OFSCDRS 2010

The applicant's representative sought to be removed from the record due to an irreparable breakdown in the solicitor-client relationship.

The applicant opposed the removal, citing his inability to represent himself.

Applying the principles from R. v. Cunningham, the arbitrator granted the request to withdraw, noting that there were no scheduled proceedings requiring an adjournment and the withdrawal was sought for ethical reasons.

The arbitrator declined the insurer's request to order the representative to produce documents directly to the insurer, instead ordering the representative to release the file to the applicant to avoid prejudicing the applicant's ability to claim privilege.

Following the dismissal of the applicant's claims for statutory accident benefits, the insurer sought its expenses for the arbitration.

The arbitrator found that the applicant was completely unsuccessful and his evidence was unbelievable, but his conduct did not cross the threshold of an improper or vexatious proceeding.

The insurer was awarded its expenses fixed at $8,532.81.

The arbitrator declined the insurer's request to order the applicant's solicitors to personally pay a portion of the expenses, holding the applicant completely liable.

The applicant was struck by a motor vehicle and subsequently underwent arthroscopic knee surgery.

She sought payment for $2,261.56 in physiotherapy treatment under the Statutory Accident Benefits Schedule.

The insurer denied the claim, relying on an insurer's examination which concluded the knee surgery was unrelated to the accident and the therapy was unnecessary.

While the arbitrator found the knee injury was caused by the accident, the application was dismissed because the treating chiropractor's records did not demonstrate an understanding of the applicant's knee condition, rendering the treatment neither reasonable nor necessary.

The applicant sought statutory accident benefits following a 2004 motor vehicle accident.

The insurer raised a preliminary issue, arguing the application for arbitration was barred by the two-year limitation period under the Insurance Act.

The insurer claimed it had provided clear and unequivocal denials of income replacement and housekeeping benefits in 2005 via Explanation of Benefits (OCF-9) forms.

The arbitrator found no evidence that the applicant received the unsigned OCF-9 forms, which lacked proof of delivery.

Furthermore, the arbitrator held that even if received, the forms were vague, confusing, and requested further information, thus failing to constitute clear and unequivocal denials.

The insurer's limitation defence was dismissed, allowing the applicant to proceed to arbitration.

The insurer requested an expense hearing after the applicant's arbitration for statutory accident benefits was dismissed as frivolous and vexatious due to his failure to participate.

The applicant did not attend the expense hearing.

The arbitrator awarded the insurer $1,144.63 in expenses, finding that the applicant's conduct unnecessarily prolonged the proceedings.

The insurer's request for the applicant to pay the $3,000 arbitration filing fee was denied for lack of jurisdiction.

Following an arbitration decision regarding statutory accident benefits where both parties achieved partial success, the parties made written submissions on expenses.

The arbitrator found that the insurer's degree of success was greater, having successfully refuted claims for housekeeping and a functional abilities evaluation, while sharing success on the income replacement benefit issue.

After deducting unallowable disbursements such as court reporting and preparation fees for expert witnesses, the arbitrator ordered the applicant to pay the insurer $3,000.00 in expenses.

The applicant sought statutory accident benefits, alleging she was injured when her arm was caught in the doors of a TTC bus and she was dragged.

The insurer denied the claim on the basis that no such accident occurred.

The arbitrator found the applicant's uncorroborated evidence to be vague, contradictory, and implausible.

The arbitrator concluded that the applicant failed to prove on a balance of probabilities that she was injured as a result of an 'accident' as defined in section 2(1) of the Schedule.

The appellant insurer appealed an arbitrator's decision finding that the respondents were involved in an 'accident' under the Statutory Accident Benefits Schedule when a disconnected trailer rolled down a driveway and crushed one of the respondents.

The Director's Delegate upheld the arbitrator's finding that the trailer was an 'automobile' because it was being used in connection with the pickup truck at the time of the incident.

Although the Director's Delegate disagreed that the pickup truck was the direct cause of the injuries, finding instead that the trailer was the dominant feature, the ultimate conclusion that the appellant was liable to pay accident benefits was confirmed.

The appeal was dismissed.

Following a decision on statutory accident benefits where the applicants were partially successful, the applicants sought their expenses of the arbitration.

The insurer argued that the parties should bear their own costs.

The arbitrator found that the applicants were entitled to their expenses as they achieved partial success.

After assessing the bill of costs, including reductions for unsupported time claims and excessive supervision hours, the arbitrator ordered the insurer to pay the applicants $9,002.60 plus GST for their arbitration expenses.

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

During the arbitration process, the insurer requested the production of the applicant's OHIP records and family doctor's clinical notes dating back to prior motor vehicle accidents alleged to have occurred in 2000, 2001, and 2002.

The applicant opposed the expanded production, arguing there was no reliable evidence of inconsistencies in his reporting.

The arbitrator found that references to earlier accidents in medical reports provided a foundation for the insurer's request, as the information was relevant to assessing causation and quantum.

The arbitrator ordered the applicant to produce the requested records dating back to 2000.

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

After the applicant's counsel was removed from the record due to a breakdown in the solicitor-client relationship, the applicant failed to respond to communications from the Commission or attend the pre-hearing and hearing.

The arbitrator found that the applicant had abandoned the arbitration and dismissed the application.

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

The applicant sought payment of $20,242.82 for a catastrophic impairment rebuttal report following a motor vehicle accident.

The insurer denied payment on the basis that the report was not provided within the 80 business day time limit set out in section 42.1(3) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant failed to prove the report was provided to the insurer within the required timeframe and failed to provide a reasonable explanation for the delay under section 31.

The application for arbitration was dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the insurer.

The insurer terminated the IRBs and the applicant requested a Designated Assessment Centre (DAC) assessment.

The insurer argued the applicant failed to provide an updated Disability Certificate, and thus the two-year limitation period to apply for mediation had expired.

The Arbitrator found that the applicant had already provided a valid Disability Certificate covering the termination date, and was not required to provide a new one.

Because the insurer failed to arrange the DAC, there was no valid termination of benefits, and the limitation period did not preclude the applicant from proceeding to arbitration.

The insurer brought a motion to compel production of the applicant's complete Ontario Works file, including his Ontario Disability Support Pension file, from the Ministry of Community and Social Services.

The applicant consented to the order.

The arbitrator found that the requirements under Rule 67.7 of the Dispute Resolution Practice Code were met, as reasonable efforts had been made to obtain the documents, the Ministry had a reasonable opportunity to respond, and the documents were relevant to the applicant's claim for income replacement benefits.

The motion was granted.

The applicant was injured when he slipped on ice while exiting his vehicle to escape an out-of-control salt truck sliding towards him.

The insurer denied statutory accident benefits, arguing the incident did not meet the definition of an 'accident' under section 2(1) of the Schedule.

The arbitrator found that exiting a vehicle is an ordinary use of an automobile and that the impact of the salt truck directly caused the applicant's impairment.

The arbitrator concluded that the applicant was involved in an 'accident' and is entitled to claim benefits.

The appellant appealed an arbitrator's decision dismissing his claims for non-earner benefits and income replacement benefits following a 1999 motor vehicle accident.

The Director's Delegate dismissed the appeal, finding that the appeal was based on questions of fact rather than questions of law as required by section 283(1) of the Insurance Act.

The arbitrator's findings that the appellant's impairments were related to pre-existing conditions rather than the accident, and that he was not employed at the time of the accident, were supported by the evidence.

The applicant sought statutory accident benefits for housekeeping and home maintenance services, as well as the cost of an assessment, following a motor vehicle accident.

The arbitrator found the applicant's evidence regarding his pre- and post-accident housekeeping activities to be unreliable, inconsistent, and exaggerated.

The arbitrator concluded that the applicant did not suffer a substantial inability to perform his housekeeping tasks and that the claimed expenses were not reasonable or necessary.

The request for the cost of the assessment was also denied as it amounted to a duplication of services.

The application was dismissed.

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 applicant failed to attend multiple pre-hearing conferences despite receiving notice and being advised of the consequences by his counsel.

The insurer sought to dismiss the arbitration.

The arbitrator found that the applicant had effectively abandoned his arbitration and that the proceeding was frivolous.

The arbitration was dismissed without a hearing pursuant to Rule 68.1 of the Dispute Resolution Practice Code.

The insurer appealed an arbitrator's decision finding that the parties had reached a binding settlement of $17,000 for non-earner benefits following mediation.

The Director's Delegate allowed the appeal and rescinded the arbitrator's order, finding that the arbitrator erred in law by reversing the onus of proof, ignoring post-mediation conduct, and concluding there was a meeting of the minds despite a discrepancy in the settlement amount discussed by the parties.

The matter of arbitration expenses was remitted for reconsideration.

The insurer sought its expenses following a successful preliminary issue hearing where the applicant's claim for income replacement benefits was found to be statute-barred.

The arbitrator determined that the insurer was entitled to its expenses, as it was entirely successful and the applicant did not raise any novel issues.

The arbitrator awarded the insurer $2,627.86 in expenses, adjusting the claimed hourly rates to align with the Legal Aid Services Act and denying the disbursement for a court reporter.