Other Tribunals - OFSCDRS

The insurer brought a motion for disclosure of information and documents in a statutory accident benefits dispute.

The insurer sought the addresses of the applicant's attendant care and housekeeping service providers, Defence Medical Reports from a related tort action, and details of the tort settlement.

The arbitrator ordered the applicant to provide the names and addresses of the service providers, finding it necessary for the insurer to prepare its defence.

However, the arbitrator denied the requests for the Defence Medical Reports and tort settlement details, as the insurer failed to provide sufficient evidence to justify production and the settlement details were not relevant to the issues in dispute.

The applicant, injured in a motor vehicle accident, sought income replacement benefits and requested that the insurer disclose whether it had conducted surveillance and, if so, produce it 90 days before the hearing.

The insurer refused to disclose whether surveillance existed and offered to produce any relied-upon surveillance 60 days prior.

The arbitrator ordered the insurer to promptly disclose whether surveillance had been conducted and, if it intended to rely on any surveillance, to produce it 90 days before the hearing to allow the applicant sufficient time to respond with medical evidence without incurring undue financial burden under the Dispute Resolution Practice Code.

The applicant was injured in two separate motor vehicle accidents and filed two separate arbitration applications for statutory accident benefits against the same insurer.

At a pre-hearing discussion, the arbitrator considered whether the applications should be combined under Rule 30 of the Dispute Resolution Practice Code.

Finding that the parties and counsel were identical, and that there were common questions of fact and law regarding the duration and cause of the applicant's disability, the arbitrator ordered the applications combined to ensure the most just, quickest, and least expensive resolution and to avoid inconsistent findings.

The applicant's representative, Mazin Rooz Mazin, brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, as the applicant failed to attend a pre-hearing conference and could not be reached for instructions.

The insurer did not oppose the removal but sought an order requiring the representative to produce an affidavit detailing the breakdown, to determine if costs should be sought against the representative for the lost pre-hearing day.

The arbitrator granted the motion to be removed from the record but declined to order the production of the affidavit, finding it intrusive and potentially involving privileged information without a substantial basis.

The arbitrator awarded the insurer $100 in expenses for the lost pre-hearing day against the applicant, noting the insurer was represented by a paralegal.

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

The parties resolved all outstanding issues prior to the arbitration hearing, leaving only the issue of expenses.

The applicant submitted a Bill of Costs for $8,544.13.

The arbitrator reviewed the claimed fees and disbursements, noting the lack of supporting dockets and the uncomplicated nature of the case.

The arbitrator reduced the claimed fees but allowed the disbursements in full, awarding the applicant a total of $6,628.75 in expenses.

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

The insurer denied coverage and initiated a priorities dispute, arguing another insurer was responsible.

The insurer sought a preliminary determination at the Financial Services Commission of Ontario (FSCO) on whether the applicant was an 'insured' under the Schedule.

The arbitrator held that distinguishing between coverage disputes and priority disputes is artificial and contrary to the legislative scheme.

The issue of whether the applicant is an insured must be determined by a private arbitrator as part of the priorities dispute under O. Reg. 283/95, not by a FSCO arbitrator.

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

Following a preliminary issue hearing where the applicant was found not entitled to elect a non-earner benefit, the insurer sought its expenses.

The arbitrator considered the criteria under section 12 of Regulation 664, noting the insurer was entirely successful but the applicant's conduct did not unduly delay the proceeding.

The arbitrator ordered the applicant to pay $1,000 in expenses to the insurer.

The Applicant sought leave to withdraw her application for arbitration regarding the termination of her caregiver benefits, preferring to pursue the matter in Superior Court alongside a pending tort action.

The Insurer did not oppose the withdrawal but argued it should be allowed to proceed with its claim for repayment of benefits and a preliminary issue hearing on whether the Applicant was actually involved in the accident.

The Arbitrator granted the Applicant leave to withdraw, subject to resolving expenses.

The Arbitrator dismissed the Insurer's claim for repayment without prejudice, finding that the Commission lacks jurisdiction to hear a free-standing claim by an insurer when the applicant has withdrawn all issues from arbitration.

The insurer brought a motion for an order compelling the applicant to attend further psychological and orthopaedic assessments under section 42 of the Statutory Accident Benefits Schedule, and for an adjournment of the upcoming arbitration hearing.

The arbitrator dismissed the motion, finding it to be an exercise in tactical brinkmanship on the eve of the hearing.

The insurer failed to provide a reasonable explanation for its delay in requesting the assessments, despite having early notice of the psychological and orthopaedic components of the claim.

Furthermore, the arbitrator noted a lack of jurisdiction to directly compel attendance at a section 42 examination.

Following a previous arbitration decision finding that the insurer unreasonably withheld payment for two treatment plans, the parties made submissions on the quantum of a special award.

Applying the criteria from Persofsky, the arbitrator determined that the insurer's imprudent and unreasonable conduct warranted a modest special award.

The arbitrator ordered the insurer to pay a special award of $3,500.00.

The applicant was injured when her bicycle was struck by a parked car's door.

She was later diagnosed with Multiple Sclerosis (MS) and claimed statutory accident benefits, arguing the trauma from the accident triggered her MS.

The arbitrator reviewed expert neurological evidence on the theory that trauma can disrupt the blood-brain barrier and trigger latent MS.

The arbitrator found the theory speculative and concluded the applicant failed to prove the accident triggered her MS, noting she had pre-accident neurological symptoms and lacked evidence of serious trauma.

The claims for income replacement benefits, medical benefits, and a special award were dismissed.

Following the dismissal of the applicants' claims for statutory accident benefits, the insurer sought $33,500 in expenses.

The arbitrator found that while the insurer was completely successful in defending the claims, it had spent excessive time pursuing an unproven conspiracy theory regarding a fraud ring.

The arbitrator reduced the allowable preparation and hearing time, disallowing expenses for the days devoted entirely to the conspiracy theory.

The applicants were ordered to pay a total of $12,013.36 in expenses, apportioned between them based on their respective involvement in the hearing.

The appellant's appeal regarding his entitlement to statutory accident benefits was previously dismissed.

The respondent insurer subsequently sought its appeal expenses.

The Director of Arbitrations found that the respondent was entirely successful on the appeal and that the issues raised were not novel, as the appellant had challenged the application of well-settled law to an unusual set of facts.

The Director awarded the respondent its appeal expenses, reducing the claimed amount to align with Legal Aid rates for senior counsel and to remove duplication for a second counsel's attendance, fixing the total at $4,318.79.

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

The parties entered into a settlement agreement, which the appellant subsequently attempted to rescind, then reconfirmed, and then attempted to rescind again after the two-day cooling off period had expired.

The arbitrator found that the settlement was binding because the appellant failed to rescind it within the statutory cooling off period.

On appeal, the Director's Delegate upheld the arbitrator's decision, finding no error in the conclusion that the settlement was binding and that there was no undue influence or coercion.

Following an unsuccessful arbitration for statutory accident benefits, the insurer sought its expenses.

The applicant argued the insurer was precluded from claiming expenses due to a four-month delay in requesting the assessment.

The arbitrator found the delay was a technical breach that caused no prejudice to the applicant.

In assessing the quantum of expenses, the arbitrator reduced the insurer's claim from $12,339.87 to $6,000, noting that the applicant's case raised a novel issue regarding the Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II injuries, which warranted a reduction in the costs payable.

The applicant's representative requested a last-minute adjournment of an arbitration hearing because he was out of the country.

The arbitrator found that the representative's delay and failure to manage his travel plans caused the insurer to incur expenses without reasonable cause.

Pursuant to section 282(11.2) of the Insurance Act, the representative was ordered to personally pay $250 to the insurer for costs thrown away due to the adjournment.

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

The insurer denied claims for income replacement benefits, housekeeping benefits, and functional assessments.

After mediation failed, the applicant applied for arbitration.

The insurer raised a preliminary issue that the arbitration application was filed beyond the two-year limitation period and the 90-day period following the mediator's report.

The arbitrator found that the insurer clearly refused the benefits and that the applicant failed to apply for arbitration within 90 days of the mediator's report.

The arbitration was dismissed as time-barred.

The appellants appealed an arbitrator's decision dismissing their claims for income replacement benefits and a special award.

They brought a motion to stay the arbitrator's orders pending the appeal and requested that their appeals be combined.

The Director's Delegate combined the appeals as they arose from the same accident and involved the same parties and counsel.

However, the motion for a stay was dismissed because the arbitrator had not ordered the payment of any monies, meaning there was currently nothing to stay.

The representative of an insured appealed an arbitrator's decision ordering him to personally pay the insurer's fixed expenses of $1,566 for costs thrown away prior to the withdrawal of the insured's application for arbitration.

The Director's Delegate dismissed the appeal, finding no error in the arbitrator's conclusion that the representative caused expenses to be wasted by unreasonable delay under s. 282(11.2) of the Insurance Act by failing to withdraw the claim when it was apparent that the underlying dispute had been resolved.

The applicant was injured in a motor vehicle accident and applied for arbitration regarding his entitlement to income replacement and medical benefits.

The parties settled the substantive issues prior to the hearing for a lump sum of $5,000, but could not agree on the quantum of expenses payable to the applicant.

The arbitrator assessed the applicant's expenses, allowing his legal fees in full as reasonable, but reducing several claims for disbursements, including medical reports and photocopies, on the basis that they were partially incurred for the applicant's concurrent tort action or were excessive.

The insurer was ordered to pay $8,110.57 in total expenses.