OFSCDRS 2017

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

The arbitrator dismissed the claim for income replacement benefits, finding that post-accident funds provided by the applicant's company to her service provider were deductible employment income.

The claim for attendant care benefits was also dismissed because the service providers were not healthcare professionals and did not suffer an economic loss, and the expenses were not deemed incurred under s. 3(8) of the SABS.

The arbitrator granted claims for rehabilitative coaching, occupational therapy, physiotherapy, and a nutritional assessment, but denied claims for assistive devices, attendant care assessments, and a speech language assessment.

The claim for a special award was dismissed as the insurer's conduct was not unreasonable.

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

After her legal representative was removed from the record due to a breakdown in the solicitor-client relationship, the applicant failed to participate in the arbitration proceedings or attend the scheduled hearing.

The insurer brought a motion to dismiss the application.

The arbitrator found that the applicant's failure to participate constituted an abuse of process and dismissed the application, awarding $2,121.84 in expenses to the insurer.

The applicant sought accident benefits following a motor vehicle accident where a garage door closed on his car.

The insurer denied the treatment plans, arguing the applicant's injuries fell under the Minor Injury Guideline (MIG) and were related to pre-existing conditions.

The arbitrator found no compelling evidence that the applicant suffered an impairment directly related to the accident or that his pre-existing chronic pain was exacerbated by it.

The application for medical benefits, cost of examinations, and interest was dismissed.

The Applicant, a self-employed truck driver, was injured in a motor vehicle accident and sought income replacement benefits from the Insurer.

The Insurer argued that the $3,000 per month the Applicant received from a private disability policy (NAL Insurance) was deductible as an income continuation benefit plan.

The Arbitrator found that the Applicant was 'employed' for the purposes of the Schedule and that the private disability benefits were calculated with reference to his income from employment.

Consequently, the private benefits were deductible, reducing the Applicant's income replacement benefit entitlement to $0.

The applicant, a migrant worker from Jamaica, was injured in a motor vehicle accident while being transported to work.

He initially received WSIB benefits but later sought to claim statutory accident benefits from the motor vehicle insurer.

The insurer argued the applicant was precluded from proceeding to arbitration because he failed to provide notice within the time limit under section 32(1) of the Schedule.

The arbitrator found that the applicant, who was illiterate and unfamiliar with the Ontario accident benefits system, provided a reasonable explanation for the delay, as he was navigating the complex interaction between WSIB, tort, and accident benefits systems and seeking legal advice.

The applicant was permitted to proceed to arbitration.

Following an arbitration where the insurer successfully defended against the applicant's claims for statutory accident benefits, the insurer requested an expense hearing.

The insurer sought $20,630.09 in costs.

The arbitrator found the insurer's claimed hours unsubstantiated for a non-complex case and noted the applicant's case had some merit, as evidenced by the insurer's settlement offers.

Applying a global approach based on Legal Aid rates, the arbitrator ordered the applicant to pay the insurer $8,595.96 in expenses.

The applicant was unsuccessful in her arbitration for accident benefits and was ordered to pay the insurer's expenses.

In this expense hearing, the insurer claimed over $44,000 in costs.

The arbitrator reduced the claimed amount, noting the applicant was self-represented and the insurer's claim was disproportionate to the amounts at issue.

The arbitrator awarded the insurer $14,928.26 in expenses for the main hearing but denied the insurer's request for the costs of the expense hearing itself.

The applicant sought a non-earner benefit following a 2013 motor vehicle accident, claiming it exacerbated her pre-existing psychiatric issues and chronic pain.

The insurer denied the benefit, arguing her activities of daily living had not substantially changed.

The arbitrator found that the applicant's normal life had changed due to a prior 2011 accident and family conflicts, not the 2013 accident.

Despite an aggravation of her chronic pain, she continued to engage in substantially all her pre-accident activities, such as attending workshops, driving, and socializing.

The application was dismissed, and expenses were awarded to the insurer.

The applicant sought accident benefits following a motor vehicle accident and applied for arbitration.

The applicant failed to attend the scheduled arbitration hearing.

The insurer brought a motion to dismiss the application.

The arbitrator proceeded in the applicant's absence pursuant to Rule 37.9 of the Dispute Resolution Practice Code.

As the applicant bore the onus of proving entitlement and presented no evidence, the application was dismissed.

The arbitrator awarded $1,000 in expenses to the insurer due to the applicant's failure to prove his claim and attend the hearing.

The Applicant sought to withdraw his Application for Arbitration for accident benefits.

The Insurer consented to the withdrawal but sought its expenses of $6,166.85.

The Arbitrator permitted the withdrawal and ordered the Applicant to pay the Insurer's expenses fixed at $1,500, noting the Applicant's participation in the process and the lack of evidence that the application was vexatious or in bad faith.

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

The parties were unable to resolve their disputes through mediation, and the applicant applied for arbitration.

The applicant's legal counsel was removed from the record due to a breakdown in the solicitor-client relationship.

The applicant failed to attend the scheduled arbitration hearing.

The arbitrator dismissed the application for arbitration as an abuse of process due to the applicant's non-participation and failure to meet the onus of proving entitlement to the claimed benefits.

The insurer was awarded expenses in the amount of $3,243.61.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, medical benefits, transportation expenses, an assessment expense, interest, and a special award.

The arbitrator found that credible psychological and orthopedic evidence established chronic pain and related psychological sequelae, taking the claim outside the Minor Injury Guideline and supporting entitlement to the disputed physiotherapy treatment plans.

Applying the Schedule's pre-104-week test, the arbitrator held that the applicant had a substantial inability to perform the essential tasks of his pre-accident employment and was entitled to weekly income replacement benefits for that period only.

The post-104-week claim failed because the evidence did not prove a complete inability to engage in any suitable employment.

Transportation and interest were awarded, the in-home assessment expense and special award were denied, and expenses were left to further determination if necessary.

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

After his legal counsel was removed from the record, the applicant failed to attend the scheduled arbitration hearing or file any documentation.

The insurer brought an oral motion to dismiss the application.

The arbitrator dismissed the application for arbitration due to the applicant's failure to appear and awarded $2,000 in expenses to the insurer.

The appellant appealed an Arbitrator's order dismissing her arbitration for statutory accident benefits due to her failure to attend insurer examinations (IEs).

The appellant argued the Arbitrator breached procedural fairness, the IEs were not reasonably necessary, the insurer was precluded from relying on the Minor Injury Guideline (MIG), and the IE notices lacked valid medical reasons.

The Director's Delegate dismissed the appeal, finding no breach of procedural fairness and that the insurer had a prima facie right to request the IEs.

The Delegate upheld the Arbitrator's findings that the insurer did not waive its right to rely on the MIG by approving treatment within the $3,500 limit, and that the IE notices provided sufficient medical reasons by asserting the injuries fell within the MIG definition.

Preclusion from arbitration was confirmed as the mandatory remedy under section 55 of the Schedule.

The insurer sought its expenses following a preliminary issue hearing where the arbitrator found that no 'accident' had occurred and dismissed the applicant's claim for statutory accident benefits.

The applicant's paralegal sought to be removed from the record due to a breakdown in the solicitor-client relationship, but the arbitrator denied the request to prevent prejudice to the applicant.

The arbitrator found that the applicant's claim was frivolous and his testimony fabricated, causing the insurer to incur unnecessary costs.

The arbitrator ordered the applicant to pay the insurer's expenses fixed at $8,419.18.

The three applicants were involved in a motor vehicle accident and sought various statutory accident benefits, including non-earner benefits, attendant care benefits, and medical rehabilitation benefits.

The insurer denied the claims based on independent medical examinations indicating that the applicants' ongoing impairments were related to pre-existing conditions rather than the accident.

The arbitrator found that none of the applicants suffered a complete inability to carry on a normal life, and that the proposed treatment plans and attendant care were neither reasonable nor necessary.

All claims for benefits were dismissed.

The Appellant was injured in a motor vehicle accident while serving the two-week waiting period for Employment Insurance (EI) benefits, following a period of salary continuance from his former employer.

He applied for an income replacement benefit (IRB) under the Statutory Accident Benefits Schedule.

The Arbitrator ruled that the Appellant was not entitled to an IRB because he was not 'receiving' EI benefits at the time of the accident, as required by section 5(1)(ii) of the Schedule.

On appeal, the Director's Delegate upheld the Arbitrator's decision, finding no error in the interpretation that 'receiving' requires actual payment, which had not occurred due to the statutory waiting period.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the insurer, including attendant care benefits, medical benefits for an eye exam, and replacement costs for damaged clothing and prescription sunglasses.

The insurer denied the benefits.

The arbitrator found the applicant was entitled to attendant care benefits at the rate determined by the initial assessment, as the service provider had sustained an economic loss.

The arbitrator also awarded the costs of the eye exam and prescription sunglasses, but denied the clothing claims due to a lack of receipts.

Furthermore, the arbitrator ordered the insurer to pay a special award of 50% of the owing benefits, finding that the insurer had unreasonably withheld payment contrary to the Schedule and ignored evidence of the service provider's economic loss.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The arbitrator found that the applicant's injuries, which included chronic pain, a head injury resulting in hearing impairment, and psychological impairments, took him outside the MIG.

The arbitrator ordered the insurer to pay for the disputed medical benefits and the costs of various examinations.

Although the applicant established an entitlement to attendant care benefits, the claim was dismissed because the quantum could not be proven under section 19(3)4 of the Schedule.

The arbitrator also ordered the insurer to pay a $5,000 special award for unreasonably delaying and withholding benefits, noting the insurer's failure to properly investigate the applicant's head injury and chronic pain.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits from his insurer.

The insurer initially paid some benefits but later terminated them, arguing the applicant suffered only minor injuries and was capable of working.

The arbitrator found that the applicant was entitled to IRBs for a limited period from August 2013 to October 2013, as he had returned to work thereafter and failed to prove a complete inability to engage in employment.

The claims for further medical benefits were dismissed because the insurer had already paid the $50,000 policy limit after conceding the applicant's pre-existing condition removed him from the Minor Injury Guideline.

Interest was awarded on benefits that the insurer had delayed paying.