Other Tribunals - OFSCDRS

The applicant sought an order requiring the insurer to produce its complete file created after the date she filed her Application for Mediation.

The insurer opposed, arguing the file was protected by litigation privilege and irrelevant as claims handling was complete.

The arbitrator dismissed the motion, finding the applicant failed to establish the relevance of post-mediation documents and upholding the Commission's general presumption that documents created after an Application for Mediation are prepared for the dominant purpose of litigation.

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

After failing to attend a scheduled pre-hearing discussion without excuse, the applicant's counsel successfully moved to be removed from the record.

The applicant again failed to attend the resumed pre-hearing discussion.

The insurer brought a motion to dismiss the application as abandoned and an abuse of process.

The arbitrator granted the motion, finding that permitting the matter to proceed would constitute an abuse of process, and ordered the applicant to pay $750 in expenses to the insurer.

The appellant's appeal from a preliminary arbitration decision regarding statutory accident benefits was previously rejected.

The parties could not agree on the legal expenses of the appeal, leading to this expense hearing.

The Director's Delegate found that the respondent was completely successful and that the appeal was unnecessary, as the appellant had conceded the adjudicator lacked jurisdiction to grant the requested relief from forfeiture.

The respondent was awarded its claimed legal expenses of $1,949.96.

The applicant, a taxi driver, was injured in a motor vehicle accident and applied for statutory accident benefits, including income replacement, medical, and housekeeping benefits.

The insurer denied the benefits and the matter proceeded to arbitration.

The applicant failed to attend the pre-hearing and the hearing proceeded in writing.

The arbitrator found that while the applicant was substantially disabled for a period, he was not entitled to income replacement benefits because he failed to provide the insurer with reasonable information to calculate the quantum, such as tax returns and taxi run sheets.

The claims for medical and housekeeping benefits were also dismissed for lack of evidence.

The applicant was ordered to pay the insurer's arbitration expenses.

The applicant sought expenses following a preliminary issue arbitration hearing regarding his employment status at the time of a motor vehicle accident.

Although the applicant was unsuccessful on the preliminary issue, the arbitrator awarded him his expenses.

The arbitrator found that the insurer's conduct unnecessarily prolonged the proceedings by requesting an unfounded last-minute adjournment, conducting a lengthy and mostly irrelevant cross-examination, calling witnesses who added no relevant evidence, and insisting on a separate expense hearing.

The applicant's expenses were assessed and fixed at $10,261.22 plus GST.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to appear at the arbitration hearing.

The arbitrator found that the applicant had been given reasonable notice of the hearing.

Because the applicant did not appear, he failed to satisfy the burden of proof, and the application was dismissed.

The arbitrator further found that the applicant's conduct in pursuing the arbitration without intending to proceed to a hearing was frivolous and vexatious.

Consequently, the applicant was ordered to pay the insurer $2,500 for the expenses of the arbitration proceeding and $3,000 for the return of the assessment fee under the Insurance Act.

The appellant insurer sought to compel the respondent insured to produce documents from a related tort action in a statutory accident benefits arbitration.

The arbitrator dismissed the request, relying on the principles underlying the deemed undertaking rule.

On appeal, the Director's Delegate upheld the arbitrator's decision, finding that compelling production of defence medicals and discovery transcripts from the tort action would distort the arbitration process and prejudice the insured, particularly given the insurer's ability to conduct its own medical examinations under the Statutory Accident Benefits Schedule.

The Applicant sought to withdraw her claim for income replacement benefits from arbitration to pursue it in court, where she could seek relief from forfeiture for failing to attend an insurer's medical examination.

The arbitrator refused to allow the Applicant to split her case between two forums due to the risk of inconsistent results and increased costs.

However, the arbitrator permitted the Applicant to withdraw her entire application for arbitration without terms or conditions, finding that both parties contributed to the confusion regarding the issues in dispute and that the arbitration was not frivolous or vexatious.

In a pre-hearing dispute over statutory accident benefits, the applicant sought production of investigator's reports regarding an alleged offer of employment.

The insurer claimed litigation privilege over the reports but reserved the right to call the investigator as a witness.

The arbitrator applied the dominant purpose test and the Dispute Resolution Practice Code, finding that the reports were likely requisitioned to adjust the file rather than for litigation.

Given the insurer's reservation of the right to call the investigator, the arbitrator ordered the production of the reports to ensure full and fair disclosure.

The Ministry of Finance, acting as an intervenor, brought a motion to introduce new evidence in the form of an affidavit from a former Director of Arbitrations.

The underlying appeal involved a challenge by the insurer to the dispute resolution system based on alleged institutional bias.

The insurer and another intervenor objected to portions of the affidavit referring to historical reports and special award statistics.

The Director of Arbitrations allowed the motion, finding the historical context relevant to the institutional bias issue and noting that the insurer had the opportunity to cross-examine the affiant.

The affidavit was admitted in its entirety.

The insurer raised a preliminary issue regarding the self-represented applicant's mental competence to proceed with his arbitration for statutory accident benefits.

The applicant had a history of paranoid schizophrenia and hospitalizations.

Applying the presumption of capacity under the Substitute Decisions Act, the arbitrator reviewed medical evidence and heard testimony from the applicant.

The arbitrator found that the applicant's cognitive functions were intact while on medication, he understood the issues in dispute, and he appreciated the consequences of his decisions.

The arbitrator concluded the applicant was mentally capable and could proceed without a litigation guardian.

The applicant applied under s. 282(12) of the Insurance Act for the appointment of a new arbitrator, alleging that the current arbitrator demonstrated bias against her representatives in another case.

The Director of Arbitrations dismissed the application, finding no evidence of bias against the representatives or the applicant in the present case, relying on reasons detailed in a concurrent decision.

The insurer brought a motion on preliminary issues regarding the format of a pre-hearing discussion and the applicant's failure to attend insurer examinations.

The self-represented applicant requested a teleconference for convenience, while the insurer insisted on an in-person meeting to better assess credibility and facilitate settlement.

The arbitrator ordered the pre-hearing to be held face-to-face, noting that in-person discussions are generally more fruitful for settlement and the applicant lived a reasonable distance from the Commission.

The issue regarding the insurer examinations was withdrawn after the applicant clarified he was only claiming benefits up to a specific date.

The Applicant sought to withdraw her application for arbitration mid-hearing after an unfavourable evidentiary ruling, intending to pursue the matter in court.

The Insurer opposed the withdrawal.

The Arbitrator denied the request, finding that permitting a withdrawal after three days of hearing and testimony from two witnesses would be unfair to the Insurer, detrimental to the arbitration process, and amount to forum shopping.

The hearing was ordered to continue, and the Insurer was awarded $350 in costs for the withdrawal request.

The applicant was injured in a motor vehicle accident and commenced a court action against the insurer for statutory accident benefits.

The parties settled the court action and executed a release.

The applicant subsequently applied for arbitration at the Financial Services Commission of Ontario, claiming entitlement to money deducted for Canada Pension Plan benefits during the settlement period.

The insurer raised a preliminary issue regarding jurisdiction.

The arbitrator held that the Commission lacked jurisdiction, as the applicant had elected to proceed in court under section 281(1) of the Insurance Act, and any dispute regarding the interpretation of the settlement agreement must be dealt with by the court.

The applicant sought to withdraw his application for arbitration regarding statutory accident benefits after a settlement had been reached.

The insurer agreed to the withdrawal but sought costs and its assessment fee against the applicant's representative or the applicant personally, arguing the proceeding was an abuse of process.

The arbitrator held there was no jurisdiction under the Insurance Act to order costs against a representative or non-party.

The arbitrator also declined to order costs against the applicant personally, finding his conduct was not frivolous, vexatious, or an abuse of process.

The withdrawal was permitted on the condition that if the matter is brought again, the applicant must pay the insurer's assessment fee and costs.

The insurer brought a motion seeking relief from the implied undertaking rule to compel the production of the applicant's related tort file, including medical and financial documentation.

The applicant opposed the motion, arguing that the documents were protected by the deemed undertaking rule under Rule 30.1 of the Rules of Civil Procedure.

The arbitrator held that while arbitrators have the jurisdiction to grant relief from the implied undertaking rule under sections 20 and 22 of the Insurance Act, the insurer failed to demonstrate special circumstances or specific relevance to justify overcoming the presumption of privacy.

The motion for production was denied.

Following a decision denying the applicant's claim for statutory accident benefits, both parties sought their expenses for the arbitration.

The arbitrator found that the applicant had engaged in wilful misrepresentation, delayed the resolution of the matter, and abused the tribunal's process.

Consequently, the applicant was denied his expenses.

The insurer was awarded its full claimed expenses of $14,960.76, as the applicant's conduct unnecessarily prolonged and obstructed the proceedings.

Following a preliminary issue hearing where the insurer successfully argued the applicant was not an insured person, the applicant sought her arbitration expenses.

The arbitrator found that the application was brought in good faith on a novel and significant issue of interpretation, which outweighed the insurer's ultimate success.

The applicant was awarded expenses fixed at $9,197.93, with deductions made for certain pre-arbitration fees, an unnecessary airline ticket for the applicant's mother, and unallowable travel disbursements.

The applicant was injured in a motor vehicle accident and her claims for statutory accident benefits were dismissed in a prior decision.

The insurer sought its expenses for the arbitration proceeding.

The arbitrator found that the applicant's representative's conduct hindered the proceeding and that the application had little merit.

Applying the criteria under the Expense Regulation, the arbitrator ordered the applicant to pay the insurer's expenses, assessed at $2,461.99.