OFSCDRS 2015

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

The insurer denied the benefits and sought repayment of previously paid benefits.

The applicant failed to attend the arbitration hearing.

Consequently, the arbitrator proceeded in his absence under the Statutory Powers Procedure Act and the Dispute Resolution Practice Code.

The applicant's claim was dismissed for failing to meet the burden of proof, and the insurer withdrew its claim for repayment.

The applicant was ordered to pay $1,000 in expenses to the insurer.

The insurer sought to appeal an arbitrator's preliminary decision which held that the insurer had waived its right to dispute whether the claimant's incident met the definition of an 'accident' under the Statutory Accident Benefits Schedule.

The Director's Delegate considered the criteria for hearing an appeal of a preliminary order under Rule 50.2 of the Dispute Resolution Practice Code.

Finding that hearing the appeal at this stage would not provide the quickest, most just, and least expensive resolution of the dispute, the Delegate rejected the appeal without prejudice to the insurer's right to renew it upon the issuance of a final arbitration decision.

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

She also received Canada Pension Plan (CPP) disability benefits and settled a long-term disability (LTD) claim for a lump sum that allegedly accounted for her CPP benefits.

On a preliminary issue, the applicant argued that the insurer should not be allowed to deduct CPP benefits from her IRBs, as this would result in a double deduction.

The arbitrator held that under the applicable Statutory Accident Benefits Schedule, the deduction of CPP disability benefits from IRBs is mandatory.

The insurer was therefore entitled to deduct the CPP benefits regardless of the LTD settlement terms.

Following an arbitration where the insurer was largely successful in defending against claims for statutory accident benefits, the parties sought expenses.

The arbitrator found that the insurer was entitled to its expenses due to its overwhelming success, though the amount was slightly reduced because the applicant had marginal success on two treatment plans and the insurer had listed 36 witnesses it did not call.

The applicant was ordered to pay the insurer $6,400.00 in expenses.

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

The Insurer refused to pay certain benefits, leading to an arbitration application.

The Applicant brought a motion for the production of the Insurer's complete log notes from the date of loss to the date the Application for Arbitration was filed.

The Insurer claimed litigation privilege over notes created after the first Application for Mediation.

The Arbitrator found that the Insurer has an ongoing obligation to adjust the file, and ordered the production of the adjuster's file up to the date of the Application for Arbitration, limited to the specific issues in dispute, subject to the Insurer providing a list of documents over which it asserts privilege.

The applicant sought income replacement benefits (IRBs) and non-earner benefits (NEBs) following two motor vehicle accidents.

The insurer denied the benefits and sought repayment of $42,402.58 in IRBs previously paid, alleging material misrepresentation regarding the applicant's employment and income.

The arbitrator dismissed the applicant's claims, finding that his pain complaints were long-standing and pre-existing, and he failed to prove a substantial inability to perform his employment tasks or a complete inability to carry on a normal life.

The arbitrator also dismissed the insurer's claim for repayment, concluding there was insufficient evidence to prove the applicant wilfully misrepresented his employment or committed fraud.

Following a successful arbitration for statutory accident benefits, the applicant sought her expenses.

The arbitrator found the applicant was entitled to expenses based on her degree of success and an unaccepted offer to settle.

The arbitrator awarded $15,360.72 in legal fees and $12,025.07 in disbursements, reducing some claimed amounts for expert fees and photocopying to align with the Schedule to the Expense Regulation, for a total award of $27,385.79.

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

The insurer brought a motion to dismiss the arbitration on the basis that the applicant was entitled to workers' compensation benefits under the Workplace Safety and Insurance Act.

The Workplace Safety Insurance Appeals Tribunal had previously ruled that the applicant was entitled to workers' compensation benefits.

The arbitrator found that section 59(1) of the Statutory Accident Benefits Schedule precluded the applicant from receiving accident benefits and dismissed the arbitration.

The insurer was awarded expenses of $3,443.71.

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

After settlement discussions failed, the Applicant sought to withdraw her application for arbitration and close her file.

The Insurer raised concerns about the Applicant's capacity to enter into a settlement without legal advice.

The Arbitrator found the Applicant had the capacity to participate and permitted her to withdraw her application for arbitration without costs, with the consent of the Insurer.

The insurer appealed an arbitration decision awarding the insured various statutory accident benefits, including attendant care, a hot tub, massage therapy, psychological counselling, occupational therapy, and a special award.

The insurer brought a preliminary motion to stay the Arbitrator's orders pending the appeal.

Applying the three-part test for a stay, the Director's Delegate granted a stay regarding the hot tub expense, the increased cost portion of the occupational therapy equipment, and the special award, finding substantive grounds for appeal on those issues.

The request to stay the remaining benefit awards and the accrual of interest was dismissed, as the insurer failed to demonstrate that the hardship of payment outweighed the hardship of non-payment to the insured.

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

After his legal representative was removed, the applicant failed to appear at a resumption of a pre-hearing discussion and subsequently failed to appear at the scheduled arbitration hearing, despite being properly served with notice.

The arbitrator dismissed the application for arbitration as the applicant failed to meet the burden of proving his claim.

The appellant insurer appealed an arbitrator's decision awarding the respondent income replacement benefits (IRBs) and housekeeping and home maintenance benefits following a motor vehicle accident.

The Director's Delegate allowed the appeal in part.

The Delegate found the arbitrator erred in law by awarding IRBs for a period prior to September 3, 2010, as there was no evidence of a shortfall, and reduced the IRB award accordingly.

The Delegate also rescinded the housekeeping benefits award because the arbitrator decided entitlement for a period not in dispute.

The appeal regarding arbitration legal expenses was dismissed as the arbitrator had not yet made a formal order on expenses.

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

After disputes arose, she applied for arbitration but subsequently failed to communicate with her legal representatives or participate in the proceedings.

Her representatives were permitted to withdraw.

The insurer brought a motion to dismiss the application under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator found that the applicant's failure to participate rendered the proceeding frivolous or vexatious and dismissed the application.

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

During the pre-hearing conference stage, the applicant passed away.

The trustee of the applicant's estate requested that the arbitration proceedings be discontinued.

The insurer consented to a dismissal on a without costs basis.

The arbitrator dismissed the application on consent.

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

After failing to attend a pre-hearing discussion and failing to communicate with her paralegal, the paralegal was permitted to withdraw.

The insurer moved to dismiss the application under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator found that the applicant had manifested no interest in pursuing her claims and dismissed the application as frivolous or vexatious.

The applicant claimed statutory accident benefits following a motor vehicle accident but failed to attend the arbitration hearing.

Her representative was permitted to withdraw due to a breakdown in the representative-client relationship.

As the applicant did not attend to present evidence, her claims were dismissed and she was ordered to pay $500 toward the insurer's expenses.

The applicant failed to attend a peremptory resumption of a pre-hearing discussion regarding her claim for statutory accident benefits.

Her legal representative brought a motion to be removed from the record due to an inability to obtain instructions, which was granted.

The insurer brought a motion to dismiss the application for arbitration.

The arbitrator dismissed the application without a hearing on the basis that it was frivolous, vexatious, or commenced in bad faith due to the applicant's failure to participate in the proceedings.

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

After disputes arose, the applicant applied for arbitration but subsequently lost contact with her legal representative and failed to attend the pre-hearing and the hearing.

The arbitrator granted the representative's request to be removed from the record.

As the applicant failed to participate and presented no evidence, the arbitration was dismissed.

The insurer was awarded its expenses of $898.56.

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

After her counsel was removed from the record due to a breakdown in the lawyer-client relationship, the applicant failed to attend a scheduled pre-hearing and failed to comply with an order requiring her to confirm her intention to continue the arbitration.

The insurer brought a motion to dismiss the arbitration.

The arbitrator granted the motion, finding that the applicant's ongoing refusal to obey arbitral orders and participate in the process constituted an abuse of process, rendering the proceeding frivolous and vexatious under section 4.6(1) of the Statutory Powers Procedure Act.

The claims were dismissed, and the insurer was awarded its reasonable expenses.

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

The insurer claimed $19,355.53 in fees and disbursements.

The arbitrator found the fees reasonable based on the legal aid tariff but disallowed $1,951.64 in travel-related expenses and associated HST, noting the insurer chose to retain out-of-town counsel without justification.

The applicant was ordered to pay fixed expenses of $18,403.89.