OFSCDRS 2018

The appellant appealed an arbitrator's decision dismissing his claims for income replacement benefits and housekeeping expenses, and ordering him to pay $49,982.10 in costs to the respondent insurer.

The Director's Delegate found that the arbitrator's conclusions were based on factual findings regarding the appellant's lack of credibility and failure to provide reliable evidence of pre-accident employment and housekeeping expenses.

The Delegate held that there were no errors of law in the arbitrator's substantive findings, costs award, or procedural rulings.

The appeal was dismissed and the arbitrator's orders were confirmed.

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

The parties settled the substantive issues prior to the arbitration hearing but could not agree on expenses.

The applicant sought expenses for preparation, including time spent investigating the insurer's assessors and alleging unfair practices.

The insurer argued these actions were unnecessary and unrelated to the disputed issues.

The arbitrator found the applicant was entitled to expenses as she was successful in the settlement, but reduced the claimed amount because the case did not proceed to a hearing and some time was spent on systemic issues rather than the specific dispute.

The arbitrator awarded $3,000 for fees and $3,294.49 for disbursements.

The insured, a minor, applied for accident benefits following a motor vehicle accident.

The insurer paid $12,000 in attendant care benefits but later sought repayment, alleging material misrepresentation.

At arbitration, the insured's representative withdrew all her disputes.

The Arbitrator permitted the withdrawal and precluded the insurer from pursuing its repayment claim, finding no application remained before the Commission.

On appeal, the Director's Delegate reversed the decision, holding that under section 282(3) of the Insurance Act, an arbitrator must determine all issues in dispute, including those raised by the insurer, regardless of the withdrawal of the insured's issues.

The matter was returned to arbitration.

Following the dismissal of the appellant's statutory accident benefits appeal, the respondent requested an assessment of appeal expenses.

The Director's Delegate directed the parties to file written submissions regarding expenses.

Neither party provided submissions.

Consequently, the request for an assessment was dismissed and no award of expenses was made.

The insurer appealed an arbitrator's decision finding the insured catastrophically impaired due to a mental or behavioural disorder.

The appeal was dismissed.

The insured sought her legal appeal expenses.

The Director's Delegate awarded the insured $30,000 in expenses, inclusive of disbursements and HST, noting that the insurer's appeal was misguided and the matter was of great importance to the insured.

Following an arbitration where the applicant was largely successful in claiming statutory accident benefits, the parties could not agree on the quantum of expenses.

The applicant sought $43,405.26 in costs, while the insurer argued for a significantly reduced amount due to alleged delays, improper conduct, and excessive disbursement claims.

The arbitrator found that both parties contributed to procedural frustrations and applied a broad stroke approach, reducing certain excessive disbursements and correcting the law clerk's hourly rate.

The insurer was ordered to pay $38,000.00 in expenses.

The appellant insurer filed an appeal from an arbitrator's order, which the Director's Delegate declined to hear on the basis that it was an appeal of an interim or preliminary order.

The respondent subsequently sought expenses for the appeal proceeding.

The Director's Delegate rejected the insurer's argument that expenses should be deferred until a hypothetical future hearing on the merits, and awarded the respondent $700 inclusive of disbursements and HST for the written proceeding.

Following an arbitration where the applicant was found not to have sustained a catastrophic impairment and was denied various benefits, the insurer requested an expense hearing.

The arbitrator considered the criteria under Rule 75.2 of the FSCO Dispute Resolution Practice Code, including the insurer's complete success and a rejected offer to settle.

The arbitrator awarded the insurer expenses, applying a 4:1 preparation to hearing ratio for counsel and a 2:1 ratio for the articling student, and reduced certain disbursements.

The applicant was ordered to pay the insurer $101,205.11 inclusive of fees, disbursements, and taxes.

State Farm appealed an arbitration order to vary the quantum of Income Replacement Benefits (IRBs) payable to the insured, who began receiving CPP disability benefits after the original order.

The Director's Delegate allowed the variation, reducing the ongoing IRB rate to account for the CPP deduction.

However, State Farm's request for repayment of past overpayments was denied because its notices under section 52 of the Statutory Accident Benefits Schedule were defective, claiming periods longer than the permitted 12 months and miscalculating the maximum allowable deduction.

Consequently, State Farm was ordered to repay the insured all amounts it had already collected through weekly deductions, with interest.

The appellant was injured in a motor vehicle accident and sought statutory accident benefits.

In a previous arbitration, the arbitrator found the appellant was entitled to treatment plans but denied a special award.

On appeal, the denial of the special award was rescinded and returned to a new arbitrator for redetermination.

The second arbitrator also denied the special award.

The appellant appealed again.

The Director's Delegate found that the second arbitrator committed errors of law by making factual findings based on speculation, unsupported by evidence, and contradicting the binding factual findings of the first arbitrator.

The decision was rescinded and the issue of the special award was returned to a different arbitrator for redetermination.

The Applicant sought expenses following the settlement of his claim for an income replacement benefit arising from a motor vehicle accident.

The Insurer had initially denied the benefit, alleging the accident was staged, but agreed to pay after a jury in a bifurcated tort action found the accident was not staged.

The Arbitrator determined that the Applicant was entitled to expenses because he had to pursue arbitration to dispute the Insurer's position.

Taking a broad stroke approach, the Arbitrator awarded the Applicant $11,996.64 for legal fees, disbursements, and HST, rejecting claims for tort-related reports and fees.

The appellant appealed an arbitrator's order requiring him to pay the respondent's arbitration expenses of $6,558.11 following the dismissal of his claims for accident benefits.

The appellant argued the arbitrator lacked jurisdiction because she was not the hearing arbitrator and erred in her application of the Expense Regulation.

The Director's Delegate dismissed the appeal, finding that the arbitrator had jurisdiction under the Dispute Resolution Practice Code and correctly applied the results-based approach mandated by the Expense Regulation.

The appellant appealed an Arbitrator's order requiring her to pay the insurer's expenses of the arbitration in the amount of $17,755.18.

The appellant argued that the Arbitrator lacked jurisdiction because she was not the hearing arbitrator and that she erred in her application of the Expense Regulation.

The Director's Delegate dismissed the appeal, finding that the Arbitrator had jurisdiction under the Dispute Resolution Practice Code to decide the issue of expenses and correctly applied the prescribed criteria, which focus on the degree of success.

The insurer was entirely successful at the arbitration, and the Arbitrator reasonably reduced the claimed expenses to a proportionate amount.

The appellant appealed an Arbitrator's order that denied an adjournment and dismissed the application for arbitration regarding catastrophic impairment benefits.

After filing the Notice of Appeal, the appellant failed to deliver written submissions or respond to multiple inquiries from the Director's Delegate.

The Director's Delegate concluded that the appellant had abandoned the appeal and dismissed it.

The Insurer, having been wholly successful at arbitration and on appeal regarding the Applicant's claims for statutory accident benefits, sought its expenses of the proceeding.

The Insurer claimed over $36,000 in legal fees and disbursements.

The Arbitrator reviewed the criteria under the FSCO Dispute Resolution Practice Code and found that while the dispute was legitimate, the Insurer was entitled to its reasonable expenses.

After reducing excessive claims for photocopies and expert witness fees, the Arbitrator fixed the expenses payable by the Applicant to the Insurer at $10,000.00, inclusive of fees, disbursements, and taxes.

The applicant sought a special award under s. 282(10) of the Insurance Act, arguing the insurer unreasonably withheld and delayed payment of income replacement benefits (IRB) and catastrophic impairment benefits following a motor vehicle accident.

The arbitrator found that while a special award could not be based solely on the catastrophic impairment determination, the insurer's handling of the IRB claim justified an award.

The insurer had relied on incomplete and inconclusive reports to terminate benefits, ignoring a multitude of conclusive medical reports, including from its own assessors, that supported the applicant's inability to work.

The arbitrator concluded this demonstrated stubborn, inflexible, and unreasonable behaviour, and ordered the insurer to pay a special award of 35% of the owing IRB total, plus 2% compound interest.

The parties cross-appealed an Arbitrator's decision awarding the insured person all claimed accident benefits, interest, expenses, and a special award.

The Director's Delegate found that the Arbitrator correctly ordered payment of medical benefits and income replacement benefits (IRBs) where the insurer completely failed to respond to the claims, pursuant to the plain meaning of the Statutory Accident Benefits Schedule.

However, the Arbitrator erred in ordering payment where the insurer's response was merely deemed improper, and in failing to calculate the net amount of IRBs payable after deducting post-accident income.

The Delegate also found that while a special award was justified due to the insurer's unreasonable delay, the Arbitrator erred by failing to fix the amount of the award with precision.

Several issues, including the quantum of IRBs and the special award, were remitted for re-hearing.

The applicant sought expenses following a successful appeal of an arbitrator's decision that had dismissed his application for accident benefits on preliminary issues.

The Director's Delegate allowed the appeal and permitted an expense hearing if the parties could not agree.

The arbitrator found that the applicant was 100% successful on the appeal and was therefore entitled to his expenses for that proceeding.

As the applicant's bill of costs included work for the entire arbitration rather than just the appeal, the arbitrator estimated the reasonable hours spent on the appeal and awarded $2,418.20 inclusive of fees, disbursements, and HST.

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

After the applicant withdrew his application for arbitration at the Financial Services Commission of Ontario (FSCO) to proceed at the Licence Appeal Tribunal, the insurer sought its expenses for defending the FSCO application.

The arbitrator found that the applicant's initial refusal to attend an examination under oath and his unnecessary resistance to re-opening the FSCO application prolonged and hindered the proceeding.

The arbitrator ordered the applicant to pay the insurer $6,037.84 in expenses.

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

The insurer later sought to vary or revoke the benefits, alleging the applicant fraudulently misrepresented his employment.

The applicant brought a motion to dismiss the variation application or exclude evidence, arguing the insurer breached its duty of good faith and the applicant's privacy by sharing information between its tort and accident benefits departments.

The arbitrator dismissed the motion, finding that the Personal Information Protection and Electronic Documents Act permitted the collection of information and that the applicant had authorized the insurer to verify his employment information.

No breach of privacy was established.