OFSCDRS 2015

The applicant was injured in a motor vehicle accident in 1998 and applied for statutory accident benefits.

The insurer denied certain benefits but failed to provide a valid refusal containing the required dispute resolution information.

Almost 16 years later, the applicant applied for arbitration.

The insurer raised a preliminary issue that the claims were statute-barred.

The arbitrator held that despite the defective refusal, the applicant was precluded from proceeding because he was aware of the time limits and his extraordinary delay caused significant prejudice to the insurer.

The application for arbitration was dismissed.

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

Her legal representatives withdrew prior to the hearing.

The applicant failed to attend the rescheduled arbitration hearing.

The arbitrator dismissed the applicant's claims for failing to meet the burden of proof.

The insurer was awarded $1,500 in expenses due to the applicant's failure to participate, which prolonged the proceedings.

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

After her legal representatives withdrew due to a breakdown in the solicitor-client relationship, the applicant failed to attend the scheduled arbitration hearing despite being given notice and an adjournment.

The arbitrator dismissed the claims because the applicant failed to participate and meet her burden of proof.

The insurer was awarded $1,500 in expenses for legal fees and obtaining an OHIP summary, but its request for reimbursement of a $3,000 assessment fee was denied.

The applicant was injured in a motor vehicle accident and sought enhanced statutory accident benefits, claiming a catastrophic impairment based on three Glasgow Coma Scale (GCS) scores of 9.

The insurer denied the claim, arguing the applicant sustained only a minor injury and that the GCS scores were not caused by a brain impairment resulting from the accident.

The arbitrator found that the applicant sustained a concussion, which qualifies as a brain impairment, and that the impairment was caused by the accident.

Applying the Divisional Court's ruling in Hodges, the arbitrator held that the GCS score is conclusive and an inquiry into the seriousness of the brain injury is irrelevant.

The arbitrator concluded that the applicant sustained a catastrophic impairment within the meaning of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, including medical benefits and assessment costs.

The applicant failed to attend the arbitration hearing, and the arbitrator proceeded in his absence pursuant to section 7(1) of the Statutory Powers Procedure Act.

As the applicant presented no evidence, he failed to meet his burden of proof.

All claims for benefits were dismissed, and the applicant was ordered to pay $1,000 in expenses to the insurer.

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

The applicant failed to attend the arbitration hearing.

As the applicant bore the onus of proving entitlement to the benefits and presented no evidence, the arbitrator dismissed the claims.

The insurer was awarded $1,750 in expenses due to the applicant's failure to participate in the pre-hearing process and the hearing.

The Appellant, who sustained a catastrophic impairment in a 2009 motor vehicle accident, appealed an arbitrator's decision denying his claims for ongoing income replacement benefits (IRBs) and a $56,600 treatment plan at the Sierra Tucson facility.

The Director's Delegate dismissed the appeal, refusing to admit fresh medical evidence because it could have been obtained earlier with due diligence or was inappropriate for an appeal restricted to questions of law.

The Delegate found no error of law in the arbitrator's conclusions that the Appellant failed to meet his onus to prove post-accident income for IRB quantum, failed to meet the post-104 week complete inability test, and required updated neuropsychological testing before the intensive treatment plan could be approved.

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

A dispute arose and the applicant applied for arbitration.

The applicant's representative brought a motion to be removed from the record, which was granted after the applicant failed to attend the hearing.

As the applicant did not attend the proceedings or present any evidence to support his claim, he failed to discharge his onus of proving entitlement to the benefits claimed.

The application for arbitration was dismissed, and the applicant was ordered to pay $500 in expenses to the insurer.

TD Home and Auto Insurance Company applied to vary a consent order to deduct long-term disability benefits received by the insured from her income replacement benefits (IRB).

The arbitrator granted the variation, finding that the insured's subsequent receipt of disability benefits from Sunlife constituted a material change in circumstances and new evidence.

The arbitrator held that the disability benefits were deductible under the Statutory Accident Benefits Schedule as payments under an income continuation benefit plan.

The arbitrator also rejected the insured's argument that her legal expenses incurred in obtaining the Sunlife benefits should be deducted from the collateral benefits amount, as the Schedule does not provide for such a deduction.

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

The insurer denied the claim on the basis that the accident was staged and therefore did not meet the definition of an 'accident' under section 2(1) of the Statutory Accident Benefits Schedule.

A preliminary issue hearing was scheduled to determine this issue.

Neither the applicant nor his representative attended the hearing.

Pursuant to Rule 37.7 of the Dispute Resolution Practice Code, the arbitrator proceeded in the applicant's absence.

Without any evidence from the applicant to prove an accident occurred, the arbitrator dismissed the arbitration and ordered the applicant to pay the insurer's expenses.

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

After his counsel was removed from the record, the self-represented applicant failed to properly sign settlement documents despite multiple extensions.

The applicant subsequently failed to attend the scheduled arbitration hearing.

The arbitrator dismissed the application for arbitration due to insufficient evidence to meet the burden of proof and ordered the applicant to pay the insurer's costs of $1,334.63.

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

At the hearing, the applicant's legal representative successfully moved to withdraw due to a breakdown in the solicitor-client relationship.

The applicant failed to attend the hearing.

As no evidence was presented to support the claims, the application was dismissed as abandoned.

The insurer was awarded $2,500 in expenses due to the unnecessary costs incurred by the applicant's repeated failure to participate.

The appellant sought to appeal an arbitrator's preliminary decision finding that the parties had not reached a settlement, and requested a stay of the upcoming arbitration hearing.

The Director's Delegate declined to exercise discretion to hear the interlocutory appeal, finding that it did not finally decide all issues in dispute and that hearing it would not facilitate the most cost-effective resolution.

The Delegate also refused to stay the arbitration hearing, noting the absence of special circumstances to take control of the process away from the hearing arbitrator.

The appeal was rejected without prejudice to renewing it after all issues are finally determined.

The applicant sought statutory accident benefits, including income replacement benefits, following a motor vehicle accident.

The applicant and his paralegal representative failed to appear at the scheduled arbitration hearing.

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

The applicant was ordered to pay $500 in expenses to the insurer.

The insurer was entirely successful in an arbitration regarding the applicant's claim for weekly caregiver benefits.

The insurer sought its expenses of the arbitration proceeding under the Expense Regulation.

The arbitrator found that the insurer's complete success entitled it to its reasonable expenses.

Applying a 2:1 ratio for preparation to hearing time and allowing for one counsel, the arbitrator awarded the insurer $5,600.00 for fees and $1,350.00 for disbursements, for a total of $6,950.00 inclusive of HST.

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

After failing to resolve disputes through mediation, the applicant applied for arbitration.

However, the applicant failed to appear at the pre-hearing and the hearing, and his counsel was removed from the record due to an inability to locate him.

The arbitrator dismissed the application for arbitration due to the applicant's failure to pursue it.

The Applicant applied for statutory accident benefits following a motor vehicle accident, but the Insurer denied various medical and rehabilitation benefits and cost of examination expenses.

The Applicant failed to attend the arbitration hearing and presented no evidence to support her claims.

The arbitrator dismissed the Applicant's claims for failing to meet the burden of proof.

The Insurer was awarded $1,500 in expenses due to the Applicant's conduct prolonging the proceeding.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries fell outside the Minor Injury Guidelines (MIG) due to chronic pain and psychological impairments.

The arbitrator found the applicant lacked credibility, having provided inconsistent and inaccurate information to various medical assessors, including failing to disclose a subsequent eye surgery.

The arbitrator concluded the applicant did not prove his injuries fell outside the MIG.

Consequently, the claims for multidisciplinary treatment plans and a psychological assessment were dismissed.

The applicant was also ordered to repay an erroneous payment of $135.60 to the insurer.

The insured was injured in a motor vehicle accident and received income replacement and housekeeping benefits.

Years later, the insurer requested an examination under oath (EUO).

The insured attended but refused to answer questions regarding those benefits, arguing the request was out of time under the Statutory Accident Benefits Schedule.

The insurer suspended benefits.

The arbitrator found the insurer was precluded from requesting the EUO because it had already paid the benefits.

On appeal, the Director's Delegate reversed the decision, holding that the time limits in sections 35/36 apply only to the initial determination of benefits, and do not restrict the insurer's ongoing right to request an EUO under section 33 to determine continuing entitlement.

The insurer was successful in its appeal of an arbitration decision that had found the insured suffered a catastrophic impairment.

The Director's Delegate subsequently determined the issue of costs for both the arbitration and the appeal.

Applying the Dispute Resolution Practice Code, the Delegate found the insurer was entitled to its costs due to its success and the insured's conduct which prolonged the proceedings.

The Delegate awarded the insurer $20,000 in total costs, inclusive of disbursements and HST, rejecting the insurer's claim for over $64,000 and noting that transcript costs are generally not recoverable.