OFSCDRS 2005

The applicant was injured in motor vehicle accidents in 1994 and 1996 and applied for statutory accident benefits.

The insurer terminated weekly income replacement benefits.

On the eve of an arbitration hearing, a preliminary issue was raised regarding which statutory accident benefit claims were captured in the applications for mediation and could proceed to arbitration.

The arbitrator determined that the applicant could proceed to arbitration on nine specific issues, including income replacement benefits, loss of earning capacity benefits, supplementary medical expenses, rehabilitation benefits, special awards, and expenses.

The applicants claimed they were injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied the claims, alleging the accident did not occur.

The applicants failed to attend the arbitration hearing.

Relying on the insurer's expert evidence in accident reconstruction, which demonstrated that the physical damage to the vehicles was inconsistent with the applicants' description of the collision, the arbitrator concluded that the accident did not occur.

The claims for statutory accident benefits were dismissed.

The applicant applied for statutory accident benefits, claiming he was injured in a motor vehicle accident.

The insurer refused to pay, alleging the applicant wilfully misrepresented that he was involved in an accident.

At the arbitration hearing, the insurer presented expert evidence on physical damage, which concluded that the damage to the vehicles was inconsistent with a collision between them.

The arbitrator accepted the expert evidence, rejected the applicant's testimony, and found that the applicant wilfully misrepresented a material fact.

The application for benefits was dismissed pursuant to section 48(1) of the Statutory Accident Benefits Schedule, and the applicant was ordered to pay the insurer's expenses.

The applicant sought payment of legal expenses following an arbitration regarding statutory accident benefits.

The insurer argued the applicant was only entitled to half his expenses due to divided success.

The arbitrator found the applicant was the successful party overall and entitled to his full reasonable legal expenses.

The arbitrator assessed the legal fees based on a reasonable preparation-to-hearing ratio and allowed an hourly rate of $150 for counsel.

The applicant was awarded $38,409.44 in legal expenses and disbursements.

The applicant's counsel brought a motion to be removed as counsel of record following a dispute with the applicant over the conduct of the arbitration.

The applicant opposed the motion and requested her file.

The arbitrator granted the motion, removing counsel from the record, and ordered counsel to release the file to the applicant upon payment of outstanding disbursements.

The applicant, who was struck by a car as a pedestrian, sought medical benefits for chiropractic, physiotherapy, and psychological treatments under the Statutory Accident Benefits Schedule.

The insurer denied the benefits, arguing the impairments were not caused by the accident.

The arbitrator found that the accident materially contributed to the applicant's chronic pain and depression.

The arbitrator awarded the cost of an initial course of chiropractic treatment and the psychological treatment, finding them reasonable and necessary.

The claims for further chiropractic treatment and physiotherapy were dismissed as they were not shown to be effective.

The insurer was ordered to pay the applicant's arbitration expenses and interest on overdue payments.

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

At the arbitration hearing, the applicant initially failed to appear, and his representative's request for an adjournment was denied.

When the applicant eventually arrived, he elected to present no evidence to support his claims.

Consequently, the arbitrator dismissed all claims for benefits, interest, and a special award, and ordered each party to bear their own expenses.

The applicant was injured in a motor vehicle accident and received income replacement benefits.

The insurer terminated these benefits based on a Designated Assessment Centre (DAC) report.

However, the DAC was not authorized to conduct the required post-104 week disability assessment and applied the wrong test.

The arbitrator held that the insurer failed to comply with the statutory termination procedures under section 37 of the Statutory Accident Benefits Schedule, rendering the termination invalid.

The applicant was awarded ongoing income replacement benefits, housekeeping benefits, and a nominal special award of $1 for the insurer's unreasonable conduct.

Claims for attendant care benefits and hearing expenses were dismissed.

The applicant sought a variation or revocation of an earlier arbitration decision, arguing that the arbitrator mistakenly recorded the date the insurer terminated income replacement benefits as February 1, 2001, instead of February 1, 2002.

The arbitrator acknowledged the error but found it did not affect the substantive conclusion that the applicant's accident-related disability ended on August 28, 2001, after which any disability was due to a pre-existing psychiatric illness.

Because the insurer had already paid benefits beyond August 28, 2001, the original order requiring payment of benefits was revoked and the application for income replacement benefits was dismissed.

Each party was ordered to bear their own expenses for the variation application.

The applicant applied for statutory accident benefits following a motor vehicle accident.

The insurer failed to file its Response to the Application for Arbitration within the 20-day time limit prescribed by the Dispute Resolution Practice Code.

The insurer brought a motion for an order extending the time for delivery of its Response nunc pro tunc.

The arbitrator applied the criteria for setting aside a default judgment, finding that the insurer's default was unintentional, the motion was brought promptly, and the applicant suffered no prejudice.

The motion was granted and the time for delivery of the Response was extended.

Following a preliminary issue hearing where it was determined that the applicants were not involved in a motor vehicle accident, the insurer sought its expenses.

The arbitrator found that the insurer was entirely successful and that the applicants' failure to make reasonable efforts to obtain new representation had prolonged the proceedings.

The applicants were ordered to jointly and severally pay the insurer's legal fees and disbursements, assessed at $7,373.11 based on Legal Aid Tariff rates.

The insurer brought a motion to dismiss the insured's arbitration application on the basis that the parties had reached a full and final settlement at a private mediation.

The insured, who was self-represented on the motion but had counsel at the mediation, argued she was brain-injured and pressured into an improvident settlement.

The arbitrator found no compelling evidence to rebut the statutory presumption of capacity and no evidence of illegitimate pressure amounting to economic duress.

The settlement complied with the Settlement Regulation, and the insured failed to rescind it within the statutory cooling-off period.

The motion was granted and the arbitration dismissed.

The applicant sought statutory accident benefits after falling at a subway station while approaching a stationary bus.

She claimed she was pushed by another pedestrian and struck the bus as she fell.

The arbitrator found the applicant's evidence regarding striking the bus to be inconsistent and not credible, concluding she fell to the ground without contacting the bus.

Applying the direct causation test, the arbitrator held that the use or operation of the bus did not directly cause her injuries, as she had not yet commenced boarding.

The application was dismissed, and the applicant was ordered to pay $500 in expenses.

The applicant sought expenses following a successful preliminary issue hearing regarding statutory accident benefits.

The parties disputed the appropriate hourly rate for the applicant's representative, an experienced paralegal.

The arbitrator held that Rule 78.2 of the Dispute Resolution Practice Code applies to agents, limiting their fees to the rates under the Legal Aid Services Act for law clerks, articling students, and investigators, rather than the higher rates for lawyers under Rule 78.1.

The insurer was ordered to pay expenses of $834.07.

Following a successful appeal by the insurer regarding the arbitrator's jurisdiction over a settlement enforcement proceeding, both parties sought their expenses of the arbitration and appeal.

The Director's Delegate declined to award expenses to either party, finding that although the insurer was entirely successful on appeal, the issues raised regarding the application of the method of payment rules to settlement funds were novel and the arbitration proceeding was not improper.

The parties were ordered to bear their own expenses.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After the applicant's representative's law practice was taken over by the Law Society, the Commission made multiple unsuccessful attempts to contact the applicant.

The applicant failed to attend two scheduled pre-hearing conferences.

The insurer requested a dismissal of the arbitration.

The Arbitrator issued a notice of intention to dismiss the arbitration without a hearing on the grounds that the proceeding is frivolous, vexatious, or commenced in bad faith, giving the parties 20 days to object.

The applicant sought an assessment of legal fees following a successful arbitration for statutory accident benefits.

The insurer disputed the amount claimed, arguing that the preparation time was excessive and the hourly rate should be reduced.

The arbitrator found the applicant's bill of costs reasonable, noting the insurer's late reinstatement of benefits and unsuccessful adjournment request necessitated the preparation.

The arbitrator awarded the applicant $13,634.48 in legal fees and GST, including costs for the expense assessment hearing.

The applicant failed to attend a peremptory preliminary issues hearing regarding his claim for statutory accident benefits.

His counsel requested an adjournment, stating the applicant was in the Philippines, but provided no evidence or instructions.

The arbitrator dismissed the application due to the applicant's failure to meet his onus of establishing a basis for his claim.

The arbitrator also ordered expenses payable to the insurer and allowed submissions on whether the applicant's counsel should be personally liable for a portion of the costs.

The applicant, who was injured in a motor vehicle accident, applied for statutory accident benefits and subsequently for arbitration.

He failed to appear at the hearing, having sent a letter requesting an adjournment due to alleged family emergencies, but subsequently lost contact with his counsel and the Commission.

The arbitrator refused to grant the adjournment immediately but declined the insurer's request to dismiss the application outright.

Instead, the arbitrator stayed the proceeding and ordered the applicant to provide justification for his absence and pay $750 in expenses to the insurer by a specified date, failing which the application would be dismissed.

The applicant was injured in a motor vehicle accident and applied for non-earner benefits.

The insurer denied the claim.

At arbitration, the adjudicator found that the applicant did not suffer a complete inability to carry on a normal life as a result of the accident.

While her life changed post-accident, she continued to engage in substantially all of her pre-accident activities, particularly her religious activities, and her reduced functioning was largely attributable to marital breakdown rather than the accident.

The application for non-earner benefits and interest was dismissed.