OFSCDRS 2010

The appellant appealed an arbitrator's decision regarding legal expenses following a settled arbitration for statutory accident benefits.

The appeal was dismissed, and the parties were unable to agree on the costs of the appeal.

The Director's Delegate assessed the costs, finding the respondent entitled to its legal expenses for the main appeal hearing and an interim motion, while the appellant was entitled to costs for a separate motion.

After reducing the hours claimed by both parties and setting off the awards, the appellant was ordered to pay the respondent net appeal legal expenses of $4,338.44.

Following an arbitration where the applicant recovered approximately $4,000 in attendant care benefits but was unsuccessful on claims for caregiver benefits, housekeeping expenses, and catastrophic impairment, the insurer sought its arbitration expenses.

The arbitrator found the insurer was largely successful and had made a $33,000 settlement offer that exceeded the applicant's recovery.

The arbitrator awarded the insurer its expenses but applied a 20% reduction because both parties had hindered and prolonged the hearing with duplicative documents and lengthy examinations.

The applicant was ordered to pay $16,230.08 in arbitration expenses.

The Applicant, injured in a 2004 motor vehicle accident, sought an adjournment of his statutory accident benefits arbitration hearing on the eve of the hearing to obtain a medical report from his treating pain specialist.

The Insurer opposed the adjournment, noting it was the Applicant's third request and the Insurer was ready to proceed.

The Arbitrator granted the adjournment, finding that the Applicant had not appreciated the implications of his treatment and had not informed his counsel, and that the evidence was likely critical.

The adjournment was granted peremptory to the Applicant, who was ordered to pay costs thrown away.

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

After two days of hearing, the parties reached a settlement wherein the Insurer agreed to pay $10,000 for benefits, $3,000 for interest, and the Applicant's expenses in accordance with the Expense Regulation.

The parties could not agree on the quantum of expenses.

The Arbitrator interpreted the Insurer's offer to settle and awarded the Applicant $12,639.40 in fees and disbursements, rejecting the Insurer's argument that the fees should be reduced due to the Applicant's delay in accepting the offer.

The appellant appealed an arbitrator's decision that stayed his arbitration for statutory accident benefits pending his attendance at an examination under oath.

The Director's Delegate allowed the appeal, finding that the insurer's notice for the examination under oath was fatally flawed because it failed to advise the appellant of his right to representation, a mandatory requirement under s. 33(1.3) of the Schedule.

The Delegate also held that a stay of proceedings is not an appropriate remedy for an insured's failure to attend an examination under oath, as the Schedule provides its own specific remedy (non-payment of benefits) and the arbitration process does not include pre-hearing examinations for discovery.

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

The insurer denied a non-earner benefit based on an initial disability certificate indicating the applicant did not suffer a complete inability to carry on a normal life.

More than two years later, the applicant submitted a new disability certificate supporting a complete inability and sought to arbitrate the denial.

The insurer argued the arbitration was statute-barred by the two-year limitation period.

The arbitrator held that the initial denial was not a valid refusal because there was no valid application for a non-earner benefit at that time, as the applicant had accepted his doctor's opinion that he was ineligible.

Therefore, the limitation period did not commence, and the applicant was not precluded from proceeding to arbitration.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including caregiver, housekeeping, and medical benefits.

The Insurer denied the claims, arguing in part that the Applicant failed to attend an in-home assessment.

The Arbitrator found that the Insurer's notice of examination was procedurally defective and that the Applicant had a reasonable excuse for refusing the in-home assessment.

On the substantive issues, the Arbitrator concluded that the accident materially contributed to the Applicant's physical and psychological impairments, including fibromyalgia and psychosis.

The Arbitrator awarded caregiver and housekeeping benefits for specific periods, as well as the costs of a dental assessment and a physiotherapy treatment plan, but denied the cost of a neurological examination.

Interest was awarded on the overdue benefits.

The applicant in a statutory accident benefits dispute requested that the prehearing arbitrator step down from deciding the insurer's motion to dismiss the arbitration, alleging lack of jurisdiction and a reasonable apprehension of bias.

The arbitrator held that subsection 282(3) of the Insurance Act and the Dispute Resolution Practice Code grant broad authority to prehearing arbitrators to decide preliminary issues, including motions to dismiss.

The arbitrator also found no factual basis to support the applicant's allegations of bias, noting that clarifying issues, referencing similar cases, and refusing to release an unpublished decision do not create a reasonable apprehension of bias.

The motion to disqualify the arbitrator was dismissed.