Other Tribunals - OFSCDRS

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

The Insurer denied the benefits, alleging that the accident was staged and that the Applicant's vehicle was struck while stationary.

The Insurer relied on the reports of an investigator and two accident reconstruction experts who concluded the collision did not occur as described.

The Arbitrator found the Applicant to be a credible witness and accepted her version of events.

The Arbitrator gave little weight to the Insurer's expert reports because the experts did not examine the vehicles or interview the drivers, and relied on inaccurate information.

The Arbitrator concluded that the Applicant was involved in an accident as defined in section 2 of the Schedule.

The appellant insurer and respondent insured both sought their expenses following an appeal decision where the insurer successfully reduced a special award from $40,000 to $10,000, but the insured successfully defended the entitlement to the special award and the exclusion of certain evidence.

The Director's Delegate found that the insured had the greatest degree of success overall and was entitled to expenses.

However, because success was divided, the insured was awarded only half of his reasonable expenses.

The insured's claim for over 80 hours of preparation was found excessive compared to the Legal Aid tariff for Supreme Court appeals.

Reasonable expenses were assessed at $4,000, resulting in an award of $2,000 to the insured.

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

The parties resolved the substantive issues prior to a scheduled preliminary issue hearing, but the issue of arbitration expenses remained in dispute.

The insurer argued that the arbitrator lacked jurisdiction to award expenses because no hearing on the merits had taken place.

The arbitrator held that under the Insurance Act and the Dispute Resolution Practice Code, the Commission has explicit jurisdiction to decide a claim for expenses in relation to a matter that has been resolved prior to a preliminary issue hearing.

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

The insurer denied that the applicant was involved or injured in the accident.

At the preliminary issue hearing, the applicant's counsel intended to rely on an affidavit from a student-at-law that referenced conversations the counsel had with the driver of the vehicle.

The arbitrator determined that the counsel was effectively acting as an unsworn witness, contrary to Rule 4.02 of the Rules of Professional Conduct.

The arbitrator adjourned the hearing on his own motion to allow the applicant's counsel to entrust the conduct of the hearing to another lawyer.

The applicant sought production of the insurer's post-mediation adjusting file in a dispute over statutory accident benefits.

The insurer claimed litigation and solicitor-client privilege over 18 portions of the file.

The arbitrator reviewed the unedited file and ordered production of the portions relating to ongoing payment of undisputed benefits, while upholding privilege over entries concerning reserves, litigation strategy, and communications with legal counsel.

The insurer brought a motion to dismiss the applicant's claim for statutory accident benefits or to have it deemed withdrawn.

The applicant had returned to Ukraine in 2003 and did not attend the pre-hearing or the motion.

The arbitrator found no evidence that the application was frivolous, vexatious, or commenced in bad faith, but concluded that the applicant did not intend to pursue the claim.

The application was deemed withdrawn pursuant to Rule 70.3 of the Dispute Resolution Practice Code, and the insurer was awarded its expenses.

The applicants were involved in a motor vehicle accident and sought statutory accident benefits.

The insurer settled the outstanding accounts for medical and examination expenses directly with the service providers, obtaining full and final releases.

The applicants subsequently sought to proceed to arbitration for those same expenses.

On a preliminary issue, the arbitrator held that the claims could not proceed, as the insurer had validly settled the accounts directly with the providers under the Schedule and no further expenses were incurred by the applicants.

The insurer's request for costs against the applicants' legal representatives personally was dismissed, as the claims, while lacking merit, did not constitute an abuse of process.

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

During a preliminary issue hearing, the applicant exhibited signs of mental difficulty, prompting the arbitrator to direct a hearing on his mental capacity to proceed.

The applicant brought a motion for interim expenses to retain counsel and undergo a capacity assessment.

The arbitrator granted the motion, awarding 5 hours of legal fees and up to $1,500 for a capacity assessment, finding that the applicant's mental difficulty constituted an extraordinary situation warranting interim expenses to ensure a fair hearing.

Each party was ordered to bear its own expenses for the motion.

The applicant, who was injured in a motor vehicle accident, sought a rehabilitation benefit under the Statutory Accident Benefits Schedule for the cost of two round-trip airline tickets to India for herself and her husband.

She argued the trip would provide a therapeutic environment.

The arbitrator dismissed the application, applying the ejusdem generis rule to find that airline tickets for visiting family and friends do not fall within the same class as the specific rehabilitation benefits contemplated by the Schedule.

The claims for interest and expenses were also dismissed or deferred.

The applicant was injured in two motor vehicle accidents and claimed statutory accident benefits from the insurer.

The parties engaged in settlement discussions prior to an arbitration hearing and reached an agreement.

The applicant signed a release and settlement disclosure notice but later attempted to rescind the settlement within the two-day cooling-off period.

However, she subsequently withdrew her rescission within the same period, confirming her acceptance of the settlement.

After the cooling-off period expired, she again attempted to reopen her claim.

The arbitrator held that the applicant had entered into a binding, full and final settlement and was therefore precluded from proceeding to arbitration.

Following an arbitration where the applicant was largely successful in claiming statutory accident benefits, the parties could not agree on expenses.

The arbitrator determined that the applicant was entitled to her expenses.

The arbitrator assessed the legal fees, reducing the requested hourly rate from $150 to $120 due to the representative's failure to properly organize documentary evidence, which prolonged the proceedings.

The arbitrator also reduced the preparation time ratio from 4:1 to 2:1.

Total expenses of $29,704.60, inclusive of fees, disbursements, and GST, were awarded to the applicant.

The applicant sought medical benefits following an alleged motor vehicle accident.

The insurer denied the claims, alleging the accident was staged and the applicant was not a passenger.

The applicant and her former representative failed to attend the arbitration hearing.

Based on inconsistencies in statements and evidence from another alleged passenger that the accident was fabricated, the arbitrator found the applicant was not involved in an accident and dismissed the arbitration.

The arbitrator awarded the insurer its arbitration expenses of $1,943.52, holding the applicant and her former representative jointly and severally liable due to their non-participation and the vexatious nature of the proceeding.

The insurer brought a motion to adjourn the arbitration hearing and compel the production of the applicant's pre-accident business records.

The applicant had previously agreed to produce the records but failed to do so, arguing they might be with his accountant and questioning their relevance.

The arbitrator found that the records were relevant to the issue of income replacement benefits and that the applicant was bound by his prior agreement to produce them.

The motion was granted, the hearing was adjourned, and the applicant was ordered to produce the records or confirm their non-existence, as well as pay $150 in costs to the insurer.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer disputed.

After the applicant failed to attend multiple pre-hearing resumptions and failed to comply with undertakings to produce documents, the insurer sought to dismiss the proceeding without a hearing under Rule 68.1 of the Dispute Resolution Practice Code.

The arbitrator declined to dismiss the proceeding, noting the applicant eventually provided an explanation for her absence and agreed to sign authorizations for the required documents.

However, the arbitrator awarded the insurer $300 in expenses due to the unnecessary delay and expense caused by the applicant's conduct.

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

At a scheduled pre-hearing, the insurer's counsel attended without a representative authorized to bind the insurer, in breach of a prior order by the arbitrator and section 279(5) of the Insurance Act.

The arbitrator found that the insurer knowingly flouted the order, constituting an abuse of process.

The insurer was ordered to pay $400 in expenses to the applicant, with payment suspended until the completion of the arbitration.

The insurer brought a motion to adjourn the arbitration hearing because its expert witness was away on sabbatical.

The applicant opposed the adjournment, noting she had already waited almost a year for a hearing regarding ongoing income replacement benefits and prescription expenses.

The arbitrator denied the adjournment request, finding that a further nine-month delay was unacceptable.

The hearing was ordered to commence as scheduled, but the insurer was permitted to arrange one additional hearing day before May 31, 2006, for the expert to testify if he could not attend the scheduled dates.

The insurer sought an assessment of its arbitration expenses following a decision that dismissed the applicant's claim for statutory accident benefits and awarded the insurer its reasonable expenses.

The applicant did not pay the itemized Bill of Costs and failed to appear or provide written submissions for the assessment hearing, despite receiving proper notice.

The arbitrator reviewed the insurer's Bill of Costs and found the claimed legal fees and disbursements to be reasonable in relation to the length and complexity of the arbitration.

The applicant was ordered to pay the insurer $7,005.56, inclusive of GST.

The insurer sought its expenses arising from an appeal decision that affirmed a preliminary issue decision finding the insured's paralegal had entered into a binding settlement.

The insured agreed the insurer was entitled to expenses but disputed the quantum, specifically the $150 hourly rate claimed for counsel.

The Director's Delegate found that the maximum allowable hourly rate for the insurer's counsel was $83.10 based on his year of call.

While the appeal issue was no longer novel following a prior Director's decision, the Delegate did not find the appeal frivolous or vexatious.

Considering the nature and complexity of the appeal, the Delegate awarded the insurer $2,000 in appeal expenses.

Counsel for the applicant brought a motion to withdraw as counsel of record for an assessment of expenses proceeding following an arbitration decision.

Counsel submitted that there had been a breakdown in the solicitor-client relationship and that he had lost contact with the applicant.

The insurer did not object to the motion.

The arbitrator found that the solicitor-client relationship had broken down and granted the motion, permitting counsel to withdraw without terms.

The applicants claimed statutory accident benefits following an alleged motor vehicle accident.

The insurer terminated benefits and argued the applicants were not involved in an accident as defined in the Schedule.

At a preliminary issue hearing, the arbitrator found significant inconsistencies in the applicants' evidence regarding the mechanics of the collision and the aftermath.

Relying on these inconsistencies and the expert evidence of an accident reconstruction engineer, who opined that the damage was inconsistent with the reported collision, the arbitrator concluded the applicants failed to prove they were involved in an accident.

The applicants were precluded from proceeding to arbitration, and the insurer was entitled to pursue repayment of benefits paid.