Elsie Smith v. Intact Insurance Company, 2013 ONFSCDRS 38

Financial Services Commission des Commission services financiers of Ontario de l’Ontario

Neutral Citation: 2013 ONFSCDRS 38

FSCO A12-002106

BETWEEN:

ELSIE SMITH

Applicant

and

INTACT INSURANCE COMPANY

Insurer

PRE-HEARING DECISION

Before: William J. Renahan

Heard: February 27, 2013, in at the offices of the Financial Services Commission of Ontario in Toronto, Ontario.

Appearances: Jeton Memeti for Ms. Smith David LeDrew for Intact Insurance Company

Issues:

The Applicant, Elsie Smith, was injured in a motor vehicle accident on April 20, 2010. She applied for and received statutory accident benefits from Intact Insurance Company, payable under the Schedule.¹ Intact terminated weekly benefits and refused to pay further medical benefits. The parties were unable to resolve their disputes through mediation, and Ms. Smith applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended.

At the pre-hearing discussion of this case held on February 27, 2013 the parties could not agree on a hearing date. Mr. Memti wanted dates within nine months of the pre-hearing and suggested dates in November 2013. Mr. LeDrew said neither he nor anyone in his office was available to do the hearing until February 2014.

The issue is when I should schedule this hearing.

Result:

The hearing is scheduled for November 18, 19, 20 and 21, 2013.

ANALYSIS:

One of the goals of dispute resolution at the Financial Services Commission is to provide speedy resolution of claims for no-fault benefits. According to the preamble to the Dispute Resolution Practice Code, the Code creates rules for timely, cost-effective and fair dispute resolution services. Rule 1.1 provides that the Rules “will be broadly interpreted to produce the most just, quickest and least expensive resolution of the dispute.” Practice Note 7 under the Code advises that the arbitrator will set a convenient date for the hearing, generally within four to six months of the pre-hearing. Practice Note 9 provides that FSCO has an obligation to conduct arbitrations efficiently and speedily.

One of the purposes of the no-fault benefits is to provide insured people injured in motor vehicle accidents with defined financial benefits when they most need it. Where the insurer disputes entitlement to the benefit, the insured is entitled to timely resolution of that dispute so that if it is determined that the insured is entitled to the benefit, the insured gets the benefit when she or he needs it.

Mr. LeDrew argued that the delay in resolving this dispute is the fault of FSCO, and his client should not have to bear the responsibility for a system which does not resolve disputes in a timely manner. He referred to the time it took to get a pre-hearing date. In this case, the Insurer filed its Response to the Application for Arbitration on May 23, 2012 and the pre-hearing date was scheduled for February 27, 2013, some ten months later.

The issues in dispute in this case include caregiver benefits which were terminated April 8, 2011, incurred and proposed medical benefits, housekeeping expenses which were terminated January 28, 2011 and several proposed medical examinations and assessments.

Delays in one part of the system is not justification for delays in other parts. The Applicant is still entitled to the most expeditious resolution of her dispute that the process can provide her. The issues in this case are about two years old. The pre-hearing arbitrator can usually provide a hearing date within the four to six months referred to in Practice Note 7. The dates Mr. Memti suggested are reasonable given the procedures I have referred to.

Therefore, the hearing is scheduled for November 18, 19, 20 and 21, 2013.

Neither party addressed the issues of expenses and I make no order as to expenses of this application.

March 20, 2013

William J. Renahan Arbitrator

Date