Other Tribunals - OFSCDRS

The Appellant insurer sought a stay of an Arbitrator's order requiring it to pay income replacement benefits, attendant care, housekeeping, and medical benefits to the Respondent insured, pending an appeal.

The Director's Delegate denied the stay request, finding that under subsection 283(6) of the Insurance Act, a stay is the exception rather than the rule.

The Delegate held that the Appellant failed to establish that the pre-arbitration status quo ought to be preserved, noting that the appeal was restricted to questions of law and that staying the payment orders would constitute a hardship to the Respondent that outweighed any hardship to the Appellant.

The insurer brought a motion for the production of clinical notes and records from three third-party medical clinics regarding the applicant, who claimed statutory accident benefits following a motor vehicle accident.

The insurer withdrew its request against one clinic that complied.

The arbitrator applied Rule 67.7 of the Dispute Resolution Practice Code and found that the remaining two clinics failed to respond despite reasonable efforts by the applicant's counsel to obtain the documents.

The arbitrator ordered the two clinics to produce the records forthwith and ordered each to pay $150 in expenses to the insurer for prolonging the proceeding.

State Farm appealed an arbitrator's decision awarding the respondent income replacement benefits and attendant care benefits following a motor vehicle accident.

State Farm sought a stay of the payment orders pending the appeal.

The Director's Delegate found that a complete stay would cause undue hardship to the respondent given the lengthy delays in the proceedings.

However, the Delegate granted a partial stay limited to the extent of Canada Pension Plan child benefits received by the respondent, as the deductibility of those benefits raised a legitimate and substantive question of law.

The applicant's representative brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, having lost contact with the applicant.

The insurer opposed the motion without terms, seeking its costs of $4,900 to be paid personally by the representative firm and requesting the arbitration be deemed withdrawn.

The arbitrator granted the representative's motion to withdraw, finding a fundamental breakdown in communication.

The arbitrator declined to order costs against the representative personally, finding the representative had authority to commence the proceeding to preserve the applicant's rights and was acting in the usual course of the practice of law under s. 282(11.3) of the Insurance Act.

The arbitrator also declined to deem the arbitration withdrawn, as the applicant did not have proper notice of that request.

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

The matter proceeded to an arbitration hearing, but the applicant failed to attend or communicate with his legal representative.

At the hearing, the applicant's representative brought a motion to withdraw due to a complete breakdown in the solicitor-client relationship, which the arbitrator granted.

The insurer subsequently moved to dismiss the arbitration proceeding.

The arbitrator dismissed the proceeding, finding that the applicant had abandoned the matter.

The insurer was awarded $2,293.48 in expenses for legal fees and disbursements, though its request for a refund of the arbitration filing fee was denied for lack of jurisdiction.

The appellant appealed an arbitrator's decision dismissing her claims for medical, caregiver, attendant care, and housekeeping benefits following a motor vehicle accident.

The appellant argued the arbitrator erred in law by excluding a witness and a document disclosed shortly before the hearing, applying an incorrect causation test, and improperly weighing the medical evidence.

The Director's Delegate rejected the appeal, finding the arbitrator properly exercised his discretion to exclude late evidence to prevent trial by ambush, made reasonable credibility findings, and provided adequate reasons for preferring the respondent's medical evidence.

The appeal was restricted to questions of law, and no such errors were found.

The insurer brought a motion to stay the arbitration on the grounds that the insured refused to attend a proposed in-home occupational therapy assessment as part of its catastrophic impairment assessment process.

The arbitrator dismissed the motion, finding that the insurer failed to demonstrate that the further assessment was reasonably necessary under section 44 of the Statutory Accident Benefits Schedule.

The insurer's neuropsychologist had access to numerous existing occupational therapy reports and failed to provide a credible explanation for why a new assessment was required.

Furthermore, the arbitrator held that even if the assessment were necessary, a stay would not be the appropriate remedy, as the insurer failed to establish irreparable harm or that the balance of convenience favoured a stay.

The applicant insurer sought to withdraw its Application for Variation/Revocation of an arbitrator's motion decision regarding statutory accident benefits.

The respondent consented to the withdrawal on the condition that the applicant pay $300 in legal expenses.

The Director's Delegate permitted the withdrawal on the condition that the applicant pay the requested $300 in legal expenses, finding it a just condition given the unnecessary expense caused to the respondent.

The applicant claimed to have been injured in a motor vehicle accident and received statutory accident benefits from the insurer.

The insurer subsequently investigated and obtained an engineering report concluding that the damage to the vehicles was inconsistent with the reported accident and that the accident was likely staged.

The insurer suspended benefits after the applicant failed to attend an Examination Under Oath.

The applicant applied for arbitration but failed to attend the hearing or pursue his claims.

The arbitrator dismissed the application for arbitration, finding it was commenced in bad faith and abandoned.

The arbitrator ordered the applicant to repay $24,242.01 in benefits obtained through misrepresentation, plus interest, and awarded the insurer $7,541.54 in expenses.

The applicant sought statutory accident benefits following an alleged motor vehicle collision where he claimed to be a passenger in a BMW struck by a Nissan.

The insurer denied the claim, arguing the accident did not occur.

At a preliminary issue hearing, the insurer presented uncontroverted expert evidence from a collision reconstructionist demonstrating that the physical damage to the vehicles was entirely inconsistent with a collision between them.

The arbitrator accepted the expert's findings, concluded the applicant was not involved in an accident as defined by the Schedule, and found that the applicant had wilfully misrepresented material facts in his application for benefits.

The applicant failed to attend his scheduled arbitration hearing for statutory accident benefits.

At the hearing, the applicant's counsel successfully moved to be removed from the record due to a breakdown in the solicitor-client relationship.

The arbitrator then proceeded in the applicant's absence pursuant to the Statutory Powers Procedure Act and the Dispute Resolution Practice Code.

As the applicant presented no evidence to prove his claims, the application for arbitration was dismissed.

Following an arbitration where the applicant's claims for statutory accident benefits were dismissed, the insurer sought its expenses.

The arbitrator found that the insurer was completely successful and that the applicant's conduct, including failing to comply with disclosure requirements and giving inconsistent histories to medical providers, unnecessarily prolonged the hearing.

The arbitrator awarded the insurer its expenses but reduced the requested hourly rate for counsel from $150.00 to $117.85, as the higher rate is only available to insured persons under the Dispute Resolution Practice Code.

The insurer was awarded $8,555.86 in fees, inclusive of HST, with no award for disbursements.

The applicant's representative brought a motion to be removed as solicitor of record due to a complete breakdown in the solicitor-client relationship, citing the applicant's failure to respond to numerous communications and attend scheduled pre-hearings.

The arbitrator granted the motion, finding that the representative had complied with the Dispute Resolution Practice Code requirements for withdrawal.

The applicant dismissed his counsel during a teleconference and requested an adjournment of the scheduled hearing.

The insurer objected and sought costs thrown away against the former counsel personally, or alternatively against the applicant, arguing the proceeding was commenced without authority or was frivolous.

The arbitrator dismissed the motion for costs, finding no evidence that the application was commenced without authority or that it was frivolous, as the matter had not yet been adjudicated on the merits.

The arbitrator also found no evidence that any preparation costs were actually thrown away.

The insurer brought a motion to compel the applicant to produce certain documents and for third-party production orders under Rule 67 of the Dispute Resolution Practice Code.

The insurer also requested relief, including dismissal or a stay of the arbitration, due to the applicant's refusal to attend insurer examinations.

The arbitrator declined to address the non-attendance issue, finding it was not properly before her on a productions motion and should be determined by the hearing arbitrator.

The arbitrator ordered the applicant to produce employment and income records, ordered the insurer to produce its adjusting file, and granted third-party production orders for clinical, employment, and collateral benefits files.

The arbitrator also ordered counsel to personally bear the costs of their unnecessary correspondence.

The applicant's legal representatives brought a motion to be removed as solicitors of record due to a material breakdown in the solicitor-client relationship.

The applicant had repeatedly failed to provide necessary information requested by his counsel.

The arbitrator found that the representatives had complied with the Dispute Resolution Practice Code and granted the motion to withdraw.

The applicant's legal representatives, Bergel, Magence LLP and Andrew Bergel, brought a motion to be removed as solicitors of record due to a material breakdown in the solicitor-client relationship.

The applicant had repeatedly failed to provide requested materials necessary to proceed with her statutory accident benefits claim.

The arbitrator found that the representatives had complied with the Dispute Resolution Practice Code requirements for withdrawal and granted the motion.

The appellant appealed an arbitration decision denying his $29,000 expense claim due to a 31-month delay in requesting an expense hearing.

The Director's Delegate dismissed the appeal and ordered that any request for appeal expenses be made within 60 days.

The respondent, who was entirely successful on the appeal, failed to request an appeal expense hearing within the 60-day timeline, waiting at least seven months.

The Director's Delegate found that the respondent's delay was deliberate and a disregard of an adjudicative order.

Consequently, the Director's Delegate declined to extend the timeline and ordered each party to bear their own legal expenses of the appeal.

The applicant applied for statutory accident benefits following an alleged motor vehicle accident.

The insurer denied the claim on the basis that the applicant was not involved in an 'accident'.

At the scheduled arbitration hearing, the applicant failed to attend.

Her representatives brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, which was granted.

The insurer moved to dismiss the arbitration.

As the applicant bore the onus of proving she was in an accident and presented no evidence, the arbitration was dismissed.

The applicant applied for statutory accident benefits following an alleged motor vehicle accident.

The insurer refused to pay benefits, arguing the applicant was not involved in an 'accident' as defined in the Schedule.

The matter proceeded to arbitration.

The applicant failed to attend the hearing.

The applicant's representative brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, which was granted.

The insurer moved to dismiss the arbitration.

As the applicant bore the onus of proving he was injured in an accident and presented no evidence, the arbitrator dismissed the arbitration.