Other Tribunals - OFSCDRS

The applicant filed an application for arbitration in error regarding claims that had not yet been mediated.

The insurer brought a motion to dismiss the application, seeking a return of its $3,000 assessment fee and its arbitration expenses.

The arbitrator dismissed the application for arbitration but found no jurisdiction to order the return of the assessment fee, as the relevant provision of the Insurance Act had been repealed.

However, the arbitrator ordered the applicant's representative to personally pay $150 in expenses to the insurer, as the representative's administrative error caused the application to be filed without reasonable cause.

The applicant was injured while fleeing a multi-vehicle collision as a pedestrian.

She applied for statutory accident benefits from Royal, claiming she was an insured person under her son's automobile insurance policy.

Royal responded as the first insurer but denied she was an insured person.

The arbitrator found that the applicant was not listed on the policy and rejected her claim that there was a binding oral contract to include her, applying the parol evidence rule.

The arbitrator concluded the applicant was not an 'insured person' under the policy and not entitled to seek further accident benefits from Royal.

The applicant sought arbitration for various statutory accident benefits following a motor vehicle accident.

Neither the applicant nor his representative appeared at the hearing.

The arbitrator dismissed the application for arbitration due to the absence of evidence.

The insurer sought expenses, including the assessment fee, but the arbitrator noted the statutory authority to award the assessment fee had been repealed.

The arbitrator ordered the applicant to pay $1,500 in expenses.

The issue of whether the applicant's representative should personally pay $342 in disbursements was deferred to allow the representative an opportunity to make written submissions as required by the Insurance Act.

The applicant's representative brought a motion to withdraw from the arbitration.

The insurer sought an order requiring the representative to personally pay costs previously awarded against the applicant, alleging the representative violated the Code of Conduct.

The arbitrator permitted the withdrawal on consent.

Finding that the representative made deliberate misrepresentations to the tribunal and failed to produce documents, the arbitrator applied section 282(11.2) of the Insurance Act and ordered the representative to personally pay $1,500 in expenses to the insurer.

Following a preliminary issue hearing where the applicant was precluded from proceeding to arbitration due to late notice of his intention to apply for statutory accident benefits, the insurer sought its arbitration expenses.

The arbitrator found that the applicant's conduct, including failing to attend the hearing and delaying the insurer's ability to assess his medical requirements, constituted an abuse of process.

The insurer was awarded its reasonable expenses of $1,473.90.

In a preliminary issue hearing for a statutory accident benefits arbitration, the insurer sought to admit the medical report of an expert who died before the hearing, as well as a critique report by a different doctor to stand in his place.

The arbitrator admitted the deceased doctor's report, noting it was prepared at a crucial time when benefits were terminated and no other examination could be obtained, though its weight would be adjusted since he could not be cross-examined.

However, the arbitrator refused to admit the second doctor's report or allow him to testify, as there was no evidence he shared the same medical specialty as the deceased expert.

In a dispute over statutory accident benefits, the insurer requested production of the transcript of the applicant's examination for discovery from a related tort action.

The arbitrator denied the request, noting that the dispute resolution system at FSCO does not include examinations for discovery.

Allowing the insurer to obtain the transcript would give it an unfair advantage and distort the FSCO process, allowing the insurer to do indirectly what the legislature chose not to allow directly.

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

During the arbitration process, the insurer failed to have a representative attend a mandated pre-hearing discussion, resulting in the discussion being rescheduled.

The applicant sought $125 for expenses thrown away due to the adjournment.

The arbitrator found that the insurer's failure to have a principal participate frustrated the purpose of the pre-hearing discussion and ordered the insurer to pay $125 in legal expenses pursuant to subsection 282(11.1) of the Insurance Act.

The appellant brought a motion to restore her appeal of an arbitration decision regarding accident benefits, arguing her former counsel withdrew the appeal without her authority.

In the alternative, she sought an extension of time to file a new appeal and an order for interim expenses to obtain a hearing transcript.

The Director of Arbitrations dismissed the motion, finding that the appellant was bound by her counsel's withdrawal of the appeal, which was clear and relied upon by the respondent.

The request for an extension of time was denied due to the significant delay of over three years and the resulting prejudice to the respondent.

The request for interim expenses was also denied, as transcripts are not formally required and the appellant failed to establish that the respondent should bear the cost at this stage.

The insurer brought a motion to stay the insured's arbitration proceeding at the Financial Services Commission of Ontario (FSCO) pending the outcome of a lawsuit it had filed in the Superior Court of Justice.

The insurer argued that its lawsuit, which sought a determination of the insured's income replacement benefit and repayment of alleged overpayments, was filed two days before the arbitration application.

The arbitrator dismissed the motion, finding that the arbitration had advanced more rapidly than the lawsuit and that a stay would frustrate the goal of avoiding multiple proceedings, as the court lacked jurisdiction to issue a special award.

The arbitrator emphasized that the Insurance Act gives the insured, not the insurer, the right to elect the forum for dispute resolution.

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

The applicant's former representative commenced an action in Small Claims Court for caregiver and housekeeping benefits while simultaneously pursuing medical and examination benefits at the Financial Services Commission of Ontario, constituting venue-splitting.

The Small Claims Court dismissed the action with costs against the representative.

The insurer brought a motion at the Commission for expenses related to its motion to address the venue-splitting and abuse of process.

The arbitrator awarded the insurer $1,000 in expenses, finding the motion was justified and holding the applicant responsible for the consequences of his former representative's mishandling of the claims.

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

In a prior decision, the arbitrator found the applicant made a material misrepresentation, relieving the insurer of its obligation to pay benefits.

In this costs decision, the arbitrator ordered the applicant to pay the insurer's expenses.

The arbitrator noted the applicant's vague and contradictory evidence, as well as the calling of an unhelpful witness, unnecessarily prolonged the hearing.

The insurer's costs were slightly reduced to account for delays caused by interpretive services, resulting in a total award of $8,095.38.

The insurer sought leave to appeal an Arbitrator's preliminary order that allowed the insured to proceed to arbitration on the condition that he withdraw overlapping claims from his court action.

The Director of Arbitrations denied the request, finding no compelling reason to deviate from the usual rule that appeals must wait until all issues in dispute have been finally decided.

The Arbitrator's decision involved a pragmatic balancing of interests and an exercise of discretion that should not be disturbed lightly on an interlocutory basis.

The applicant sought statutory accident benefits, claiming she was a passenger in a vehicle involved in a collision.

The insurer denied the claim, asserting she was not in the vehicle.

At the preliminary issue hearing, the applicant failed to appear.

The arbitrator accepted the evidence of the other driver and passenger, as well as the responding police officer, who all testified that there were only three people in the vehicle, none of whom was the applicant.

The application was dismissed.

The arbitrator awarded the insurer $2,668.33 in expenses and ordered the applicant to pay a $3,000 penalty for commencing a frivolous and vexatious arbitration based on a misrepresentation.

The appellant sought leave to amend his Notice of Appeal to challenge a portion of the arbitration order regarding the calculation of income replacement benefits, which he had not initially appealed.

The respondent opposed the request, citing prejudice.

The Director's Delegate allowed the amendment, finding that the delay was short, the amendment raised a legitimate question of law, and the prejudice to the respondent could be addressed by concessions, undertakings, and an award of expenses thrown away.

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

The insurer raised preliminary issues regarding whether all disputed treatment plans from the same clinic should be added to the existing arbitration, and whether the applicant's representatives should be required to provide signed, informed consents from the applicant.

The arbitrator ordered that all disputed treatment plans be added to the arbitration to avoid a multiplicity of proceedings, and required the applicant's representative to provide a signed 'Glinka' acknowledgement.

The applicant was injured in a motor vehicle accident and applied for arbitration after the insurer denied payment for an orthopaedic mattress.

The applicant and his counsel failed to attend two pre-hearings, and the applicant failed to attend the scheduled arbitration hearing.

The arbitrator dismissed the application as abandoned.

Finding the commencement of the arbitration to be vexatious and an abuse of process, the arbitrator ordered the applicant to pay the insurer $3,000 as an assessment under section 282(11.2) of the Insurance Act, plus $790.77 for the insurer's expenses thrown away.

The insurer brought a motion for expenses against the applicant's representative, who had commenced an arbitration in the name of a minor without proper authority.

The arbitrator found that the representative was the true applicant and that bringing the unauthorized application constituted an abuse of process.

The arbitrator ordered the representative to personally pay the insurer's expenses of $4,925.38.

The applicant fractured his hand when a trailer he was manually pulling to hook up to his van rolled and crushed his hand against a wall.

The insurer denied statutory accident benefits, arguing the incident was not an 'automobile accident' because the trailer was not an 'automobile' and the slip-and-fall was an intervening cause.

The arbitrator found that the trailer was being 'used in connection with' the van, bringing it within the policy's definition of an automobile.

The arbitrator concluded that the applicant was involved in an automobile accident and his impairments arose directly from the use or operation of an automobile.

The applicant's counsel brought a motion to withdraw from the record in a statutory accident benefits arbitration, citing a breakdown in the solicitor-client relationship and an inability to contact the applicant.

The insurer did not oppose the withdrawal but brought a cross-motion to dismiss the arbitration as frivolous and vexatious and for costs.

The arbitrator granted the counsel's motion to withdraw, finding the procedural requirements were met.

The insurer's motion to dismiss was found to be premature and could not be entertained because the applicant had not been given notice of it.