- (FSCO A99-000656, April 28, 2000)
- Davies, supra, p. 5.
- Section 42
- Nelson and Liberty Mutual, supra.
- Davies, supra.
- See for example the report of Dr. Richman dated May 25, 2001.

