Other Tribunals - OFSCDRS

The applicants claimed statutory accident benefits following two alleged motor vehicle accidents on July 15 and July 30, 2002.

The insurer denied the claims, arguing that the incidents did not meet the definition of an "accident" under section 2(1) of the Statutory Accident Benefits Schedule.

At a preliminary issue hearing, the arbitrator heard evidence from the applicants and three accident reconstruction experts retained by the insurer.

The arbitrator found the applicants' accounts of both incidents to be unreliable and implausible.

Relying on the expert evidence, which demonstrated that the vehicle damage was inconsistent with the applicants' descriptions, the arbitrator concluded that the applicants were not involved in accidents within the meaning of the Schedule and were therefore precluded from proceeding to arbitration.

The applicant was injured in a motor vehicle accident and sought payment from her insurer for a catastrophic impairment assessment report and a psycho-vocational assessment.

The insurer denied payment, arguing the reports were not reasonable or necessary.

The arbitrator found that both assessments were reasonable and necessary under section 24 of the Statutory Accident Benefits Schedule.

The catastrophic impairment report was required to complete the application for determination of catastrophic impairment, and the psycho-vocational report was necessary to facilitate the applicant's reintegration into the labour market.

The insurer was ordered to pay the costs of both reports.

The applicant sought to reopen an arbitration hearing to introduce fresh evidence regarding a fall and subsequent injuries that occurred after the conclusion of the evidence but before closing arguments.

The applicant claimed the fall was related to the motor vehicle accident and affected her ongoing entitlement to income replacement benefits.

The arbitrator applied the Palmer test for fresh evidence and granted the motion, finding that the circumstances were exceptional and the new evidence was relevant, reasonably capable of belief, and could affect the result.

The Applicant sought to recover GST on disbursements for medical reports as part of her hearing expenses.

The Insurer argued that the medical reports were GST-exempt.

The Arbitrator found that while the reports may be exempt when billed to the lawyer, CCRA policy requires the lawyer to charge GST when billing the client, making the GST recoverable.

The Insurer also argued that the disbursements should be reduced because they were partially recovered in a related tort settlement.

The Arbitrator held he had no jurisdiction to alter his previous costs order based on the subsequent tort settlement.

The applicant sought expenses following an arbitration decision where he achieved partial success in his claims for statutory accident benefits.

The insurer also claimed its expenses, relying on two written offers to settle that exceeded the applicant's recovery.

The arbitrator awarded the applicant 50% of his allowable arbitration expenses, considering his partial success, the insurer's conduct in delaying pre-hearing discussions, and the statutory objective of speedy dispute resolution.

The insurer's claim for expenses was denied, as the arbitrator declined to follow a strict results-based approach based solely on the offers to settle.

The applicant's total allowable expenses were assessed at $13,010, resulting in an award of $6,505.

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

The insurer brought a preliminary motion arguing the applicant was precluded from proceeding to arbitration because she failed to attend scheduled insurer's examinations and failed to return an OCF-14 form required for a Designated Assessment Centre (DAC) assessment.

The applicant's representative also brought a motion to withdraw due to a breakdown in the relationship and the applicant's failure to provide a required authorization.

The arbitrator allowed the representative to withdraw without conditions.

On the preliminary issue, the arbitrator found that while the insurer's notice for the examinations was deficient, the applicant's failure to provide the OCF-14 constituted non-compliance with section 43(2) of the Schedule.

Consequently, the applicant was precluded from proceeding to mediation and arbitration for the disputed medical benefits.

Following a preliminary issue hearing where the insurer successfully argued that the applicant was bound by a prior agreement regarding her pre-accident earning capacity, both parties sought their expenses.

The arbitrator found that the insurer was the successful party and was entitled to expenses.

The insurer argued that the applicant's law firm should personally pay the expenses due to an alleged abuse of process and conflict of interest.

The arbitrator held that while the tribunal has jurisdiction under the Statutory Powers Procedure Act to sanction non-parties for egregious abuse of process, the evidence did not establish gross negligence or dereliction of duty by the law firm.

The insurer's expenses were fixed at $500, payable by the applicant, due to the insurer submitting an outrageous and unsubstantiated bill of costs on the eve of the hearing.

The applicant failed to appear at the arbitration hearing regarding her claim for statutory accident benefits.

The arbitrator proceeded with the hearing in her absence but added a preliminary issue of whether the applicant is entitled to have the hearing reopened.

Noting concerns about the applicant's representation, address, language barriers, and potential cost consequences, the arbitrator ordered that the applicant may file submissions by January 13, 2003, to reopen the hearing, failing which a decision would be issued based on the evidence presented by the insurer.

The appellant's representative, a non-lawyer acting for an assessment facility, pursued an appeal of an arbitration decision regarding unpaid assessment accounts without the appellant's specific knowledge.

The appeal was dismissed.

The insurer sought its appeal expenses.

The Director of Arbitrations held that while the representative's conduct was disgraceful, the tribunal lacked jurisdiction to order costs against a non-party.

As the named party who had signed broad authorizations allowing the facility to act as her agent, the appellant was held responsible for the insurer's appeal expenses, fixed at $1,500.

The Insurer brought a motion for expenses against Mr. Rod Hare, who had been substituted as the applicant in place of a minor.

The Insurer served its Bill of Expenses by regular mail to Mr. Hare's former business address.

The Arbitrator found that, given evidence that Mr. Hare was no longer at that address, service by mail was insufficient to provide reasonable notice of a claim that could result in personal liability.

The Arbitrator ordered that the Insurer must serve Mr. Hare personally with the motion materials before the claim for expenses would be considered.

Following an arbitration where the insured was largely unsuccessful in claiming income replacement and non-earner benefits, the insurer sought its expenses.

The arbitrator found that the insured's claim for income replacement benefits was manifestly unfounded and that his representative's conduct prolonged and hindered the proceeding.

The insured was ordered to pay two-thirds of the insurer's arbitration expenses, fixed at $6,428.10.

The insurer brought a motion seeking to conduct an examination for discovery of the applicant and her treatment provider regarding the nature and medical benefits of a disputed treatment.

The arbitrator dismissed the motion, finding that the insurer had already received significant documentary disclosure and that ordering an oral examination for discovery would be a significant and inappropriate departure from the Commission's pre-hearing disclosure process.

The applicant, who sustained a closed head injury in a motor vehicle accident, applied for statutory accident benefits.

A preliminary issue hearing was held to determine whether the applicant had the mental capacity to proceed in the dispute resolution process and, if not, whether his son should be appointed to act on his behalf.

The arbitrator found that the applicant lacked the mental capacity to proceed, relying on capacity assessments and the applicant's demeanor at the hearing.

The arbitrator appointed the applicant's son to proceed in the dispute resolution process and to receive and administer statutory accident benefits on his behalf.

The applicant commenced an arbitration for $3,300 in medical assessments following a motor vehicle accident.

At the hearing, her counsel requested an adjournment and production orders, which were denied, and then left the hearing.

The application was subsequently dismissed.

The insurer sought expenses and an award under s. 282(11.2) of the Insurance Act.

The arbitrator found the proceeding was an abuse of process and ordered the applicant to pay $1,000 in expenses and a $3,000 award to the insurer.

The applicant sought statutory accident benefits for acupuncture treatment following a motor vehicle accident.

The applicant failed to attend the arbitration hearing, and her representative successfully moved to withdraw from the record due to a loss of contact.

In the absence of any supporting evidence, the arbitrator dismissed the applicant's claims.

The insurer's request for the return of its assessment fee under s. 282(11.2) of the Insurance Act was denied, as the application was not shown to be frivolous or an abuse of process when commenced, but the insurer was awarded $1,500 in hearing expenses.

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

The insurer denied benefits on the basis that the applicant was operating an uninsured vehicle and had made a material misrepresentation.

The arbitrator found that the applicant deliberately misled his insurance broker by producing ownership documentation for a 1983 vehicle while claiming to insure a 1988 vehicle that he did not own.

The arbitrator concluded that the applicant knew or ought reasonably to have known that he was operating an uninsured vehicle at the time of the accident.

As a result, the applicant was barred from recovering benefits under section 30(1) of the Statutory Accident Benefits Schedule.

The applicant sought to withdraw her arbitration application without penalty, alleging institutional bias among FSCO arbitrators, and requested the appointment of a private arbitrator under s. 282(12) of the Insurance Act.

The Director of Arbitrations dismissed the bias application, finding that the applicant failed to establish bias.

Furthermore, the Director noted that s. 282(12) only authorizes the appointment of arbitrators from the roster maintained by the Superintendent, not private arbitrators.

The respondent's request for expenses was deferred to the eventual determination of arbitration expenses.

The applicant sought an assessment of expenses following an arbitration for statutory accident benefits where he was unsuccessful but still awarded expenses due to the novelty and complexity of the issues.

The insurer disputed the amount of time claimed for legal fees, arguing it was excessive for a one-day hearing.

The arbitrator found the issues were complex and novel, justifying the preparation time, but reduced the time claimed for correspondence from 24.2 hours to 12 hours.

The applicant was awarded $11,745 plus GST for legal fees.

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

The parties engaged in settlement discussions and reached an oral agreement for a full and final settlement, which was confirmed in writing.

The insurer subsequently sent the required settlement notice, disclosure statement, and release.

The Applicant attempted to rescind the settlement over a month after the 48-hour cooling-off period had expired.

The arbitrator held that the delay in forwarding the settlement documents did not invalidate the agreement and that the Applicant was bound by the settlement.

The Applicant was therefore precluded from proceeding to arbitration.

The parties were ordered to bear their own expenses.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until they were terminated by the insurer.

The applicant commenced a court action against the insurer and subsequently applied for arbitration at the Ontario Insurance Commission.

The insurer brought a preliminary issue hearing to dismiss the arbitration due to the concurrent court action.

The arbitrator dismissed the arbitration application, finding that proceeding in two concurrent forums amounts to an abuse of process and a multiplicity of proceedings.

Costs of $250 were awarded to the insurer.