OFSCDRS 2006

The applicant sought statutory accident benefits following a motor vehicle accident, including caregiver benefits, medical benefits, and housekeeping expenses.

On the third day of the arbitration hearing, the parties advised the arbitrator that they had reached a settlement.

On the joint request of the parties, the application was dismissed on consent without costs.

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

Prior to the commencement of the arbitration hearing, the parties reached a settlement of all issues in dispute.

On the joint request of the parties, the arbitrator issued an order dismissing the application on consent without costs.

The applicant was injured in a motor vehicle accident and applied for medical benefits and lost educational expenses from the insurer.

The parties proceeded to arbitration at the Financial Services Commission of Ontario.

After the hearing concluded but before a decision was issued, the parties reached a settlement.

On consent of the parties, the arbitrator dismissed the application without costs.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them.

The applicant applied for arbitration, claiming ongoing entitlement due to complete inability to engage in employment.

The arbitrator found that the accident materially contributed to the applicant's disability, exacerbating pre-existing injuries and causing chronic pain and depression.

The applicant was awarded income replacement benefits for both the pre- and post-104 week periods, along with interest and arbitration expenses.

Following an arbitration decision regarding statutory accident benefits where the applicant achieved mixed success, both parties claimed entitlement to their expenses of the arbitration proceeding.

The arbitrator considered the criteria under section 12(2) of O. Reg. 664/90.

Finding that the applicant was successful on some claims but failed on others, the arbitrator concluded that the arbitration resulted in mixed success.

As no other criteria applied to the advantage of one party over the other, the arbitrator ordered that each party bear their own expenses.

The Insurer requested an adjournment of the arbitration hearing to allow it to have the Applicant assessed by a psychologist or psychiatrist and a knee specialist under section 42 of the Statutory Accident Benefits Schedule.

The Arbitrator denied the request, finding that the Insurer had ample opportunity to request the examinations earlier and that granting an adjournment on the eve of the hearing would cause significant prejudice to the impecunious Applicant.

The Arbitrator noted that the arbitration system requires strict time discipline and that the Insurer's delay was not reasonably explained.

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 applied for statutory accident benefits following a motor vehicle accident.

After failing to resolve disputes through mediation, the applicant applied for arbitration.

The insurer brought a motion to dismiss the arbitration without a hearing because the applicant failed to comply with a previous order and did not attend the pre-hearing.

The arbitrator found the proceeding to be frivolous and commenced in bad faith, dismissing the arbitration and awarding reasonable expenses to the insurer.

The applicant was injured when she slipped and fell on ice after exiting a taxi cab.

She applied for statutory accident benefits, which the insurer denied on the basis that the fall was not an 'accident' under section 2(1) of the Statutory Accident Benefits Schedule.

The arbitrator found that the location and orientation of the taxi compelled the applicant to walk around it, leading her to the ice.

The arbitrator concluded that the use or operation of the taxi was a direct cause of the impairment, satisfying the definition of an accident.

The applicant was injured in a motor vehicle accident and sought income replacement and housekeeping benefits from her insurer under the Statutory Accident Benefits Schedule.

The insurer terminated her income replacement benefits in February 2004.

At arbitration, the arbitrator found that the applicant's inability to work was primarily due to a pre-existing shoulder injury from a prior workplace incident, and there was insufficient medical evidence to prove the car accident caused an ongoing inability to perform her pre-accident employment beyond the termination date.

The claim for income replacement benefits was dismissed.

The arbitrator awarded a limited housekeeping benefit of $15.00 per week for a period of approximately five months following the accident, based on an occupational therapy assessment.

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 sustained severe mobility impairments following a motor vehicle accident and sought $60,291.10 from her insurer for the costs of moving from her multi-level home to a single-level bungalow.

The insurer denied the claim, arguing that the applicant could still ambulate and later asserting that she failed to submit a formal treatment plan before incurring the expense.

The arbitrator found that the move was a reasonable and necessary accommodation under section 15(5)(i) of the Statutory Accident Benefits Schedule.

The arbitrator also held that the insurer was estopped from relying on the procedural defence regarding the treatment plan due to its conduct.

A special award of $25,000 was granted against the insurer for unreasonably withholding benefits.

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

The insurer issued a notice to stop paying benefits, but continued payments pending a Designated Assessment Centre (DAC) assessment.

The applicant filed for arbitration more than two years after the initial stoppage notice.

The arbitrator held that the two-year limitation period under s. 281(5) of the Insurance Act and s. 51(1) of the Schedule commenced upon the insurer's initial refusal to pay, and was not suspended by the DAC assessment or the continuation of payments.

The application was therefore statute-barred.

The applicant claimed various statutory accident benefits, interest, a special award, and arbitration expenses following a motor vehicle accident.

Neither the applicant nor her representative attended the scheduled arbitration hearing, despite having received proper notice.

The arbitrator proceeded in their absence pursuant to the Statutory Powers Procedure Act.

As the applicant tendered no evidence, she failed to discharge her burden of proof.

All claims for benefits, interest, a special award, and expenses were dismissed.

The Applicant was injured in a motor vehicle accident and received income replacement benefits until the Insurer terminated them based on a DAC assessment.

The Insurer argued the Applicant's arbitration was statute-barred because she failed to apply for mediation within two years of the refusal.

The Arbitrator found that the Insurer's notice of refusal only mentioned mediation and failed to explain the entire dispute resolution process, as required by the Supreme Court in Smith v. Co-operators.

Consequently, the notice was deficient, the limitation period was not triggered, and the Applicant was permitted to proceed with her arbitration.

The applicants, a husband and wife, were injured in a motor vehicle accident and sought statutory accident benefits from their insurer.

The insurer denied claims for caregiver benefits, housekeeping and home maintenance services, medical benefits, and transportation expenses.

The arbitrator found that both applicants suffered impairments that substantially prevented them from performing their pre-accident housekeeping and caregiving duties.

The arbitrator ordered the insurer to pay the claimed medical, transportation, housekeeping, and caregiver benefits, finding the expenses to be reasonable and necessary.

The applicant's claims for statutory accident benefits were previously dismissed after he failed to attend the arbitration hearing.

The insurer sought its expenses for the proceeding.

The arbitrator found that the insurer was entirely successful, the applicant's failure to attend delayed the proceedings, and the insurer's second attendance was unnecessary.

Applying the criteria under Regulation 664, the arbitrator ordered the applicant to pay the insurer's legal fees and disbursements totaling $2,601.55.

In a dispute over statutory accident benefits, the insurer brought a pre-hearing motion seeking the production of medical reports and raw data from two doctors prepared for the applicant's tort action.

The applicant objected, citing the implied undertaking rule and arguing the insurer had sufficient medical evidence.

The arbitrator ordered the production of the documents, finding that the applicant had waived any right to deny access by providing the tort reports to his own experts in the arbitration, who relied on and commented on them.

The insurer was entitled to the documents to properly respond to and cross-examine the applicant's experts.

The insurer sought an assessment of expenses after an arbitrator previously ordered a paralegal to personally pay the insurer's expenses for commencing an unauthorized arbitration on behalf of the applicant.

The insurer claimed expenses on a substantial indemnity basis.

The arbitrator found that she lacked the authority to award expenses on a substantial indemnity basis under the Insurance Act or the Statutory Powers Procedure Act, as costs are limited to Legal Aid rates under the Dispute Resolution Practice Code.

The insurer's expenses were assessed and ordered to be paid by the paralegal in the amount of $2,910.41.

The applicant sought interim benefits for diagnostic and assessment expenses related to a temporomandibular joint (TMJ) condition following a motor vehicle accident.

The insurer had requested an adjournment of the arbitration, arguing the applicant failed to provide a valid, signed treatment plan.

The arbitrator found the insurer's technical refusal to process the substantially complete treatment plan was unsupportable and ordered the insurer to pay the predetermination expenses as a just condition of granting the adjournment.