OFSCDRS 2015

Following the dismissal of the applicant's claim for statutory accident benefits, the insurer sought its expenses for the arbitration.

The applicant had failed to attend the hearing and her claim was found to have been concocted.

The arbitrator reviewed the insurer's bill of costs, which included legal fees capped at the legal aid tariff rate and disbursements including an engineering report and travel expenses.

The arbitrator found the claimed expenses reasonable and ordered the applicant to pay $4,865.43 to the insurer.

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

The insurer disputed entitlement on the basis that the applicant was not injured in an 'accident' as defined in the Schedule.

The applicant failed to participate in the arbitration process and did not attend the hearing despite receiving proper notice.

The arbitrator dismissed the arbitration due to the applicant's failure to tender evidence and ordered the applicant to pay $500 in expenses to the insurer.

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

The insurer disputed entitlement on the basis that the applicant was not involved in an "accident" as defined in the Schedule.

The applicant failed to participate in the arbitration process and did not attend the hearing despite receiving proper notice.

The arbitrator dismissed the arbitration due to the applicant's failure to tender evidence and ordered the applicant to pay $500 in expenses to the insurer.

The insurer, having been entirely successful on the claimant's appeal of an arbitration decision denying further statutory accident benefits, requested an appeal expenses hearing.

The claimant's representative engaged in inappropriate communications regarding settlement discussions and failed to provide responding submissions, citing an unrelated court action.

The Director's Delegate found the insurer entitled to its reasonable appeal expenses based on its degree of success.

The insurer was awarded $5,000 inclusive of disbursements and HST, reflecting the extra time required due to the challenging conduct of the claimant and her representative.

The applicant sought statutory accident benefits following a motor vehicle accident but subsequently failed to participate in the arbitration proceedings.

Her legal counsel was removed from the record after being unable to contact her, and the applicant's son later left a voicemail indicating she did not want to proceed with her claim.

The arbitrator dismissed the application without a hearing under Rule 68 of the Dispute Resolution Practice Code, finding the application was frivolous, vexatious, or commenced in bad faith due to the failure to participate.

The insurer was awarded $250 in expenses for having to prepare for and participate in the proceedings.

The applicant was injured in a motor vehicle accident and sought accident benefits from the insurer.

After filing an Application for Arbitration, the applicant failed to participate in the proceedings or communicate with her counsel.

The applicant's counsel 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 application with expenses.

The arbitrator granted the motion to remove counsel, dismissed the application as frivolous and vexatious due to the applicant's failure to participate, and awarded the insurer $250 in expenses.

The applicant failed to participate in the arbitration proceedings or respond to communications after her legal counsel was removed from the record.

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

The arbitrator dismissed the application without a hearing under Rule 68 of the Dispute Resolution Practice Code, finding it was frivolous, vexatious, or commenced in bad faith due to the applicant's failure to participate.

The insurer was awarded $500 in throw-away costs.

The applicant was injured in a motor vehicle accident and sought accident benefits from the insurer.

After the applicant's legal representatives lost contact with him and were removed from the record, the applicant failed to attend a pre-hearing resumption and a subsequent preliminary issue hearing.

The insurer brought a motion to dismiss the application.

The arbitrator granted the motion and dismissed the application for arbitration pursuant to Rule 68 of the Dispute Resolution Practice Code.

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

The insurer denied various benefits, and the applicant applied for arbitration.

The applicant failed to attend the pre-hearing and the arbitration hearing.

The arbitrator proceeded in the applicant's absence.

The applicant failed to meet the burden of proof to establish entitlement to benefits.

The claims were dismissed, and the applicant was ordered to pay the insurer's expenses of the arbitration fixed at $1,500.

The applicant sought statutory accident benefits following a motor vehicle accident, including medical benefits and income replacement benefits (IRBs).

The insurer denied the claims on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG) and that he did not meet the disability test for IRBs.

The arbitrator dismissed all of the applicant's claims, finding significant credibility issues due to inconsistent reporting of pre-accident medical history, post-accident employment, and income.

The arbitrator concluded that the applicant's impairments were predominantly minor injuries and that he failed to prove a substantial inability to perform the essential tasks of his pre-accident employment, noting that he had worked in physically demanding jobs post-accident.

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

The matter proceeded to an arbitration hearing, but the applicant failed to attend on two scheduled dates despite receiving notice.

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, she failed to meet her burden of proof, and her claims were dismissed.

The arbitrator ordered the applicant to pay $2,000 in expenses to the insurer due to her conduct prolonging the proceeding.

The appellant, who was catastrophically impaired in a motor vehicle accident, moved into an OHIP-funded nursing home.

She appealed an arbitrator's decision that her insurer was only required to pay the copay for her accommodation and services as an attendant care benefit, rather than the maximum $6,000 monthly benefit.

The Director's Delegate dismissed the appeal, finding that attendant care benefits are paid for incurred expenses and that OHIP payments are deductible as collateral benefits under s. 60(2) of the SABS.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming he was unable to work and that his business income was passive.

The insurer argued the applicant returned to work immediately, continued to operate his property development business, and earned income exceeding any IRB entitlement.

The arbitrator found that the applicant continued to perform his pre-accident duties, earned substantial post-accident income, and deliberately failed to produce his company's general ledger.

The application for IRBs was dismissed, as the post-accident income reduced the IRB entitlement to zero.

The appellant was injured in a motor vehicle accident and sought $12,960 in interim expenses to fund a catastrophic impairment rebuttal assessment.

The arbitrator dismissed the motion, finding that while the criteria for interim expenses were met, the $50,000 monetary cap for medical and rehabilitation benefits under section 18 of the 2010 Schedule had been exhausted.

On appeal, the Director's Delegate held that the arbitrator erred in applying the section 18 monetary cap to an award of interim legal expenses under subsection 282(11.1) of the Insurance Act.

The appeal was allowed in part, and the insurer was ordered to pay $6,780 for four expert reports, conditional upon catastrophic impairment being formally added as an issue in the arbitration.

Following the dismissal of the applicant's claim for statutory accident benefits, the successful insurer sought its expenses for the arbitration.

The arbitrator found the insurer was entitled to expenses, noting it had bettered its offer to settle and the issues were not novel.

However, the arbitrator reduced the claimed amount because the insurer's counsel incorrectly billed at the higher hourly rate reserved for an insured person's counsel under the Dispute Resolution Practice Code, rather than the applicable legal aid tariff rate.

Costs were fixed at $5,000.00 inclusive of HST.

The applicant was injured in a motor vehicle accident when she hit her head on a streetcar.

She applied for non-earner benefits, attendant care benefits, housekeeping benefits, and the cost of medical assessments.

The arbitrator found that the applicant did not suffer a complete inability to carry on a normal life, as she continued to travel, live independently, and engage in social activities, and therefore denied the non-earner benefits.

The arbitrator awarded $1,560.97 for attendant care services (hair and foot care) and granted the withheld housekeeping benefits, accepting her explanation for the delayed disability certificates.

The claims for the cost of medical assessments were dismissed for lack of evidence.

The applicant claimed statutory accident benefits following a motor vehicle accident but failed to participate in the arbitration process or provide contact information.

The insurer moved to dismiss the claim as abandoned.

The arbitrator found that the applicant's ongoing failure to attend hearings or communicate with his counsel constituted an abuse of process.

The claim was dismissed as frivolous and vexatious under Rule 68 of the Dispute Resolution Practice Code, and the applicant was ordered to pay the insurer's reasonable expenses.

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

The applicant failed to attend the peremptory arbitration hearing, despite a recent denial of her adjournment request.

The arbitrator proceeded in her absence and dismissed the arbitration, finding the applicant failed to discharge her onus of establishing entitlement to the claimed medical benefits and examination expenses.

The insurer was awarded arbitration expenses due to the applicant's conduct, which prolonged the proceeding and amounted to an abuse of process.

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

After a lengthy history of delays and adjournments, the applicant failed to attend the peremptory arbitration hearing, claiming illness at the last minute.

The arbitrator proceeded in his absence and dismissed the claims, finding the applicant failed to discharge his onus.

The insurer was awarded arbitration expenses due to the applicant's conduct, which prolonged the proceeding and constituted an abuse of process.

The applicant's representatives, Lofranco Corriero, brought a motion to be removed as solicitors of record due to an irreparable breakdown in the solicitor-client relationship.

The applicant failed to provide instructions, refused to proceed with recommendations, and could not be contacted.

The insurer did not oppose the motion.

The arbitrator found that the representatives had complied with Rule 9.7 of the Dispute Resolution Practice Code and granted the motion to remove them as representatives of record.