OFSCDRS 2007

The applicant claimed statutory accident benefits after allegedly being injured while a passenger on a TTC bus that was struck from behind by a car.

The insurer denied the claim on the basis that the applicant could not prove he was a passenger on the bus at the time of the accident.

Following a hearing on this preliminary issue, the arbitrator found the applicant and his witness to be credible, noting their evidence was consistent with the bus driver's testimony and occurrence report.

The arbitrator concluded on a balance of probabilities that the applicant was a passenger on the bus and was involved in an accident as defined in the Schedule.

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

Her representative lost contact with her and was granted a motion to be removed from the record.

The applicant failed to attend the arbitration hearing.

The arbitrator dismissed the applicant's claims for income replacement benefits due to a lack of evidence.

The insurer's claim for repayment of income replacement benefits paid pending a Designated Assessment Centre report was granted, as the report concluded the applicant did not suffer a substantial inability to perform the essential tasks of her employment.

The applicant was ordered to repay $3,853.08 and pay the insurer's arbitration expenses of $2,947.01.

The appellant appealed an arbitrator's order dismissing her claims for statutory accident benefits on the basis that the parties had reached a binding settlement.

The appellant argued that she lacked capacity, was under duress, and had rescinded the agreement.

The Director's Delegate found no error in the arbitrator's conclusion that the settlement complied with the regulatory requirements, that there was no compelling evidence of incapacity or duress, and that the appellant failed to rescind the agreement within the required two-day period.

The appeal was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment, massage therapy, acupuncture, and prescription medication.

The insurer denied the claims.

The arbitrator found that the applicant failed to establish on a balance of probabilities that the disputed treatments and medications were reasonable and necessary as a consequence of the accident.

The applicant's testimony regarding the benefits of the treatment was vague, and the prescription medications were for pre-existing conditions.

The application for medical benefits was dismissed.

The insurer sought expenses against the applicant and her former representative following an arbitration decision regarding statutory accident benefits.

A hearing was convened to determine whether the former representative should be held personally liable for expenses under section 282(11.2) of the Insurance Act.

During the hearing, the parties engaged in settlement discussions and reached an agreement on the expense issue.

On consent of the parties, the arbitrator dismissed the application for expenses.

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

The parties reached a settlement at a pre-hearing, but the applicant failed to execute the settlement documents despite cashing the settlement cheque.

The applicant and his representative failed to attend the resumed pre-hearing or respond to communications.

The arbitrator issued a notice of intention to dismiss the proceeding without a hearing on the grounds that it is frivolous, vexatious, or commenced in bad faith.

The applicant applied for arbitration after the insurer terminated her housekeeping benefits following a motor vehicle accident.

The applicant failed to attend the pre-hearings and the scheduled arbitration hearing, and her representative was previously permitted to withdraw.

As no evidence was adduced in support of the application, the arbitrator dismissed the application as abandoned.

The applicant was ordered to pay the insurer's arbitration expenses in the amount of $1,703.11 due to her conduct which prolonged and hindered the proceeding.

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 completely successful on a preliminary motion regarding post-104 week examinations.

The arbitrator assessed the applicant's expenses under s. 282(11) of the Insurance Act and s. 12 of O. Reg. 664.

Finding the applicant's claim for 10.4 hours of legal work reasonable, the arbitrator awarded expenses of $1,653.60 inclusive of GST.

The applicant sought interim income replacement, housekeeping, and attendant care benefits pending the arbitration of her dispute with the insurer over a motor vehicle accident claim.

The arbitrator dismissed the motion, finding that the applicant failed to establish an urgent financial need or any other compelling reason to grant interim relief.

The applicant's evidence regarding her family's financial circumstances was deemed evasive and insufficient, and the insurer's conduct regarding the attendant care assessment did not amount to a blatant disregard of its obligations.

The applicants sought a determination of expenses, interest, and a special award following a successful claim for statutory accident benefits (death benefits) against the insurer.

The arbitrator fixed the interest owing at $14,173.50 and the special award at $39,173.50 as of April 10, 2006.

The arbitrator held that statutory interest under section 46 of the Schedule continues to accrue post-arbitration until paid, as it is a contractual right rather than post-judgment interest under the Courts of Justice Act.

The applicants were also awarded $9,628.43 in expenses, with the arbitrator approving their counsel's hourly rate of $150 due to his experience and success in obtaining a maximum special award.

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

The insurer denied the claim under section 30(1)(a) of the Schedule, arguing the applicant knew or ought to have known she was operating an uninsured vehicle.

The arbitrator found that the applicant reasonably believed her former partner had renewed her insurance and was not wilfully blind to the fact that she was uninsured.

The insurer was not entitled to rely on the exclusion.

The appellant insurer sought an order for expenses following a successful appeal that revoked an arbitrator's decision allowing the respondent to proceed to arbitration for statutory accident benefits.

The parties agreed the insurer was entitled to its expenses for both the arbitration and the appeal.

The Director's Delegate assessed the claimed arbitration expenses, reducing the hours claimed for two of the insurer's counsel due to duplication and disproportionate billing.

The respondent was ordered to pay the appellant's arbitration expenses fixed at $15,917.23 and appeal expenses fixed at $5,731.16.

The insurer brought a motion to dismiss the applicant's claim for statutory accident benefits on the basis of issue estoppel.

The applicant had previously sued in Small Claims Court for medical benefits, where the judge found that no motor vehicle accident had occurred.

The arbitrator held that the Small Claims Court's finding that no accident occurred was fundamental to the applicant's claim before the Commission.

Applying the doctrine of issue estoppel, the arbitrator dismissed the application for arbitration and ordered the applicant to pay $500 in expenses.

The insurer brought a motion to stay or adjourn an upcoming arbitration hearing until the applicant attended a functional abilities evaluation and an orthopaedic assessment.

The applicant had been receiving income replacement benefits which were terminated before the 104-week mark.

The insurer requested the examinations 19 months after the 104-week mark and shortly before the arbitration hearing.

The arbitrator found that the insurer had missed multiple earlier opportunities to request the examinations and concluded their only apparent purpose was to bolster the insurer's case for arbitration.

The motion was dismissed, and the hearing was ordered to proceed as scheduled.

The applicant claimed statutory accident benefits from the insurer of another vehicle involved in the accident, as the vehicle he was driving was uninsured.

The insurer sought to exclude the applicant from benefits under section 30(1)(a) of the Schedule, alleging he knew or ought to have known the vehicle was uninsured.

At a preliminary issues hearing, the arbitrator ruled that the insurer bears the burden of proving all elements of the exclusion, including that the applicant was uninsured.

A ruling on the admissibility of a driver record search was deferred, and the insurer was ordered to pay $350 in costs thrown away due to an adjournment.