OFSCDRS 2013

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

The applicant applied for arbitration but failed to attend the pre-hearing discussions or communicate with his counsel, who was permitted to withdraw from the record.

The insurer moved to dismiss the arbitration as frivolous and vexatious.

The arbitrator found that the applicant had failed to fulfill his obligations to support his claim and had been given ample notice of the proceedings.

The application for arbitration was dismissed, and the insurer was awarded $500 in expenses.

The applicant was injured in a motor vehicle accident and applied for a catastrophic impairment designation under the Statutory Accident Benefits Schedule.

The insurer argued the applicant required a below-knee amputation and assessed her as an amputee, resulting in a 35% Whole Person Impairment (WPI) rating.

The applicant's assessors found her to be wheelchair dependent, resulting in an 80% WPI rating under the Gait Derangement Table, and also found significant psychological impairments.

The Arbitrator preferred the applicant's assessors, finding that the insurer's assessors failed to evaluate the applicant as she presented herself.

The Arbitrator concluded the applicant was wheelchair dependent and met the definition of catastrophic impairment.

The appellant appealed an arbitration decision denying his $29,000 expense claim due to a 31-month delay in requesting an expense hearing.

The Director's Delegate dismissed the appeal and ordered that any request for appeal expenses be made within 60 days.

The respondent, who was entirely successful on the appeal, failed to request an appeal expense hearing within the 60-day timeline, waiting at least seven months.

The Director's Delegate found that the respondent's delay was deliberate and a disregard of an adjudicative order.

Consequently, the Director's Delegate declined to extend the timeline and ordered each party to bear their own legal expenses of the appeal.

The applicant was injured in a motor vehicle accident when he was nine years old.

He applied for non-earner benefits upon turning 16, arguing that his accident-related impairments continuously prevented him from engaging in substantially all of his pre-accident activities, leading him to drop out of school.

The arbitrator found that the applicant's academic and social difficulties were not primarily caused by the accident, but rather by pre-existing learning issues, a more demanding high school curriculum, and non-accident-related back pain.

The application for non-earner benefits, along with claims for a special award and interest, was dismissed.

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

The insurer denied her claim for catastrophic impairment and terminated her income replacement benefits.

The applicant brought a motion for interim benefits, seeking funding for a catastrophic assessment rebuttal report and the reinstatement of her income replacement benefits.

The arbitrator applied a holistic approach to interim benefits and found that the applicant had a strong prima facie case.

The arbitrator held that the applicant had a vested contractual right to funding for a rebuttal report because her accident occurred before the 2010 SABS amendments eliminated that benefit.

The arbitrator ordered the insurer to pay $10,500 for rebuttal reports and to reinstate the applicant's income replacement benefits at $374.16 per week pending the final arbitration.

The insurer brought a motion seeking an order that the applicant attend several Insurer Examinations (IEs) to determine his ongoing entitlement to income replacement benefits (IRBs) more than 104 weeks after the accident.

The applicant argued the request was delayed and intended to bolster the insurer's case for arbitration.

The arbitrator found that the IEs were reasonably required, noting that the insurer acted promptly after receiving late medical reports from the applicant supporting his post-104 claim.

The arbitrator also found that the applicant was not precluded from mediating his disputes because the insurer's notices for the IEs were deficient in failing to list the assessors' qualifications.

The applicant was injured in a motor vehicle accident and delayed notifying his insurer of his intention to apply for accident benefits for 16 months.

An arbitrator dismissed his application for benefits, finding no reasonable explanation for the delay.

Instead of appealing, the applicant filed an Application for Variation/Revocation.

The Director's Delegate rejected the application, finding that the applicant's new medical reports were either available prior to the arbitration or obtained reactively, and that his arguments regarding the interpretation of the law did not constitute an 'error in the order' under Rule 61.1 of the Dispute Resolution Practice Code.

The applicant sought interim attendant care and housekeeping benefits following a motor vehicle accident.

The insurer opposed the motion, alleging the applicant's wife did not suffer an economic loss and raising late allegations of misrepresentation based on undisclosed surveillance evidence.

The arbitrator found the applicant established a prima facie case for interim benefits and refused to consider the ambush surveillance evidence.

However, because the applicant failed to attend a requested examination under oath, the arbitrator held that benefits were suspended under the Schedule.

The motion for interim benefits was denied and suspended pending compliance with the examination under oath.

The applicant was injured in a motor vehicle accident and received caregiver benefits for over five years before the insurer terminated them.

She sought a continuation of the caregiver benefit and a non-earner benefit, claiming physical and psychological impairments prevented her from caring for her children and engaging in pre-accident activities.

The Arbitrator found that while the accident materially contributed to her psychological impairments, she exaggerated her physical complaints.

The Arbitrator concluded the applicant did not suffer a complete inability to carry on a normal life, as she was capable of engaging in activities with her children and her condition had improved enough for her supportive counseling file to be closed.

The claims for caregiver benefits, non-earner benefits, and interest were dismissed.

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

The insurer denied the claim on the basis that the applicant was not involved in an 'accident'.

At the scheduled arbitration hearing, the applicant failed to attend.

Her representatives brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, which was granted.

The insurer moved to dismiss the arbitration.

As the applicant bore the onus of proving she was in an accident and presented no evidence, the arbitration was dismissed.

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

The insurer refused to pay benefits, arguing the applicant was not involved in an 'accident' as defined in the Schedule.

The matter proceeded to arbitration.

The applicant failed to attend the hearing.

The applicant's representative brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, which was granted.

The insurer moved to dismiss the arbitration.

As the applicant bore the onus of proving he was injured in an accident and presented no evidence, the arbitrator dismissed the arbitration.

The applicant applied for statutory accident benefits following a motor vehicle accident, which the insurer denied on the basis that she was not involved in an 'accident'.

The applicant failed to attend the scheduled arbitration hearing.

Her representatives brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, and the insurer moved to dismiss the arbitration.

The arbitrator granted both motions, removing the representatives from the record and dismissing the arbitration due to the applicant's failure to present evidence.

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

The insurer denied the claim on the basis that the applicant was not involved in an 'accident'.

At the scheduled arbitration hearing, the applicant failed to attend.

The applicant's representative brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, which was granted.

The insurer moved to dismiss the arbitration.

As the applicant bore the onus of proving she was injured in an accident and presented no evidence, the arbitration was dismissed.

The appellant insurer appealed an arbitrator's preliminary order requiring the production of reserve information, surveillance reports, and investigative reports.

On appeal, the respondent sought to introduce fresh evidence consisting of two letters that were not before the arbitrator.

The Director's Delegate applied the Palmer test and refused leave to file the fresh evidence, finding that the letters could have been adduced at the motion with due diligence and were not determinative of the issues.

The insurer was entirely successful on two appeals regarding licence suspensions and workplace benefits, and sought its appeal expenses.

The insurer claimed approximately $6,100 in legal fees and disbursements.

The insured disputed the amount, arguing that the time spent drafting pleadings and the revised bill of costs was excessive.

The Director's Delegate found that the appeals were more complex than average, justifying an award higher than the typical $2,800, but reduced the claimed amount to account for excessive time spent.

Appeal expenses were fixed at $4,000 inclusive of disbursements and HST.

The insurer appealed a preliminary arbitration decision which found that the insured was not precluded from proceeding to arbitration despite the expiry of the two-year limitation period.

The arbitrator had ruled that the termination form (OCF-17) was confusing and did not properly commence the limitation period.

The Director's Delegate acknowledged the appeal, finding that the issue of whether an approved form was insufficient to commence the limitation period was novel and of great importance, and that the insurer raised bona fide legal issues.

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

After mediation failed, they applied for arbitration but subsequently failed to pursue their claims, instruct counsel, or attend pre-hearings and the scheduled arbitration hearing.

The arbitrator dismissed the applications for arbitration without a hearing under Rule 68 of the Dispute Resolution Practice Code due to abandonment.

The insurer was awarded $1,500 in expenses because the applicants' conduct unnecessarily prolonged the proceedings.

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits from the Insurer.

The Insurer terminated the benefits, and after failed mediation, the Applicant applied for arbitration.

The Insurer raised a preliminary issue that the application was filed beyond the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule.

The Arbitrator found that the Insurer's refusals were clear and unequivocal, meeting the test in Smith v. Co-Operators.

The Applicant's only explanation for the delay was his lawyer's failure to file on time.

The Arbitrator held that the Applicant was precluded from proceeding to arbitration for most of his claims, except for two specific medical assessments that were not time-barred.

Each party was ordered to bear its own expenses for the preliminary issue hearing.

During a dispute over statutory accident benefits, the insurer inadvertently disclosed privileged documents to the applicant's counsel.

The applicant's counsel reviewed the documents and subsequently brought a motion to amend the claim to include a Special Award based on the privileged information.

The insurer brought a cross-motion to remove the applicant's counsel from the record.

The arbitrator granted the insurer's motion, finding that the applicant's counsel had reviewed the privileged documents in detail and attempted to use the information to the insurer's detriment.

The applicant's motion to amend the claim was denied as an abuse of process, and the applicant's counsel was removed from the record.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to 29 treatment plans, attendant care, housekeeping, and examination costs.

The arbitrator found the applicant lacked credibility, noting he minimized pre-accident health issues and submitted false invoices.

The arbitrator rejected the applicant's expert evidence and found the claimed treatments were not reasonable or necessary.

However, six treatment plans totaling $6,398.23 were payable because the insurer failed to respond to them, resulting in deemed approval under the Schedule.

All other claims were dismissed.