OFSCDRS 2014

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The applicant failed to attend the arbitration hearing or provide particulars of her claims.

The insurer presented an engineering report concluding that the vehicles involved never made contact and the damage was inconsistent with the reported collision.

The arbitrator found that the accident was staged and dismissed the application in its entirety, ordering the applicant to pay the insurer's arbitration expenses.

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

The insurer terminated or denied some benefits, leading the applicant to apply for arbitration at the Financial Services Commission of Ontario.

The applicant failed to attend the scheduled hearing despite receiving proper notice.

As no evidence was submitted in support of the claim, the arbitrator dismissed the application.

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

After his representatives were removed from the record, a hearing was scheduled to determine his application.

The applicant failed to attend the hearing and no evidence was submitted in regard to his claim.

The arbitrator dismissed the application.

The applicant was catastrophically injured in a motor vehicle accident and sought attendant care benefits of $6,000 per month while residing in a nursing home.

The insurer argued it was only required to pay the nursing home copay amount plus reasonable and necessary family care services, relying on section 60(2) of the Schedule.

The arbitrator agreed with the insurer, finding that paying the maximum benefit when the actual incurred nursing home costs were lower would amount to unfair enrichment.

The arbitrator calculated the reasonable and necessary family care services to be added to the copay amount.

The applicant's claim for a home renovation assessment was denied because prior approval was not obtained and there was no immediate risk of harm.

Interest was awarded on overdue amounts, but a special award was denied as the insurer had acted reasonably.

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

The insurer terminated or denied some benefits, leading the applicant to apply for arbitration.

The applicant failed to attend the scheduled hearing despite receiving notice.

As no evidence was submitted in regard to the claim, the application was dismissed.

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

After mediation failed, the applicant applied for arbitration.

A hearing was scheduled, and notice was sent to the applicant.

The applicant failed to attend the hearing and submitted no evidence in regard to her claim.

The arbitrator dismissed the application due to the applicant's non-attendance and lack of evidence.

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

After his legal representative withdrew due to a breakdown in the relationship, the applicant failed to attend a pre-hearing discussion and the scheduled arbitration hearing.

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 entitlement to the claimed benefits, the application was dismissed and the applicant was ordered to pay the insurer's expenses of $1,500.

The insurer brought a motion to dismiss the applicant's arbitration application for statutory accident benefits after the applicant failed to participate following an order for a rehearing.

The arbitrator declined to dismiss the application as frivolous or vexatious, noting that such a finding requires an assessment of the merits.

However, given the applicant's failure to retain new counsel, attend the motion, or respond to communications, the arbitrator deemed the application constructively withdrawn pursuant to Rule 70 of the Dispute Resolution Practice Code.

No expenses were awarded to the insurer.

The applicant was injured in a motor vehicle accident and claimed attendant care benefits for services provided by her two daughters.

The insurer denied the claim, arguing the expenses were not 'incurred' under s. 3(7)(e) of the Statutory Accident Benefits Schedule because the daughters did not suffer an economic loss.

The arbitrator found that the daughters did suffer an economic loss by renting an apartment and paying household expenses to support the applicant during her convalescence.

The applicant was awarded attendant care benefits, but her claim for a special award was dismissed as the insurer's denial was not unreasonable given the justiciable issue of economic loss.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The applicant failed to attend examinations under oath and did not appear at the arbitration hearing.

The respondent insurer presented an engineering report concluding that the vehicles involved never made contact and the damage was inconsistent with the reported collision.

The arbitrator found the accident was staged, dismissed the application in its entirety, and ordered the applicant to pay the respondent's arbitration expenses.

The appellant was injured in a motor vehicle accident and sought additional income replacement benefits, a physical rehabilitation treatment plan, and assessment costs from the respondent insurer.

The Arbitrator denied the claims, finding the appellant's evidence regarding his employment status, pre-accident income, and disability to be inconsistent and unreliable.

On appeal, the Director's Delegate confirmed the Arbitrator's decision, holding that the Arbitrator made no error of law in her assessment of the evidence and was not required to accept uncontradicted evidence.

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

After failing to attend multiple scheduled pre-hearings and failing to respond to communications from his representative and the Commission, the applicant's representative was permitted to withdraw.

The arbitrator dismissed the application for arbitration under Rule 68 of the Dispute Resolution Practice Code, finding the proceeding to be frivolous, vexatious, or commenced in bad faith due to the applicant's abandonment of the matter.

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

After failing to attend a scheduled pre-hearing discussion and failing to maintain contact with her representatives, the Arbitrator issued a notice of intent to dismiss the proceeding.

The Applicant did not respond to the notice, failed to attend the resumed pre-hearing, and did not provide an updated address.

The Arbitrator dismissed the Application for Arbitration as frivolous, vexatious, or commenced in bad faith under Rule 68 of the Dispute Resolution Practice Code.

The applicant's representative brought a motion to withdraw as counsel in a statutory accident benefits arbitration.

The representative submitted that the applicant was incarcerated and unreachable, resulting in a complete breakdown of the solicitor-client relationship.

The arbitrator granted the motion, finding that the representative had complied with the requirements of the Dispute Resolution Practice Code and that the inability to reach the applicant justified the withdrawal.

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

After failing to attend multiple pre-hearing resumptions and her counsel withdrawing due to an inability to contact her, the insurer brought a motion to dismiss the arbitration.

The arbitrator attempted to reach the applicant by telephone at the hearing but was unsuccessful.

Finding that the applicant had abandoned her application, the arbitrator granted the motion and dismissed the application for arbitration.

The applicant claimed statutory accident benefits, alleging he was injured when a parked van he was occupying was rear-ended by another vehicle.

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

At a preliminary issue hearing, the arbitrator found the applicant and his witnesses lacked credibility due to significant inconsistencies in their evidence.

Relying on the testimony of an independent witness and a police officer, the arbitrator concluded that the van was unoccupied at the time of the collision.

Consequently, the applicant was not involved in an accident as defined in section 2(1) of the Schedule.

The insured was injured in a motor vehicle accident and applied for a catastrophic impairment determination.

The insurer denied the application based on its medical examinations.

The insured submitted a rebuttal report beyond the 80-day time limit and sought payment for its cost.

The arbitrator found the insured had a reasonable explanation for the delay and ordered the insurer to pay the report's cost.

On appeal, the Director's Delegate upheld the finding of a reasonable explanation but found the arbitrator erred in law by reversing the onus of proof regarding the reasonableness of the report's cost.

The issue of the report's cost was remitted for re-determination.

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

Disputes arose and the applicant applied for arbitration at the Financial Services Commission of Ontario.

The applicant failed to attend the hearing and failed to instruct his representative.

The arbitrator granted the representative's motion to be removed from the record due to a breakdown in the relationship.

As the applicant bore the onus of proving entitlement to the claimed benefits and presented no evidence, the arbitration was dismissed.

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

Disputes arose and the applicant applied for arbitration.

The applicant's counsel was removed from the record at a pre-hearing discussion due to a breakdown in the solicitor-client relationship.

The applicant failed to attend the arbitration hearing despite receiving notice.

As the applicant bore the onus of proving entitlement to the claimed benefits and provided no evidence, the arbitrator dismissed the arbitration.

The applicant, who was four years old at the time of a 1996 motor vehicle accident, sought Loss of Earning Capacity Benefits (LECBs) under the Statutory Accident Benefits Schedule.

The insurer argued that section 20.1 of the Schedule, introduced in 2006, barred the claim because the applicant had not met the prerequisite conditions before March 1, 2006.

The applicant argued that section 20.1 was merely procedural or, alternatively, that it violated his section 15 Charter rights by discriminating on the basis of age, as he was too young to have met the prerequisites.

The arbitrator held that section 20.1 substantively eliminated the right to LECBs for those who did not meet the conditions and found no Charter violation, concluding that the provision's effect was based on the circumstances existing as of February 28, 2006, rather than age, and did not perpetuate prejudice or stereotyping.