Other Tribunals - OFSCDRS

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

The parties reached a settlement resolving all substantive issues, including the reinstatement of income replacement benefits.

However, the applicant sought an arbitral order confirming ongoing entitlement, which the insurer refused to consent to, arguing it would improperly shift the burden of proof in any future termination under the variation/revocation provisions of the Insurance Act.

The arbitrator held that proceeding to a hearing when there was no active dispute was unreasonable and stayed the arbitration, with conditions allowing for its resumption if the insurer later sought to terminate the benefits.

The applicant commenced an arbitration application against the insurer but subsequently failed to communicate with her legal representatives, who were granted permission to be removed from the record.

The applicant failed to attend a scheduled pre-hearing conference and did not respond to the arbitrator's notice of intent to dismiss the proceeding.

Finding that the applicant had no interest in pursuing the matter and that the application had become vexatious, the arbitrator dismissed the application without a hearing pursuant to Rule 68 of the Dispute Resolution Practice Code.

The Applicant sought expenses for an arbitration hearing that concluded in 2008 when the Insurer conceded the issue of catastrophic impairment.

The Insurer argued the Applicant was not entitled to expenses due to a 4.5-year delay in submitting a Bill of Costs, relying on Rule 79.1 of the Dispute Resolution Practice Code and the principle of finality.

The Arbitrator found that Rule 79.1 did not apply because no final arbitration order had been issued.

Given the ongoing dealings between the parties over the years, the delay did not deprive the Applicant of her entitlement under s. 282(11) of the Insurance Act.

The Arbitrator awarded the Applicant $30,972.81 in expenses.

The respondent was injured when she fell off a golf cart being driven on a highway.

She applied to the Motor Vehicle Accident Claims Fund for statutory accident benefits.

The Fund denied the claim, arguing that golf carts are exempt from the requirement to carry motor vehicle liability insurance under the Off-Road Vehicles Act.

The Director's Delegate affirmed the Arbitrator's decision that while golf carts are exempt when driven off-road, the exemption does not apply when driven on a highway.

Under the Highway Traffic Act and the Compulsory Automobile Insurance Act, a golf cart driven on a highway is a motor vehicle requiring insurance, and therefore qualifies as an 'automobile' for the purpose of statutory accident benefits.

The Fund's appeal was dismissed.

The respondent was catastrophically injured while riding an uninsured off-road motorcycle on a private motocross track.

He applied to the Motor Vehicle Accident Claims Fund for statutory accident benefits.

The Fund denied the claim, arguing that under section 226(2) of the Insurance Act, the required insurance policy did not include accident benefits because the motorcycle did not need to be registered under the Highway Traffic Act.

The Director's Delegate dismissed the Fund's appeal, finding that the Off-Road Vehicles Act required the motorcycle to be insured under a motor vehicle liability policy, which by definition includes statutory accident benefits.

The applicant was struck by an uninsured driver and applied for accident benefits from the Motor Vehicle Accident Claims Fund (MVAC Fund).

The applicant had previously settled a lawsuit against her long-term disability carrier, Great West Life (GWL), for a lump sum of $150,000.

The MVAC Fund brought a motion to determine whether the GWL settlement was deductible from any accident benefits owing under s. 267.8 of the Insurance Act or s. 22 of the Motor Vehicle Accident Claims Act.

The arbitrator found that the settlement funds were paid to settle a legal obligation rather than as a payment under an income continuation benefit plan.

As there was no evidence breaking down the settlement funds to past benefits owing, the arbitrator concluded the settlement was not deductible under either statute.

The appellant insurer sought to appeal an arbitrator's preliminary decision allowing the respondent, who was a minor at the time of a purported settlement, to resume a pre-hearing discussion because the settlement was never approved by a court.

The Director's Delegate found that the arbitrator's decision was a preliminary or interim order that did not finally decide the issues in dispute.

The Delegate declined to exercise discretion to accept the appeal, finding no apparent strength to the appeal and significant prejudice to the respondent if the appeal were allowed to proceed, given the small amount in dispute.

The appeal was rejected.

The applicant's legal representative brought a motion to withdraw from the arbitration proceeding due to an inability to locate or contact the applicant.

The insurer brought a cross-motion to dismiss the application for arbitration without a hearing, arguing the applicant had abandoned the proceeding by failing to attend multiple scheduled medical assessments and examinations under oath.

The arbitrator granted the representative's motion to withdraw and dismissed the application for arbitration, finding the applicant had abandoned the proceeding.

The insurer was awarded $2,500 in expenses.

The applicant, who was injured in a motor vehicle accident, sought an adjournment of the arbitration hearing to allow his psychiatrist to respond to the insurer's catastrophic impairment assessments.

The insurer opposed the adjournment, arguing the applicant had ample time to respond.

The arbitrator found that the insurer had failed to properly serve the catastrophic reports on the applicant's counsel or litigation guardian, causing unavoidable delay.

The adjournment was granted with conditions, and the insurer was ordered to pay $750 in expenses due to its role in delaying the process.

The applicant failed to attend his scheduled arbitration hearing regarding accident benefits following two motor vehicle accidents.

His legal representative brought a motion to withdraw due to a breakdown in the solicitor-client relationship, which was granted.

As the applicant did not attend to present evidence, he failed to prove his claims on a balance of probabilities, and his applications for arbitration were dismissed.

The applicant was ordered to pay the insurer's expenses fixed at $1,500.

The Applicant requested an adjournment of an arbitration hearing regarding statutory accident benefits, citing the need for further medical examinations scheduled on the first day of the hearing.

The Insurer opposed the adjournment.

The Arbitrator refused the adjournment, finding that the Applicant's counsel had failed to act diligently in reviewing the file and scheduling the examinations, and that granting the adjournment would cause undue delay and prejudice to the Insurer.

The applicant's representative brought a motion to withdraw as counsel of record prior to the arbitration hearing, citing a breakdown in the solicitor-client relationship and ethical reasons.

The applicant opposed the motion, arguing prejudice and delay.

Applying the principles from R. v. Cunningham, the arbitrator granted the motion to withdraw, finding that the request was made far enough in advance of the rescheduled hearing and that counsel should not be forced to continue representing the applicant given the ethical reasons and irreconcilable differences.

The withdrawal was made conditional on the representative continuing to make the applicant's file available for review at her office.

The parties sought their legal expenses following an appeal of an arbitration pre-hearing decision that ordered the appellant to produce photographs from her Facebook profile.

The Director's Delegate considered the criteria under the Expense Regulation, noting the novelty of Facebook production issues at the appeal level and the appellant's initial failure to comply with an order to preserve the Facebook pages.

Balancing the relative merits of success and novelty, the Delegate ordered that each party bear their own legal expenses for the appeal.

Following a preliminary hearing where the applicant was found to be catastrophically impaired, the applicant sought arbitration expenses of $144,279.21.

The insurer disputed the amount, arguing the dockets were vague, excessive, and included non-compensable items.

The arbitrator agreed with the insurer's critique, noting the applicant's counsel unnecessarily lengthened the hearing by cross-examining the insurer's experts whose reports were already deficient, and provided superficial submissions.

Applying the principles of reasonableness and global assessment, the arbitrator fixed the applicant's expenses at $60,000 inclusive of taxes.

The applicant, injured in a motor vehicle accident, sought an order for the production of various internal documents from the insurer, including re-insurance records, committee minutes, adjusters' performance reviews, and the file of the broker who arranged the insurer's medical examinations.

The arbitrator dismissed the request, noting that the arbitration process is intended to be more expedient and restricted in scope than the court system.

The applicant had not claimed a special award, and there was no evidence that a re-insurer was involved in adjusting the claim or that the broker had edited medical reports.

The requested productions were deemed irrelevant and contrary to the efficiency goals of the arbitration process.

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

The applicant's legal representative brought a motion to withdraw due to a breakdown in the solicitor-client relationship, which was granted.

The applicant failed to attend the arbitration hearing despite receiving proper notice.

Consequently, the arbitrator proceeded in the applicant's absence, dismissed the application for arbitration, and ordered the applicant to pay $1,500 in expenses to the insurer.

The insurer sought its expenses of the arbitration process after successfully appealing a preliminary decision that had allowed the insured to continue his claims for statutory accident benefits.

The Director's Delegate had ruled on appeal that the insured was excluded from the Schedule and properly belonged under the Workplace Safety and Insurance Act.

The arbitrator found that the insurer had the greatest degree of success and was entitled to its expenses.

The arbitrator awarded the insurer $1,246.14 for legal fees, deferring the issue of disbursements to the Director's Delegate.

The applicant's counsel brought a motion to withdraw as solicitors of record due to a breakdown in the solicitor-client relationship.

The insurer took no position on the withdrawal but requested urgent notice regarding whether the upcoming hearing would proceed.

The applicant consented to the withdrawal.

The arbitrator granted the motion to withdraw without terms and adjourned the hearing on consent of the parties.

Following the dismissal of the applicant's claims for statutory accident benefits, the insurer sought its expenses for the arbitration proceeding.

The arbitrator found that the insurer was completely successful and the applicant was completely unsuccessful, largely due to adverse credibility findings and grossly exaggerated claims.

The arbitrator ordered the applicant to pay the insurer's expenses, fixed at $5,000 inclusive of fees and disbursements.

The applicant, who suffered from pre-existing secondary progressive multiple sclerosis, was injured in a motor vehicle accident.

Following the accident, his mobility rapidly declined, necessitating a wheelchair-accessible vehicle.

The insurer denied the $41,761.45 claim for vehicle modifications, arguing the decline was the natural progression of his disease.

The arbitrator preferred the evidence of the applicant's treating neurologist, finding that the trauma and subsequent hospital deconditioning materially contributed to the rapid functional decline.

The claim for rehabilitation benefits was granted.