OFSCDRS 2009

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

The insurer brought a motion to stay the arbitration because the applicant had not participated in the process and had lost contact with his counsel for over a year, preventing the production of relevant documents.

The arbitrator found that the insurer should not be put to the expense of responding to the application under these circumstances.

Relying on section 25.1 of the Statutory Powers Procedure Act, the arbitrator ordered that the arbitration would be stayed unless the applicant or his counsel provided written notice of objection and an undertaking to proceed diligently by a specified date.

The appellant appealed a preliminary order of an arbitrator regarding the admissibility of a hearing transcript for the purpose of determining whether the appellant's counsel should be personally liable for legal expenses.

The Director's Delegate rejected the appeal, finding that it was from a preliminary or interim expense order that did not finally decide the issues in dispute, and that the appeal was moot pending the arbitrator's final expense decision.

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

After the applicant failed to attend two scheduled pre-hearings and his counsel withdrew from the record, the insurer requested that the proceeding be dismissed.

The arbitrator found that the applicant had effectively abandoned his case and dismissed the proceeding as vexatious pursuant to Rule 68.1 of the Dispute Resolution Practice Code.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer denied.

The insurer raised a preliminary issue that the applicant's arbitration request was filed beyond the two-year limitation period.

On the morning of the preliminary issue hearing, the applicant's counsel requested an adjournment because the applicant had travelled to Germany and could not attend.

The insurer opposed the adjournment and moved to dismiss the arbitration.

The arbitrator granted the adjournment, noting it was the applicant's first request and her life was in transition, but ordered the hearing peremptory to the applicant and awarded $1,500 in costs to the insurer.

The motion to dismiss was denied as it would severely prejudice the applicant's rights without a hearing.

Following a decision denying the insured's claim for income replacement benefits, the insurer sought to recover its expenses.

The arbitrator assessed the insurer's bill of costs, reducing the claimed legal fees by applying a 2.5 to 1 ratio of preparation to hearing time and deducting time spent on an ill-founded medical argument.

The arbitrator also disallowed disbursements for official examiner fees (transcripts) and the attendance fee of the insurer's medical expert.

The insurer was awarded $15,750 in legal fees and $7,440.21 in disbursements.

Following the dismissal of the appellant's appeal, the parties were unable to agree on the legal expenses of the appeal.

The respondent initially sought to summons the appellant to the expense hearing to determine if he or his counsel should be personally liable for costs.

The appellant brought a motion to quash the summons.

The respondent subsequently withdrew its request, rendering the motion redundant, but was ordered to pay the costs of the motion.

Additionally, a lawyer from the firm representing the appellant brought a motion in his personal capacity seeking particulars and bifurcation regarding his potential personal liability for costs.

The Director's Delegate dismissed this motion, finding that the lawyer lacked independent standing to bring a motion while his firm continued to represent the appellant, as it raised conflict of interest concerns.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for caregiver services, housekeeping expenses, and the costs of various medical assessments.

The arbitrator found that the applicant was not the primary caregiver for his nephew's children prior to the accident, and that the invoices submitted for both caregiver and housekeeping expenses were unreliable and failed to establish the amounts claimed.

The claims for caregiver and housekeeping benefits were dismissed.

The arbitrator awarded the costs of a functional abilities evaluation and a reduced amount for an in-home assessment, but denied funding for neurological and orthopaedic assessments as they were not reasonably required.

The applicant sought production of any surveillance evidence held by the insurer, regardless of whether the insurer intended to rely on it at the hearing.

The arbitrator dismissed the motion, holding that under Rule 40 of the Dispute Resolution Practice Code, an insurer is not obligated to produce surveillance evidence or disclose its existence unless and until it decides to rely on it.

The arbitrator found that he was bound by prior appellate decisions of the Director's Delegate confirming this interpretation.

The appellant insurer sought a stay of an arbitrator's order requiring it to pay interest on medical benefits from the date the applications or invoices were received.

The insurer argued that interest should only run from the date of the arbitrator's decision, relying on previous case law.

The Director's Delegate denied the stay request, finding that the insurer failed to demonstrate hardship and that staying the order would prejudice the respondent insured, given the compensatory nature of the interest provisions and the lengthy delay since the claims arose.

The applicant, a school bus driver, was injured when her bus rolled forward and struck other vehicles.

She applied for statutory accident benefits but did not pursue a WSIB claim.

Two years later, after the insurer raised a defence under s. 59(1) of the SABS, she commenced a tort action against the bus manufacturer.

The arbitrator found that the applicant's delay in bringing the tort action and her failure to prosecute it demonstrated that her election to sue was made primarily for the purpose of claiming accident benefits.

Therefore, under s. 59(2) of the SABS, she was precluded from receiving statutory accident benefits.

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

The insurer denied the claim on the basis of late notice.

The applicant applied for arbitration but failed to identify any substantive issues in dispute.

After multiple adjournments to allow the applicant to obtain legal representation, a preliminary issue hearing was scheduled.

The applicant failed to attend the hearing in person, citing car trouble, and subsequently stated over the phone that he wanted the proceeding concluded.

The arbitrator deemed the application for arbitration withdrawn pursuant to Rules 70.1(c) and 70.2 of the Dispute Resolution Practice Code.

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

The insurer denied the claim under section 59(1) of the Schedule, arguing the applicant was a Schedule 1 employee entitled to workers' compensation.

At the preliminary issue hearing, the insurer requested an adjournment to apply to WSIAT for a determination on the applicant's employment status.

The arbitrator denied the adjournment, finding no valid reason to stay the proceeding sine die when the insurer had ample notice to make the WSIAT application earlier.

Following the refusal, the parties consented to withdraw the preliminary issue.

The applicant applied for statutory accident benefits following an alleged motor vehicle accident.

The insurer terminated benefits and sought repayment of over $27,000, alleging the applicant was not involved in the accident.

Prior to the preliminary issue hearing, the applicant sought to withdraw her application.

The parties reached a consent agreement whereby the application was withdrawn, the applicant agreed to pay the insurer $1,000 in monthly instalments towards its expenses, and the insurer agreed not to pursue its claim for repayment of the benefits.

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

After terminating his legal representation at a pre-hearing discussion, the applicant failed to attend the resumed pre-hearing and the subsequent arbitration hearing despite receiving proper notice.

The arbitrator proceeded in the applicant's absence pursuant to Rule 37.7 of the Dispute Resolution Practice Code.

As the applicant presented no evidence to establish his entitlement to benefits, his application was dismissed.

The applicant was ordered to pay the insurer's arbitration expenses fixed at $750.

The applicant sought death benefits from the insurer following her father's death in a motor vehicle accident, claiming she was a dependant.

The insurer denied the claim.

In the course of arbitration, the applicant brought a motion for a third-party production order against her brother to obtain their late father's financial records.

The brother did not respond to the motion.

The arbitrator granted the motion, finding the documents relevant to the dependency issue and satisfying the requirements for third-party production under the Dispute Resolution Practice Code and the Insurance Act.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement, medical, and housekeeping benefits, as well as a special award.

The applicant failed to attend the pre-hearing and the arbitration hearing.

As the applicant did not appear to present evidence and meet the burden of proof, the arbitrator dismissed all claims.

The applicant was ordered to pay the insurer's reasonable arbitration expenses, fixed at $1,669.46.

The applicant was injured in a motor vehicle accident while driving a rental car.

He submitted an Application for Accident Benefits to the Motor Vehicle Accident Claims Fund.

The Fund argued it was not an insurer under section 268 of the Insurance Act and section 2 of O. Reg. 283/95 because there was no sufficient nexus between it and the applicant.

The arbitrator found that the applicant's decision to send the application to the Fund was arbitrary, given his limited efforts to determine the insurer of the rental car.

The arbitrator concluded that the Fund was not required to respond to the application as it was not the first insurer to receive a completed application.

The insurer appealed an arbitrator's decision denying its request for an order requiring the insured to attend insurer examinations (IEs) with a psychiatrist, oncologist, and physiatrist.

The Director's Delegate confirmed the arbitrator's decision, finding no error in the conclusion that the insurer failed to provide sufficient evidence that the IEs were reasonably necessary.

The appeal was dismissed.

The insurer brought a motion to dismiss or stay the arbitration proceeding on the grounds that the applicant had commenced both an arbitration and a Superior Court action for different benefits arising from the same motor vehicle accident and the same failed mediation.

The arbitrator held that section 281 of the Insurance Act, consistent with the rule against multiple proceedings, requires an insured person to choose a single forum for all issues in dispute arising from a single mediation.

The arbitration was stayed pending the outcome of the court case, with leave for the applicant to amend her application to include all issues if she chooses to proceed in arbitration.

The insurer appealed an arbitrator's order requiring it to disclose information regarding its setting of reserve amounts in respect of the insured's claim for statutory accident benefits.

The Director's Delegate allowed the appeal, finding that reserve information is generally irrelevant to an insurer's conduct in assessing a claim and is protected by a zone of privacy.

The arbitrator's order was rescinded, and the insurer was not required to disclose its reserves.