OFSCDRS 2017

The applicant sought death benefits following the death of her spouse in a motor vehicle accident.

At the hearing, the insurer objected to the applicant testifying because her counsel failed to provide a witness list in advance, contrary to a pre-hearing agreement and Rule 41 of the Dispute Resolution Practice Code.

The arbitrator ruled that the applicant could testify, noting that the insurer was prepared for cross-examination, claimed no prejudice, and procedural fairness required allowing the applicant to present her case fully.

The insured was injured in a motor vehicle accident and sought a determination of catastrophic impairment.

The insurer denied the designation, and the insured filed an Application for Mediation.

Before the 60-day mediation period expired and before mediation had failed, the insured filed an Application for Arbitration.

The insurer requested a preliminary issue hearing to determine if the arbitrator had jurisdiction.

The arbitrator held that the Application for Arbitration was barred because the statutory pre-condition of a failed mediation under s. 281(2) of the Insurance Act had not been met at the time the application was filed.

The applicant sought accident benefits following a motor vehicle accident.

The insurer denied the claims and mediation failed.

The applicant submitted an application for arbitration, which the insurer argued was time-barred under section 281.1(2)(b) of the Insurance Act.

The applicant claimed she had mailed the application within the limitation period, but it was misplaced by the Financial Services Commission of Ontario.

The arbitrator found no credible evidence that the application was submitted on time and dismissed the application as time-barred.

The Applicant sought accident benefits for physiotherapy and massage therapy following a rear-end motor vehicle collision.

The Insurer denied the claims on the basis that the Applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment plans were unsigned.

The Arbitrator dismissed the Applicant's claims, finding that the Applicant failed to sign the OCF-18 treatment plans as required by section 38(3) of the SABS.

Furthermore, the Arbitrator accepted the Insurer's expert medical evidence that the Applicant's soft tissue injuries were treatable within the MIG and that the Applicant did not suffer from chronic pain.

The Insurer was awarded its expenses for the arbitration.

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

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

Following a series of pre-hearings where the applicant's legal representatives were removed from the record, the applicant failed to participate in a scheduled pre-hearing.

The insurer brought a verbal motion to dismiss the application.

The arbitrator granted the motion, finding the applicant's actions over the past 12 months provided proper grounds for dismissal under Rule 68.1 of the Dispute Resolution Practice Code.

The application was dismissed and the applicant was ordered to pay $1,250 in costs to the insurer.

The Applicant was injured as a pedestrian in a motor vehicle accident and sought statutory accident benefits.

She submitted a treatment plan for a neuropsychological assessment totaling $5,028.50.

The Insurer paid $2,200, arguing the work constituted a single assessment capped at $2,000 plus $200 for the OCF-18 form.

The Applicant argued the work constituted two separate assessments, entitling her to an additional $2,000.

The Arbitrator found that the two reports submitted had the same purpose, author, and tests administered, and therefore constituted a single assessment under the Schedule.

The application for the remaining balance and interest was dismissed.

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

A dispute arose and the applicant applied for arbitration at FSCO.

The applicant subsequently sought to add the cost of two examinations to the arbitration.

The insurer brought a preliminary issue motion arguing that FSCO lacked jurisdiction to add issues after April 1, 2016, due to legislative amendments transferring jurisdiction to the Licence Appeal Tribunal.

The arbitrator dismissed the insurer's motion, finding that FSCO has a longstanding practice of adding issues to existing arbitrations, which is supported by the Dispute Resolution Practice Code, the doctrine of legitimate expectation, and the Statutory Powers Procedure Act.

Adding the issues avoids a multiplicity of proceedings and does not cause significant prejudice to the insurer.

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

After a dispute arose, she applied for arbitration at FSCO.

She later sought to add the issue of non-earner benefits to the arbitration.

The insurer brought a preliminary issue motion arguing that FSCO lacked jurisdiction to add issues after April 1, 2016, when amendments to the Insurance Act transferred jurisdiction for new applications to the Licence Appeal Tribunal.

The arbitrator dismissed the insurer's motion, finding that FSCO retains jurisdiction to add issues to existing arbitrations, consistent with its longstanding practice, the Dispute Resolution Practice Code, and the Statutory Powers Procedure Act.

Adding the issue avoids a multiplicity of proceedings and prevents potential prejudice to the applicant regarding limitation periods.

The Insurer sought its expenses of $75,343.92 following an arbitration where success was divided but predominantly in favour of the Insurer.

The Applicant also sought his expenses.

The Arbitrator considered the criteria under Rule 75.2 of the Dispute Resolution Practice Code, noting the Insurer's written offer to settle for $100,000, which exceeded the Applicant's recovery.

The Arbitrator also noted the Applicant's conduct in failing to comply with production orders, which prolonged the proceedings.

The Arbitrator reduced the Insurer's claimed legal fees and disbursements to reflect the Applicant's partial success and the applicable hourly rates, awarding the Insurer $40,357.10 in expenses.

The Applicant's request for expenses was dismissed.

The Insurer brought a motion to stay the arbitration hearing pending the Applicant's attendance at a follow-up insurer's psychiatric examination.

The Applicant had submitted new medical information regarding his psychological state 19 months after the Insurer's initial psychiatric assessment.

The Arbitrator found that the Insurer's request for a follow-up in-person assessment was reasonable and necessary to address the new information and determine catastrophic impairment.

The Arbitrator held that proceeding without the assessment would be procedurally unfair to the Insurer.

The motion was granted and the hearing was stayed.

The applicant sought accident benefits following a motor vehicle accident but failed to appear at the arbitration hearing or communicate with her former counsel.

The arbitrator proceeded in the applicant's absence and dismissed the application for arbitration because the applicant failed to meet her onus of proving entitlement to the claimed benefits.

The insurer was awarded $875.00 in expenses due to the applicant's failure to pursue her claim and attend the hearing.

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

The Insurer denied several treatment plans and assessments, arguing the Applicant's injuries fell within the Minor Injury Guideline (MIG).

The arbitrator found that the Applicant's psychological and orthopaedic expert reports were tainted by a conflict of interest, as the primary psychologist had a close personal and financial relationship with the Applicant, and other experts relied on her clinic's flawed assessments.

The arbitrator excluded or gave no weight to the Applicant's expert evidence and accepted the Insurer's independent medical examinations.

The arbitrator concluded the injuries were predominantly minor and dismissed the claims for further benefits.

Following an arbitration decision awarding statutory accident benefits to the applicant, the parties disputed the quantum of expenses, the calculation of interest on overdue benefits, and whether the arbitrator had jurisdiction to increase the quantum of an approved medical benefit.

The arbitrator awarded the applicant $27,910.01 in expenses, finding the insurer's adversarial approach unnecessarily prolonged the proceedings.

The arbitrator also held that interest on overdue benefits runs from 30 days after the receipt of the treatment plans, rejecting the insurer's argument that interest only runs from the submission of invoices.

Finally, the arbitrator concluded she lacked jurisdiction to amend the quantum of the approved medical benefit, as it would constitute a substantive change rather than correcting a typographical error.

Following a preliminary issue hearing where it was determined that no motor vehicle accident had occurred, the insurer sought repayment of accident benefits paid to the applicants and its expenses for the arbitration.

The applicants did not participate in the written expense hearing.

The arbitrator ordered the applicants to repay the benefits they received, finding the claims were made under a misrepresentation.

The arbitrator also ordered the applicants to pay the insurer's reasonable expenses for the arbitration, reducing the claimed amount of $24,973.36 to $9,242.96 after finding the claimed legal fees and disbursements were excessive.