OFSCDRS 2007

Following a successful motion where the applicant was denied interim benefits, the insurer sought its expenses for the motion.

The arbitrator rejected the applicant's request to reserve expenses to the full hearing, finding it appropriate to determine them as the arbitrator who heard the preliminary issue.

Applying the criteria under O. Reg. 664, the arbitrator found the insurer was completely successful and entitled to expenses.

However, the arbitrator reduced the claimed preparation time due to duplication and the straightforward nature of the motion, awarding the insurer $1,046.44 in total expenses.

The insurer brought a preliminary motion seeking an order for the production of various medical, employment, and financial records by a specific date, failing which the arbitration would be stayed.

The arbitrator found that the requested documents were relevant but were largely in the possession of third parties and not within the applicant's control.

The arbitrator declined to stay the proceedings, instead accepting the applicant's representative's undertaking to forward production request letters to the third parties, copied to the insurer, within 30 days.

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

The insurer terminated weekly caregiver and housekeeping benefits, leading the applicant to apply for arbitration at the Financial Services Commission of Ontario.

Prior to the hearing, the parties resolved all substantive issues and the applicant withdrew his claims.

During the hearing, the parties also resolved the issue of expenses and consented to its withdrawal.

The arbitrator granted permission for the parties to withdraw all issues in dispute.

The applicant sought to withdraw her application for arbitration regarding statutory accident benefits shortly before a scheduled pre-hearing conference.

The insurer opposed a withdrawal without conditions, requesting payment of its expenses, the $3,000 assessment fee, and an order precluding future applications on the same issues.

The arbitrator permitted the withdrawal without conditions, finding no evidence of abuse of process to justify ordering payment of the assessment fee or barring future applications.

However, the arbitrator ordered the applicant to pay the insurer's expenses fixed at $750 for the unnecessary costs incurred in preparing for the pre-hearing conference and responding to the withdrawal request.

The applicant sought legal expenses following an arbitration decision where he was awarded $5,067 plus interest for medical services, but denied caregiver and housekeeping benefits.

The insurer argued both parties should bear their own costs due to divided success.

The arbitrator found the applicant achieved a significant degree of success and had served a reasonable offer to settle for $10,000 inclusive of costs, which he beat at arbitration.

The arbitrator also noted the insurer's late production of surveillance evidence prolonged the hearing.

The applicant was awarded $7,266.65 in legal expenses and disbursements.

The applicant sought statutory accident benefits and a special award following a motor vehicle accident.

The applicant failed to attend the arbitration hearing and had previously lost contact with his representative, who was removed from the record.

The arbitrator dismissed the application for arbitration due to the absence of any evidence tendered in support of the claims.

The applicant was ordered to pay the insurer's reasonable expenses in the amount of $1,800.

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

The insurer then terminated the benefits and sought repayment, alleging the applicant was not employed as claimed.

On a preliminary issue, the arbitrator held that, as a matter of law, an insurer can be estopped from challenging an insured's entitlement to and quantum of income replacement benefits on grounds related to pre-accident employment, despite the dispute resolution and repayment provisions of the Insurance Act and the Statutory Accident Benefits Schedule.

The insurer appealed an arbitrator's decision awarding the insured person medical benefits and the cost of assessments and reports, arguing the arbitrator erred in law by relying on the evidence of a clinic director with a financial interest in the outcome and poor record-keeping practices.

The insured person cross-appealed the dismissal of claims for translation services and the offsetting of a misdirected payment.

The Director's Delegate found that the arbitrator's findings of fact regarding the medical benefits were supported by the evidence and did not constitute an error of law.

However, the Director's Delegate allowed the appeal in part, finding the arbitrator erred in awarding section 24 expenses for certain reports that served only as advocacy or were prepared after the treatment cut-off date.

The cross-appeal was dismissed.

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

A dispute arose over the calculation of her income replacement benefit when she returned to work on modified duties.

The applicant argued that her post-accident income should be deducted from her calculated base benefit of $532, while the insurer argued it should be deducted from the maximum payable benefit of $400.

The arbitrator found the legislation unambiguous and held that post-accident income must be deducted from the maximum payable benefit of $400, not the base calculated amount.

The applicant was struck by a police vehicle while walking in a parking lot and sought non-earner benefits and medical benefits under the Statutory Accident Benefits Schedule.

The insurer denied the claims, arguing the applicant's impairments stemmed from a prior 2010 motor vehicle accident and a physical assault that occurred immediately before the 2011 accident.

The arbitrator found that the applicant failed to establish that the 2011 accident caused an impairment that continuously prevented him from engaging in substantially all of his pre-accident activities.

The arbitrator noted the applicant's expert admitted his diagnosis might have changed had he known about the applicant's prior chronic pain.

The application for benefits and a special award was dismissed.

Following an arbitration decision where the applicant was partially successful in claiming statutory accident benefits, both parties sought their expenses.

The arbitrator found that the applicant's success was significant to her, and denying expenses would undermine the consumer protection purpose of the Insurance Act.

The applicant was awarded her expenses at the Legal Aid rate, totaling $6,092.02 for the arbitration and $500.00 for the expense hearing.

The insurer's claim for expenses was dismissed.

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

After filing for arbitration, the applicant's counsel lost contact with him, and he failed to participate in the proceedings or attend the pre-hearing.

The insurer brought a motion to dismiss the arbitration without a hearing under Rule 68 of the Dispute Resolution Practice Code, or alternatively, to deem it withdrawn under Rule 70.

The arbitrator found insufficient evidence of bad faith to dismiss under Rule 68 but concluded the applicant had abandoned his claim.

The arbitration was deemed withdrawn under Rule 70, and the applicant was ordered to pay $1,000 in expenses to the insurer.

The insurer brought a motion to dismiss the applicant's arbitration for statutory accident benefits without a hearing.

The parties had previously negotiated a settlement, but the applicant drafted his own release, which the insurer rejected, and the applicant subsequently ceased communicating with the Commission and the insurer.

The arbitrator found that the applicant's conduct did not meet the high threshold for dismissal under Rule 68 as frivolous, vexatious, or in bad faith.

However, the arbitrator concluded that the applicant had abandoned his claim and deemed the arbitration withdrawn pursuant to Rule 70.

The applicant was ordered to pay $1,000 in expenses to the insurer.

The insurer appealed an arbitration decision awarding the claimant ongoing income replacement benefits, housekeeping benefits, assessment expenses, and a special award under the SABS-1996.

The Director's Delegate dismissed the appeal on the merits, finding no error in the arbitrator's preference for the claimant's medical and lay evidence over the insurer's experts.

The arbitrator's finding that the insurer unreasonably terminated benefits based on an incomplete functional abilities evaluation, justifying a special award, was also upheld.

The appeal was allowed in part only to revoke an inadvertent order regarding arbitration expenses.

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

At a pre-hearing discussion, the arbitrator ordered the insurer to produce its adjusting file up to the date of mediation and to confirm within 60 days whether it intended to rely on any surveillance or investigation evidence.

The insurer objected, arguing that under Rule 40 of the Dispute Resolution Practice Code, it was only required to produce such evidence 30 days before the hearing.

The arbitrator clarified the order, holding that Rule 40 does not create a new class of privilege and that the insurer must produce surveillance evidence created prior to the mediation date, and must confirm its intention to rely on any evidence within 60 days.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including medical, caregiver, and housekeeping benefits.

The insurer denied certain treatment plans and terminated the weekly benefits.

The arbitrator found that the chiropractic treatment incurred up to June 30, 2005, was reasonable and necessary, awarding $2,509.00 for medical benefits.

However, the claims for caregiver and housekeeping benefits were dismissed, as the applicant was not the primary caregiver and any substantial inability to perform housekeeping tasks had resolved prior to the termination of benefits.

The insurer brought a motion to have the arbitrator recuse himself from hearing a preliminary issue, arguing that his involvement in the pre-hearing conference created a reasonable apprehension of bias under Rule 33.5 of the Dispute Resolution Practice Code.

The arbitrator dismissed the motion, finding that the pre-hearing discussions did not involve concrete settlement offers that would compromise the outcome.

The arbitrator held that the statutory framework under the Insurance Act and the Code contemplates an ongoing case management role for the pre-hearing arbitrator, and the insurer failed to meet the high threshold for demonstrating a real likelihood or probability of bias.

The applicant was injured in a motor vehicle accident and suffered a brain injury and conversion disorder.

During settlement discussions, the issue of her mental capacity to proceed in the dispute resolution process was raised.

The arbitrator found, based on medical evidence, that the applicant was incapable of managing her property, appointing a representative, or conducting her own case.

The arbitrator appointed the applicant's husband to act on her behalf in the arbitration process, effective nunc pro tunc to the date the Application for Mediation was filed.

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

The insurer terminated benefits, and the applicant applied for arbitration.

The applicant's paralegal abandoned his practice and failed to attend a scheduled hearing, resulting in a conditional dismissal and costs order.

The applicant later retained new counsel and reached a settlement with the insurer.

The applicant subsequently attempted to resile from the settlement without following the proper rescission procedures.

The insurer brought a motion to dismiss the arbitration based on the settlement.

The arbitrator found the settlement binding and dismissed the arbitration.

Costs were awarded against the applicant and his former paralegal jointly for the missed hearing, and against the applicant alone for the dismissal motion.