Other Tribunals - OFSCDRS

The applicant sought attendant care and housekeeping benefits following a motor vehicle accident.

At the hearing, the self-represented applicant failed to comply with the Dispute Resolution Practice Code regarding the submission of documentary evidence and witness lists, resulting in the exclusion of his evidence.

The arbitrator dismissed the application because the applicant provided no evidence to substantiate his claims for benefits.

The insurer was awarded $2,000 in expenses.

The Applicant sought statutory accident benefits following a motor vehicle accident.

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

The Applicant's counsel brought a motion to be removed from the record due to a breakdown in the lawyer-client relationship, which was granted.

The Insurer subsequently moved to dismiss the application.

The Arbitrator proceeded in the Applicant's absence under Rule 37.9 of the Dispute Resolution Practice Code and dismissed the application, as the Applicant failed to present any evidence to prove entitlement to the claimed benefits.

The Insurer was awarded $1,500 in expenses.

The applicant sought statutory accident benefits following a motor vehicle accident.

At the arbitration hearing, the applicant failed to attend.

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

The insurer brought a motion to dismiss the application for arbitration due to the applicant's failure to attend the pre-hearings and the hearing.

The arbitrator proceeded in the applicant's absence and dismissed the application, as no evidence was presented to support the claims.

The insurer was awarded expenses of $2,182.54.

The applicant sought statutory accident benefits following an alleged rear-end collision.

The insurer denied the claim, arguing the incident was staged.

At a preliminary issue hearing, the arbitrator considered evidence from a police officer and an accident reconstruction expert, both of whom testified that the vehicle damage and resting positions were inconsistent with a rear-end collision.

The arbitrator concluded that the applicant failed to meet her burden of proving that an 'accident' occurred within the meaning of section 3(1) of the Statutory Accident Benefits Schedule.

The applicant was injured in a motor vehicle accident when the bus he was on collided with a train, resulting in catastrophic impairments.

He sought ongoing attendant care benefits and a Special Award for the insurer's unreasonable delay in paying benefits.

The arbitrator found that the applicant was entitled to ongoing attendant care benefits at $6,000 per month, rejecting the insurer's argument that the applicant must continually prove the expenses were 'incurred' each month.

The arbitrator also awarded a Special Award, finding that the insurer acted unreasonably, imprudently, and inflexibly in delaying payments for attendant care and medical benefits despite having sufficient evidence of the applicant's economic loss and catastrophic impairments.

The applicant brought a motion to remove the insurer's counsel, alleging a conflict of interest because the firm also represented the insurer in the accident benefits claim of her husband (a non-party).

The applicant also sought to exclude a medical report from her husband's file that the insurer intended to use in her arbitration.

The Arbitrator held that the medical report was inadmissible because the husband had not consented to its use in his wife's arbitration, and the insurer's privacy policy and PIPEDA protected his personal information.

However, the Arbitrator declined to remove the insurer's counsel, finding no conflict of interest as the firm had never acted for the applicant or her husband, and there was no risk of prejudice to the insurer.

The appellant appealed an arbitrator's decision dismissing his application for arbitration regarding an outstanding account for a catastrophic rebuttal report from a service provider.

The arbitrator found that the appellant had previously settled his accident benefits claim on a full and final basis and that the true claimant was the service provider, which lacked standing to commence arbitration in the insured's name.

The Director's Delegate confirmed the arbitrator's decision, holding that the service provider had no standing and that the prior settlement precluded further claims since the appellant had not rescinded the settlement or returned the funds.

The appellant appealed an Arbitrator's decision denying his request for interest and a special award following a settlement for attendant care and housekeeping benefits.

The Director's Delegate upheld the Arbitrator's finding that the appellant was required to provide proof of ongoing incurred expenses before the insurer was obligated to pay the settled benefits, and that the insurer's request for such proof did not warrant a special award.

However, the Delegate found the Arbitrator erred in denying interest on the delayed payments, ruling that interest is mandatory and compensatory under the Statutory Accident Benefits Schedule even when an insurer legitimately requests further information.

The appeal was allowed in part to award interest.

The appellant appealed an arbitrator's decision finding that a settlement was invalid because the claimant had died prior to the settlement being reached.

The Director's Delegate found that the arbitrator misapprehended the facts, as both parties were aware of the claimant's death when the settlement was negotiated.

Applying the doctrine of relation back, the Director's Delegate held that the settlement was binding, as the solicitor subsequently met the conditions to remedy his lack of authority.

The appeal was allowed and the arbitrator's order was rescinded.

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

After disputes arose, she applied for arbitration but subsequently failed to communicate with her counsel or attend the hearing.

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 insurer then moved to dismiss the application with costs.

The arbitrator granted the dismissal, finding the applicant had abandoned her claim, and ordered her to pay $1,000 in costs to the insurer.

The insurer was entirely successful in the underlying arbitration regarding accident benefits and sought its expenses of $33,653.57.

The arbitrator reviewed the criteria under Rule 75.2 of the Dispute Resolution Practice Code and section 12(2) of Ontario Regulation 664.

The arbitrator found the insurer's claimed legal fees and disbursements to be excessive, noting repetitive file reviews by multiple law clerks and students, and disallowed costs for court reporting and transcripts.

The arbitrator also limited the attendance fee for the applicant's family doctor, who was treated as an expert witness, to the tariff rate.

The applicant was ordered to pay the insurer's expenses fixed at $12,910.40 inclusive of HST.

The applicant sought accident benefits following a motor vehicle accident and applied for arbitration.

At the hearing, the applicant's representative brought a verbal motion to withdraw the application with prejudice, as the applicant was out of the country.

The insurer did not object to the withdrawal but sought costs, arguing the late withdrawal prejudiced them.

The arbitrator allowed the withdrawal on the condition that the applicant pay the insurer's reasonable legal expenses.

The arbitrator ordered the applicant to pay $3,992.68 in costs, calculating the amount based on the Legal Aid Services Act rates and a 4:1 ratio for preparation and hearing time.

The Applicant was injured in a 1997 motor vehicle accident and settled his statutory accident benefits claim in 2004.

Ten years later, the Applicant purported to rescind the settlement, alleging the Insurer failed to provide a Settlement Disclosure Notice as required by Ontario Regulation 664, and applied for arbitration.

The Insurer raised a preliminary issue, arguing the application should be dismissed under the equitable Doctrine of Laches due to the extreme delay and resulting prejudice from lost files and witnesses.

The Arbitrator held that the right to rescind under the Regulation is a statutory legal right, not an equitable claim, and therefore the Doctrine of Laches does not apply.

The preliminary motion was dismissed, allowing the arbitration to proceed.

Following a successful arbitration for statutory accident benefits, the applicant sought her expenses.

The arbitrator applied the criteria under section 12(2) of Ontario Regulation 664 and the principle of global assessment based on reasonableness.

Finding that the insurer unnecessarily prolonged the proceedings by relying on insufficient medical assessments and acting unreasonably, the arbitrator awarded the applicant her full claimed expenses of $13,369.99, inclusive of fees, disbursements, and taxes.

The insurer sought an order for expenses after successfully defending an application for arbitration regarding statutory accident benefits.

The arbitrator considered the criteria under the Expense Regulation.

Although the insurer was wholly successful, the arbitrator noted that the case involved novel issues regarding the Minor Injury Guideline (MIG) and that the insurer's own medical reports were problematic and contradictory.

Concluding that both sides were reasonably justified in believing they had a triable case, the arbitrator ordered each party to bear its own expenses.

Following the dismissal of the appellant's Application for Variation or Revocation regarding statutory accident benefits, the respondent insurer sought its legal expenses.

The Director's Delegate rejected the appellant's arguments that the issues were novel or that the expense hearing should be adjourned pending judicial review.

Finding the insurer's claimed amount of $3,642.15 to be high compared to the average expense award, the Delegate ordered the appellant to pay $2,800 in legal appeal expenses.

Following an arbitration where the insurer successfully argued that the applicant's impairments fell within the Minor Injury Guideline, both parties sought their expenses of the proceeding.

The arbitrator awarded expenses to the insurer, noting its complete success on the issues in dispute and its reasonable offers to settle made well before the hearing.

The arbitrator rejected the applicant's arguments that the insurer engaged in sharp practice or that novel issues were raised.

The insurer's claimed costs were reduced to reflect a more reasonable preparation-to-hearing time ratio and to comply with the maximum allowable disbursements for expert witnesses and travel under the Expense Regulation.

The insurer was awarded $10,928.92 inclusive of HST and disbursements.

The insurer appealed an Arbitrator's decision denying its motion to stay or dismiss the arbitration.

The insurer argued that the arbitration duplicated claims made in a concurrent Superior Court action arising from the same motor vehicle accident.

The Director's Delegate dismissed the appeal, finding that the Arbitrator correctly applied the Wasiela factors and concluded that the issues were not substantially similar.

The court action sought declaratory relief regarding a priority dispute, whereas the arbitration involved specific claims for accident benefits.

The applicant, who was injured in a 2009 motor vehicle accident, applied for arbitration regarding statutory accident benefits.

Following the applicant's reported death in 2015, no estate representative came forward.

The arbitrator issued a Notice of Intent to Dismiss, allowing 40 days for a response.

After receiving no reply from the applicant's family or estate, and upon the insurer's request, the arbitrator dismissed the applications for arbitration, finding the continued silence rendered the proceedings vexatious and an administrative burden.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to attend a pre-hearing discussion and the subsequent arbitration hearing.

The arbitrator proceeded in the applicant's absence pursuant to Rule 37.7 of the Dispute Resolution Practice Code.

As the applicant bore the onus of proving entitlement and presented no evidence, the application was dismissed.

The insurer was awarded $675.00 in expenses under Rule 78.