Other Tribunals - OFSCDRS

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment, income replacement benefits, and medical benefits.

The arbitrator found that the applicant sustained a catastrophic impairment due to a marked impairment in the adaptation domain (deterioration or decompensation in a work-like setting) under the AMA Guides.

The applicant was awarded ongoing income replacement benefits of $400 per week, as she suffered a complete inability to engage in any employment for which she was reasonably suited.

Claims for various medical benefits and a special award were dismissed.

The applicant's request for an anonymity order was also denied.

The applicant sought a caregiver benefit following a motor vehicle accident.

At a preliminary hearing, the arbitrator questioned whether the applicant's son-in-law, who is not a licensed legal practitioner, could represent her, and whether the applicant could participate by teleconference from India.

The arbitrator ruled that the son-in-law could represent the applicant only if both filed sworn declarations confirming he would receive no compensation and that any benefits would go solely to the applicant.

The issue of the teleconference hearing was deferred until the representation issue was resolved.

The insurer's request for expenses against the son-in-law personally was dismissed as he was not receiving compensation.

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

The applicant subsequently passed away before the arbitration hearing.

The applicant's former counsel was unable to obtain instructions from a representative of the estate and was permitted to withdraw as solicitors of record.

The solicitor for the estate then requested to withdraw all of the estate's disputes against the insurer on a without expenses basis.

The insurer consented to the withdrawal.

The arbitrator permitted the estate to withdraw all of its disputes on a without expenses basis.

The appellant appealed an arbitrator's decision dismissing his claims for statutory accident benefits against the insurer.

The arbitrator had found that the appellant failed to commence mediation within the two-year limitation period.

On appeal, the Director's Delegate found that the appellant's failure to notify the insurer of the accident until six months after it occurred, without a reasonable explanation, was determinative and precluded him from proceeding to arbitration for any claims arising out of the accident.

The appeal was dismissed.

The applicant repeatedly failed to attend scheduled pre-hearing conferences without adequate excuse.

The applicant's representative was unable to contact him and was removed from the record.

The insurer requested that the application be dismissed as frivolous or vexatious under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator gave the applicant twenty days to provide written submissions objecting to the dismissal.

The applicant failed to respond.

The arbitrator found the application had become vexatious and dismissed it.

The applicant was injured when she slipped and fell on black ice in a parking lot after disembarking from a motorcoach.

She applied for statutory accident benefits, which the insurer denied on the basis that the incident was not an 'accident' under section 2(1) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant had safely disembarked and walked a short distance before falling.

Applying the direct causation test from Chisholm, the arbitrator concluded that the slip and fall was an intervening act not directly caused by the use or operation of the motor vehicle.

The application for arbitration was dismissed.

The insurer brought a motion to adjourn the scheduled arbitration hearing on the grounds that it intended to seek a stay of the arbitration in favour of a companion tort action, for practical reasons related to mediation, and because the applicant failed to comply with her production obligations.

The arbitrator rejected the first two grounds due to the insurer's delay in pursuing them.

However, the arbitrator granted the adjournment because the applicant had failed to provide agreed-upon productions, finding it would be unfair to the insurer to proceed to a hearing under those circumstances.

The insurer sought an order requiring the applicant's legal representative to personally pay the expenses awarded against the applicant following the dismissal of a claim for statutory accident benefits.

The representative brought a motion for summary judgment to dismiss the insurer's request.

The arbitrator found that the representative was not in a conflict of interest by participating in the motion.

The arbitrator granted the summary judgment motion, finding no evidence that the representative acted without authority, advanced a frivolous claim, or caused expenses to be wasted without reasonable cause.

The applicant sought arbitration expenses following a successful claim for statutory accident benefits.

The insurer argued for a reduction in the hourly rate and the number of hours claimed, and objected to full reimbursement of expert reports because they were also being used in an ongoing tort proceeding.

The arbitrator allowed the maximum hourly rate of $150, reduced the claimed hours using a broad approach rather than a line-by-line analysis, and allowed 50% of the cost of the expert reports.

The applicant was awarded a total of $30,001.31 in arbitration expenses.

The applicant applied for statutory accident benefits following a motor vehicle accident.

The insurer denied benefits, and the applicant applied for arbitration at the Financial Services Commission of Ontario.

The insurer brought a preliminary motion to dismiss the arbitration on the basis that the applicant had an ongoing civil action in the Superior Court of Justice involving substantially the same issues.

The arbitrator applied the principles from King and Royal Insurance Company of Canada, finding that the civil action was broader in scope, there was no impediment to the court dealing with the accident benefits claims, and permitting the arbitration to proceed would unduly duplicate proceedings.

The application for arbitration was dismissed.

Following the dismissal of the applicant's claim for statutory accident benefits, the insurer sought its expenses of the arbitration against both the applicant and his solicitor personally.

The arbitrator ordered the applicant to pay $7,000 in expenses to the insurer, finding the insurer was completely successful and the applicant lacked credibility.

The arbitrator dismissed the insurer's claim for expenses against the solicitor personally and ordered the insurer to pay $1,000 in expenses to the solicitor for having to defend against the unreasonable claim.

The applicant's former solicitor of record failed to attend a scheduled pre-hearing and failed to take the necessary steps to formally withdraw as representative under the Dispute Resolution Practice Code.

As a result, the insurer's counsel attended the pre-hearing unnecessarily.

The arbitrator ordered the former solicitor to personally pay $600 to the insurer for costs thrown away, finding that the solicitor's neglect caused the expenses to be incurred without reasonable cause.

Following the settlement of a dispute over non-earner benefits, the parties disagreed on the quantum of expenses payable to the applicant.

The arbitrator awarded $21,490.38 in fees and disbursements, applying the maximum hourly rates permitted under the Expense Regulation.

The arbitrator denied the applicant's claim for disbursements related to witness travel time, finding no provision in the Expense Regulation or jurisprudence to support such compensation.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them at the two-year mark.

The applicant brought a motion for interim benefits pending arbitration.

The arbitrator found that the applicant had demonstrated a strong case for ongoing entitlement and severe financial hardship.

The arbitrator also excluded video surveillance evidence proffered by the insurer due to late and incomplete disclosure under Rule 40 of the Dispute Resolution Practice Code.

The motion for interim benefits was granted.

The arbitrator determined the entitlement and quantum of expenses following an arbitration decision regarding statutory accident benefits.

The Insurer achieved a greater degree of success, having successfully defended against three of four benefit claims and a claim for a special award.

The arbitrator considered written offers to settle, noting the Insurer's offer was closer to the final result than the Applicant's offer.

The arbitrator also reviewed the conduct of the Applicant's counsel but found it did not unreasonably prolong the hearing.

The Insurer was awarded 60% of its recoverable expenses, assessed at $6,552.19, after reductions for unnecessary second counsel and unrecoverable disbursements such as court reporting and transcript fees.

The applicant was struck by a motor vehicle and claimed statutory accident benefits, including income replacement benefits (IRBs) and housekeeping benefits.

The insurer terminated IRBs and housekeeping benefits, leading to arbitration.

The arbitrator found that while the applicant's complaints of pain were likely exaggerated and lacked objective medical evidence after January 2007, he was substantially disabled from performing his pre-accident employment until his shoulder bursitis healed.

The arbitrator awarded IRBs for a closed period but dismissed the claims for ongoing IRBs, housekeeping benefits, and the cost of a redundant functional abilities evaluation.

Each party was ordered to bear their own expenses.

The applicant was injured in a motor vehicle accident and received statutory accident benefits from his insurer, Coachman, until they were terminated.

He also sued the at-fault driver and settled the tort claim with the tortfeasor's insurer, Nordic.

As part of the settlement, a court order assigned the applicant's accident benefits claim to Nordic.

Nordic then pursued the accident benefits arbitration against Coachman in the applicant's name.

Coachman argued the assignment was void under section 65 of the Statutory Accident Benefits Schedule.

The arbitrator held that the court order approving the assignment fell within the exception in section 65(2)(a) for assignments under section 267.8 of the Insurance Act, and therefore Nordic was not precluded from proceeding with the arbitration.

The insured applied for statutory accident benefits following a motor vehicle accident.

After failing to attend two scheduled pre-hearing discussions and failing to maintain current contact information with the Commission, the insurer brought a motion to dismiss the arbitration proceeding.

The arbitrator found that the insured had effectively abandoned his application and that his conduct rendered the proceeding vexatious.

The application for arbitration was dismissed pursuant to Rule 68.1 of the Dispute Resolution Practice Code, and the insured was ordered to pay $1,000 in expenses to the insurer.

The applicant's law firm brought a motion to withdraw as solicitors of record due to a breakdown in the solicitor-client relationship.

The applicant did not explicitly consent to the withdrawal.

The arbitrator granted the motion pursuant to Rule 9.8 of the Dispute Resolution Practice Code, finding that the relationship had broken down.

The withdrawal was permitted subject to conditions requiring the firm to complete documentary production obligations and provide the applicant with a full copy of her file.

The applicant, an 81-year-old man, was run over by his own vehicle, sustaining orthopaedic injuries.

He subsequently developed significant cognitive impairments.

The insurer denied catastrophic impairment benefits, arguing the cognitive decline was caused by a pre-existing subdural haematoma rather than the accident.

The arbitrator preferred the applicant's medical evidence, finding that the accident likely caused a minor head trauma that, combined with the pre-existing haematoma, resulted in brain edema and catastrophic impairment.

The applicant was awarded ongoing attendant care and housekeeping benefits.