OFSCDRS 2017

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

After her legal counsel was removed, the applicant failed to attend the scheduled arbitration hearing.

The insurer brought an oral motion to dismiss the application.

The arbitrator dismissed the application for arbitration due to the applicant's failure to attend and present evidence, concluding she had abandoned her claim.

The insurer was awarded $2,000 in expenses for unnecessary time and money spent defending the claim.

Following a successful defence of an application for statutory accident benefits, the insurer sought its expenses for the arbitration hearing.

The arbitrator reviewed the insurer's bill of costs, noting that the rules for insurer's costs differ significantly from those for an insured.

The arbitrator reduced the claimed hourly rates to align with the Legal Aid Tariff and adjusted the ratio of preparation time to hearing time from 5:1 to 3:1.

Certain disbursements, including fees for a witness who did not testify and court reporter fees, were disallowed.

The insured was ordered to pay the insurer $16,115.96 for its expenses.

The applicant sought post-104 income replacement benefits following a motor vehicle accident, claiming a complete inability to work due to physical and psychological injuries.

The insurer denied the benefits and presented surveillance and social media evidence showing the applicant actively operating a holistic business, working as a life coach, and giving motivational speeches.

The arbitrator found the applicant lacked credibility and preferred the evidence of the insurer's neuropsychologist over the applicant's experts, who were unaware of her business activities.

The application for income replacement benefits, a special award, and interest was dismissed, with expenses awarded to the insurer.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment based on mental or behavioural disorders (Criterion 8).

The applicant suffered a severe breast injury resulting in chronic pain, which she argued caused marked impairments in social functioning and adaptation.

The arbitrator applied the AMA Guides and found that while the applicant suffered from mental disorders, her impairments in social functioning and adaptation were at most moderate (Class 3).

The arbitrator concluded that the applicant's work challenges stemmed primarily from physical pain rather than a mental disorder, and dismissed the application for catastrophic impairment.

The applicant was injured in a motor vehicle accident and sought accident benefits from the insurer, including the cost of a worksite assessment.

The insurer denied the assessment and took the position that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The arbitrator found that the worksite assessment was not reasonable and necessary, as the applicant had only missed one day of work and had not claimed income replacement benefits.

Furthermore, the arbitrator concluded that the applicant failed to provide sufficient objective medical evidence to establish that his injuries, including alleged chronic pain and a subsequent left knee impairment, fell outside the MIG.

The applicant's claims were dismissed.

The insurer, having successfully defended the applicant's claim for accident benefits at arbitration, sought $22,820.05 in expenses.

The arbitrator considered the criteria under Rule 75.2 of the Dispute Resolution Practice Code and the principle of fairness, noting the Schedule is consumer protection legislation.

Given the applicant's limited income from Canada Pension Plan disability benefits and the uncomplicated nature of the case, the arbitrator fixed the insurer's expenses at $2,500.00 inclusive of fees, disbursements, and HST.

The applicant was injured in a motorcycle accident and applied for catastrophic impairment benefits, which the insurer denied.

The central issue was whether the applicant's impairments met the 55% Whole Person Impairment (WPI) threshold, with the insurer arguing that a pre-existing back condition accounted for a significant portion of his current disability.

The arbitrator rejected the insurer's expert evidence regarding the pre-existing condition and symptom magnification, finding the applicant's experts more reliable.

The arbitrator concluded that the applicant sustained a catastrophic impairment as a direct result of the accident and awarded him his full arbitration expenses.

The applicant was injured in a motor vehicle accident and sought income replacement and medical benefits from her insurer.

The insurer denied the benefits, arguing that the applicant's ongoing impairments were caused by a subsequent slip and fall incident rather than the motor vehicle accident.

The arbitrator found the applicant credible and concluded that the motor vehicle accident rendered an asymptomatic condition symptomatic, making her vulnerable to subsequent flare-ups.

The arbitrator awarded income replacement benefits from March 2014 onwards and approved several treatment plans, but denied a special award, finding the insurer had not acted unreasonably given the complex medical evidence.

Following a decision that the arbitrator had no jurisdiction to order a special award regarding the handling of the applicant's claim for attendant care benefits, the insurer sought its expenses for the arbitration proceeding.

The arbitrator found that the insurer was the successful party and awarded expenses.

However, noting the lack of complexity and the consumer-oriented nature of the legislation, the arbitrator reduced the claimed hours and awarded the insurer 50% of its claimed expenses, fixing the amount at $5,580.14.

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

The matter was scheduled for an arbitration hearing, but the applicant failed to attend or send a representative, despite receiving proper notice.

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 applicant was ordered to pay $1,500 in expenses to the insurer for the costs of preparing for the hearing.

The appellant appealed an arbitrator's decision denying him post-104 week income replacement benefits following a motor vehicle accident.

The Director's Delegate allowed the appeal, finding that the arbitrator failed to provide adequate reasons for his decision and mischaracterized the test for post-104 week benefits.

The arbitrator did not properly analyze the vocational evidence or explain how the appellant was reasonably suited for the suggested alternative employments.

The decision was rescinded and the matter returned to arbitration before a different arbitrator.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) at a rate of $400.00 per week.

The insurer paid IRBs at a rate of $308.74 per week, based on the applicant's declared self-employment income to the Canada Revenue Agency.

The arbitrator held that under section 4(5) of the Statutory Accident Benefits Schedule, the applicant is bound by the income declared for tax purposes, precluding him from claiming a higher income for IRB purposes.

The applicant's IRB entitlement was fixed at $308.74 per week, subject to future adjustment if his tax returns are reassessed.

The applicant was injured in a motor vehicle accident and settled his statutory accident benefits claim with the insurer, executing a full and final release.

Subsequently, an arbitration was commenced for an unpaid catastrophic assessment report, which was dismissed due to the prior settlement.

The insurer sought its expenses for the arbitration.

The arbitrator found that the arbitration was driven by the assessment facility, AssessNet Inc., rather than the applicant.

The arbitrator awarded the insurer its expenses in the amount of $13,387.31, and ordered that they be paid by AssessNet Inc. as the party instructing the conduct of the hearing.

The appellant appealed an Arbitrator's order regarding statutory accident benefits, seeking clarification on whether a 50% special award applied to medical benefits in excess of his $100,000 policy limit.

The Director's Delegate dismissed the appeal, finding no error of law.

The Delegate held that the Arbitrator's jurisdiction to make a special award is strictly limited by the insured's statutory entitlement to benefits under the policy limits, pursuant to s. 282(10) of the Insurance Act.

The Arbitrator could not have ordered a special award on benefits to which the appellant was not entitled.

The applicant sought accident benefits following a motor vehicle accident.

The insurer terminated income replacement benefits and sought repayment, alleging the applicant misrepresented her employment status.

The applicant failed to produce ordered employment records and did not attend the hearing.

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

The arbitrator dismissed the applicant's claims and ordered her to repay $18,914.29 in income replacement benefits, finding she wilfully misled the insurer about her work history.

The insurer was also awarded $3,500 in costs.

The applicant was injured in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder.

The insurer argued that the applicant was not credible, that causation was not established due to pre-existing issues and subsequent accidents, and that her impairment was only mild to moderate.

The arbitrator found the applicant credible despite memory lapses, and concluded that the accident caused her major depressive disorder with psychotic features and posttraumatic stress disorder.

Preferring the evidence of the applicant's psychiatric assessor, the arbitrator held that the applicant sustained a marked (Class 4) impairment and was therefore catastrophically impaired.

The applicant was seriously injured in a motor vehicle accident in Georgia and sought a determination that he sustained a catastrophic impairment under the Statutory Accident Benefits Schedule.

The parties' medical experts disagreed on the applicant's whole person impairment (WPI) rating, with the applicant's experts assessing it between 62% and 71%, and the insurer's experts assessing it between 48% and 51%.

The arbitrator preferred the evidence of the applicant's experts, finding that the applicant's physical and psychological impairments, when combined, exceeded the 55% threshold.

The arbitrator also found that the accident materially contributed to the applicant's impairments, including his atrial fibrillation and peripheral neuropathy, despite the insurer's arguments regarding pre-existing susceptibility.

The applicant was found to have sustained a catastrophic impairment.

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

The central issues were whether he sustained a catastrophic impairment based on a Glasgow Coma Scale (GCS) score of 9 or less, and whether he was entitled to post-104 week income replacement benefits (IRBs) and attendant care benefits.

The Insurer argued the low GCS score was caused by a pre-accident drug overdose and high blood sugar, not a brain injury.

The arbitrator rejected this theory, finding the Applicant suffered a traumatic brain injury resulting in a GCS score of 9, meeting the catastrophic impairment definition.

The arbitrator also found the Applicant suffered a complete inability to engage in suitable employment due to cognitive and physical deficits, awarding ongoing IRBs.

The Applicant was deemed eligible for attendant care benefits pending a new Form 1.

Claims for a special award were dismissed.

The applicant sought accident benefits following a motor vehicle accident.

At a preliminary issue hearing, the insurer sought to introduce examination under oath (EUO) transcripts of the other driver and his passengers, who failed to attend the hearing despite being summoned.

The applicant brought a motion to exclude the transcripts, arguing that admitting them without an opportunity for cross-examination violated the rule in Browne v. Dunn.

The arbitrator dismissed the motion, holding that under the Statutory Powers Procedure Act and the Dispute Resolution Practice Code, the tribunal has broad discretion to admit evidence.

The failure to cross-examine the witnesses goes to the weight of the evidence rather than its admissibility.

The applicant's counsel brought a motion to be removed as solicitor of record due to a serious and irreparable breakdown in the solicitor-client relationship.

The applicant refused to provide instructions on how to proceed after the insurer agreed to fund the claimed benefits.

The applicant's nephew appeared at the hearing and confirmed the applicant no longer wanted the counsel to represent him.

The arbitrator granted the motion and removed the counsel from the record, deferring the issue of expenses to the conclusion of the arbitration.