Other Tribunals - OFSCDRS

Following a preliminary issue hearing where the insurer successfully proved fraud and was awarded expenses, the parties could not agree on the quantum.

The arbitrator assessed the insurer's costs, applying a 2:1 ratio for preparation to hearing time and capping the insurer's counsel's hourly rate at the Legal Aid rate of $96.95 per hour pursuant to Rule 78 of the Dispute Resolution Practice Code.

The arbitrator awarded the insurer $3,456.23 in total expenses, inclusive of fees, disbursements, and GST, while disallowing the $3,000 assessment fee.

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

The insurer terminated the caregiver benefits at the two-year mark without requesting a new disability certificate, contrary to section 37 of the Statutory Accident Benefits Schedule.

The insurer also failed to advise the applicant of her potential entitlement to non-earner benefits.

On a preliminary issue hearing, the arbitrator found that the insurer failed to comply with the Schedule.

Applying the principles from Yogesvaran, the arbitrator ordered the insurer to pay interim caregiver and non-earner benefits pending a full arbitration hearing on final entitlement.

Issues of interest and a special award were deferred to the hearing arbitrator.

The applicant sought expenses following a successful arbitration for statutory accident benefits.

The insurer disputed the hourly rate, the total hours claimed by the applicant's counsel, and certain disbursements.

The arbitrator awarded the maximum hourly rate of $150 for the applicant's experienced counsel, finding the case complex and vigorously pursued.

The arbitrator allowed most of the claimed hours and disbursements, resulting in a total expense award of $36,098.46, less amounts already paid.

The applicants, who were injured in a motor vehicle accident, sought to have their two separate applications for arbitration combined pursuant to Rule 30 of the Dispute Resolution Practice Code.

The insurer supported the combination to save on assessment expenses.

The arbitrator declined to combine the applications, finding that the legislative scheme contemplates a user-pay system for dispute resolution, and combining substantive, distinct claims would unfairly shift the financial burden to the general market share assessment rather than the specific users of the system.

The applicant claimed statutory accident benefits following an alleged incident on a TTC bus.

The insurer denied the claim on the basis that the incident actually occurred on a subway train, which does not meet the definition of an 'automobile' under the Statutory Accident Benefits Schedule.

At arbitration, the arbitrator found that the applicant failed to prove on a balance of probabilities that the incident occurred on a bus, relying on contemporaneous records indicating it occurred on a subway.

The arbitrator also found insufficient medical evidence of an impairment.

The application for benefits was dismissed.

The insurer's request for an award for a frivolous application was denied, but the applicant was ordered to pay half of the insurer's arbitration expenses due to his conduct during the proceeding.

The appellant abandoned his appeal before the Financial Services Commission of Ontario after his representative was excluded from the proceeding for obstructive conduct during a bias motion.

The Director's Delegate dismissed the appeal and confirmed the arbitrator's order.

The appellant was ordered to pay the respondent's appeal expenses of $1,507.50 due to the frivolous and vexatious nature of the bias motion and the representative's conduct.

The applicant, a minor whose mother was killed in a motor vehicle accident, sought statutory accident benefits from the insurer.

The parties engaged in settlement discussions and purportedly reached an agreement.

The applicant brought a motion to enforce the settlement, seeking an order for the insurer to pay a lump sum.

The insurer argued there was no binding settlement due to a lack of consensus ad idem regarding the scope of the release.

The arbitrator found he had jurisdiction to determine the existence of a settlement but concluded that no binding agreement was reached due to mutual mistake regarding the scope of the claims and the temporal scope of the settlement.

The motion to enforce the settlement was dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits from her automobile insurer, Coseco, as well as long-term disability benefits from London Life through her employer.

Coseco deducted the London Life benefits from the income replacement benefits.

The applicant disputed this deduction, arguing the matter was not settled at mediation and the deduction was unfair.

The arbitrator found that the London Life policy qualified as an income continuation plan under section 7(1) of the Statutory Accident Benefits Schedule, as it provided income security for loss of wages and was tied to her earnings.

Therefore, Coseco was entitled to deduct the collateral benefits.

Each party was ordered to bear their own costs.

The respondents were injured in a motor vehicle accident in California and claimed statutory accident benefits from the Motor Vehicle Accident Claims Fund.

The Fund denied the claim, arguing it was not responsible for out-of-province accidents, and later challenged the arbitrator's jurisdiction to decide the issue.

The arbitrator ruled she had jurisdiction, and the Fund sought leave to appeal this preliminary order before the remaining issues were decided.

The Director's Delegate denied the motion for leave to appeal, finding that proceeding with the appeal could lead to multiple appeal proceedings and unnecessary delay, and deferred the appeal until the remaining issues, including the existence of a potential insurer, were resolved.

The appellant appealed an arbitrator's decision dismissing his claim for statutory accident benefits after he and his representative failed to attend the arbitration hearing.

The appellant argued that the issues had been settled prior to the hearing and that he did not receive adequate notice.

The Director's Delegate dismissed the appeal, finding no evidence of an accepted settlement offer and concluding that the appellant received proper notice of the peremptory hearing date.

The appellant was ordered to pay $1,000 in expenses.

The applicants' claims for statutory accident benefits were brought by a treatment provider and paralegal without proper authorization from the applicants.

The insurer sought expenses and an assessment, alleging abuse of process.

The arbitrator allowed Mr. Gurevich to withdraw his application without personal liability for expenses, finding that the treatment provider and representatives were the directing minds behind the abuse of process.

Ms. Gurevich's application was dismissed for failure to produce a required authorization.

The insurer was granted the option to claim its expenses from the treatment provider and representatives.

The applicants, husband and wife, were injured in a motor vehicle accident and filed separate applications for arbitration against their insurer.

The Commission's case administrator improperly combined the applications without authority or notice.

At the pre-hearing discussion, the arbitrator ruled the administrative combination invalid but ordered the matters to be heard at the same time due to overlapping issues and identical witnesses, while remaining registered as separate proceedings pending further submissions on combining them.

Following a settlement of disputed claims for statutory accident benefits, the applicant sought an assessment of his legal expenses.

The insurer agreed the applicant was entitled to expenses but disputed the amount, specifically the hourly rate of the senior counsel, the rate and hours of the law clerk, and certain disbursements including accountant's reports.

The arbitrator allowed the senior counsel's rate of $150 per hour, the law clerk's rate of $45 per hour, and most of the disbursements, awarding a total of $19,449.35 in fees and disbursements.

The applicant applied for arbitration regarding her entitlement to loss of earning capacity benefits following a motor vehicle accident.

The insurer raised a preliminary issue, arguing the applicant was precluded from proceeding to arbitration because she refused to attend an updated insurer's medical examination.

The arbitrator found the insurer's request for a single updated examination by a doctor who had previously examined the applicant was reasonable and not overly onerous.

The applicant was ordered to attend the examination before proceeding to arbitration.

The applicant sought to withdraw her application for arbitration regarding statutory accident benefits at the pre-hearing stage, intending to pursue the claim in an ongoing court action.

The insurer agreed to the withdrawal but sought an award for its assessment fee and arbitration expenses, arguing the application was an abuse of process due to venue-splitting.

The arbitrator found that the applicant's conduct was not an abuse of process, as the application was filed before case law strongly discouraged venue-splitting.

The insurer's request for costs and assessment fees was dismissed, and the applicant was permitted to withdraw her application unconditionally.

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

The parties settled the substantive issues shortly before the scheduled arbitration hearing, leaving the quantum of the applicant's legal expenses to be determined by the arbitrator.

The insurer argued that the arbitration was an abuse of process and could have been avoided if the applicant had produced requested documents in a timely manner.

The arbitrator rejected the argument that the proceeding was an abuse of process but agreed that the applicant's delay in complying with undertakings and duplication of work by counsel warranted a reduction in the claimed expenses.

The arbitrator reduced the hours claimed by one of the applicant's counsel and awarded total expenses of $11,400.66.

The applicant was injured in a motor vehicle accident while driving a tractor-trailer and applied for statutory accident benefits.

The insurer argued the applicant was entitled to workers' compensation benefits and thus precluded from receiving accident benefits under section 59 of the Schedule.

In a preliminary issue hearing, the arbitrator found that the applicant had not elected to bring a tort action, meaning the exception under subsection 59(2) was unavailable.

The arbitrator declined to determine whether the applicant was entitled to workers' compensation benefits under subsection 59(1), finding that the Workplace Safety and Insurance Appeals Tribunal had exclusive jurisdiction over that issue, and adjourned the entitlement hearing to allow an application to the Tribunal.

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

The insurer brought a motion to strike the application because the issues had not been mediated, and sought costs.

The applicant's representative also sought to withdraw.

The arbitrator allowed the representative to withdraw, finding no jurisdiction to impose conditions or award costs against him.

The arbitrator struck the application for arbitration as a nullity because the issues had not been mediated, finding the application frivolous, vexatious, and an abuse of process.

The applicant was ordered to pay $1,500 in fixed costs to the insurer, and an additional $3,000 equivalent to the insurer's assessment fee if he attempts to proceed again on the same issues.

The applicant sought statutory accident benefits after breaking her arm when she slipped and fell on an icy road while walking back to her vehicle, which had slid into a snowbank after getting stuck.

The insurer denied benefits, arguing the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The arbitrator applied the purpose and causation tests, finding that the use or operation of the vehicle was involved and directly caused the injury, as the slip and fall was a normal and reasonably foreseeable risk of motoring in the circumstances.

The preliminary issue was resolved in favour of the applicant.

The applicant was injured in a motor vehicle accident while driving a borrowed, uninsured vehicle.

She applied for statutory accident benefits from the insurer, claiming the vehicle's owner had obtained an oral agreement for coverage from the insurer prior to the accident.

The insurer denied coverage, arguing there was no contract of insurance.

The arbitrator found that there was a binding oral agreement between the vehicle owner and the insurer, establishing a sufficient nexus for the applicant to claim benefits.

The arbitrator ruled the applicant was entitled to coverage under section 268 of the Insurance Act, but declined to order interim benefits as the applicant had not established entitlement or urgency.