Other Tribunals - OFSCDRS

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

Prior to a pre-hearing, her family doctor sent a letter stating she suffered from paranoid schizophrenia and was not mentally competent to make decisions regarding her file.

The arbitrator held a preliminary issue hearing to determine if she required a litigation guardian under the Dispute Resolution Practice Code and the Substitute Decisions Act.

The arbitrator found that the doctor's letter did not constitute compelling evidence to overturn the presumption of capacity.

Based on the applicant's testimony and demonstrated ability to manage her daily life and finances, the arbitrator concluded she was mentally capable of proceeding with her arbitration without a litigation guardian.

The applicant was injured in two motor vehicle accidents in 1993 and received statutory accident benefits until the insurer terminated them in January 1997.

The applicant sought ongoing weekly non-earner benefits, arguing that chronic pain and psychological factors continuously prevented her from engaging in substantially all of her pre-accident activities.

The arbitrator reviewed medical evidence from various experts, noting that while the applicant suffered from chronic pain and depression, her physical injuries had healed and she maintained normal muscle bulk, indicating a higher level of activity than she perceived.

The arbitrator concluded that the applicant did not meet the stringent post-156 week test under subsection 13(8)(b) of the Schedule, as her impairment did not continuously prevent her from engaging in substantially all of her former activities.

The application for weekly benefits was dismissed.

The applicant was injured in a motor vehicle accident and received weekly income benefits before returning to work.

The insurer terminated benefits and argued the applicant was barred from further benefits under subsection 16(2) of the Statutory Accident Benefits Schedule because she worked for more than 90 days.

The arbitrator held that subsection 16(2) does not bar an insured from receiving further benefits, but only affects the evidentiary presumption of ongoing eligibility.

The arbitrator also determined that the disability entitlement test under subsection 12(5) refers to 156 weeks of disability, and that post-accident employment income does not delay or interrupt the running of this period.

The applicant was injured as a pedestrian in a motor vehicle accident and applied for statutory accident benefits from multiple insurers, including the Motor Vehicle Accident Claims Fund.

A dispute arose regarding which insurer was responsible for paying the benefits and whether Ontario Regulation 283/95 applied.

The arbitrator determined that because the applications for benefits and the dispute arose after March 27, 1995, Ontario Regulation 283/95 applied.

Consequently, the Commission lacked jurisdiction to decide the priority dispute, and the issue of which insurer is required to pay benefits must be resolved through private arbitration under the Arbitration Act, 1991.

At a pre-hearing conference, the Motor Vehicle Accident Claims Fund, supported by the applicant, moved to admit transcripts from examinations for discovery in a related tort action into evidence at the upcoming arbitration hearing in lieu of viva voce evidence.

Royal Insurance Company of Canada objected.

The pre-hearing arbitrator dismissed the motion, finding that the hearing arbitrator is in a better position to determine what documentary and viva voce evidence should be heard and to exercise the evidentiary powers under section 15 of the Statutory Powers Procedure Act.

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

The parties settled all substantive issues prior to the arbitration hearing, including the location of a residual earning capacity assessment, but could not agree on the entitlement to arbitration expenses.

The arbitrator found that the application had merit and the applicant achieved some success by obtaining an assessment in her preferred location, even though the insurer did not concede the legal right to that location.

The arbitrator awarded the applicant her expenses of the arbitration proceeding.

The applicant sought weekly income replacement benefits following a motor vehicle accident but failed to attend the arbitration hearing or comply with production orders.

The arbitrator dismissed the claim for benefits due to a lack of evidence.

The insurer sought an award under section 282(11.2) of the Insurance Act, arguing the arbitration was frivolous and vexatious.

The arbitrator dismissed this request, finding the claim was not devoid of merit when commenced.

However, the arbitrator awarded the insurer its expenses of the proceeding, concluding that the applicant's repeated failures to comply with orders and attend hearings constituted an abuse of process that unreasonably prolonged the matter.

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

The insurer terminated benefits and the applicant applied for arbitration.

The insurer argued the application was barred by the two-year limitation period under subsection 281(5) of the Insurance Act.

The applicant's representative claimed to have filed two previous applications within the limitation period that were allegedly misplaced by the Commission.

The arbitrator rejected the representative's evidence as fabricated and unreliable, finding the application was filed out of time.

The arbitration was dismissed, and the applicant was ordered to pay $1,000 of the insurer's expenses due to the manifestly unfounded claims regarding the limitation period.

The applicant sought an assessment of legal and agent's fees following the settlement of a dispute over statutory accident benefits.

The insurer disputed the amount of time claimed by the applicant's legal assistants and lawyer.

The arbitrator adopted a global approach to assessing the fees, finding that the time claimed was excessive for the single issue involved.

The insurer was ordered to pay $1,819 in fees and GST.

The insured was injured in a motor vehicle accident while driving a rented van.

He initially applied for accident benefits from the van's insurer, which denied the claim.

He then applied to his wife's insurer, State Farm, which also denied the claim.

State Farm brought a preliminary issue motion to dismiss the arbitration as an abuse of process and a multiplicity of proceedings, arguing the insured was obligated to pursue the first insurer.

The arbitrator dismissed the motion, finding no legal basis to bar the insured from applying to State Farm, and noting that any priority dispute should be resolved between the insurers under O. Reg. 283/95.

The insured was awarded his expenses for the preliminary hearing.

The applicant was injured in a minor motor vehicle accident and claimed medical and rehabilitation benefits for various assistive devices, including a boat, snowmobile, and ATV, to help him function at his remote cottage.

The insurer denied the claims, arguing the need for the devices arose from a pre-existing back condition.

The arbitrator found that the applicant had a long history of severe back problems, including a prior surgery, and that the minor car accident did not materially contribute to his need for the assistive devices.

The claim for benefits was dismissed.

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

After failing to attend the arbitration hearing despite proper notice, the arbitrator proceeded in his absence.

Relying on the insurer's uncontradicted expert evidence that the claimed injuries could not have resulted from the minor impact, the arbitrator dismissed the claims.

Finding the applicant's failure to pursue his claims to be vexatious and an abuse of process, the arbitrator ordered the applicant to pay $1,000 in expenses to the insurer.

The applicant was unsuccessful in her claim for loss of earning capacity benefits and both parties sought their expenses for the arbitration.

The arbitrator reviewed the new expense provisions under section 282(11) of the Insurance Act and Ontario Regulation 464/96, which allow expenses to be awarded to either party.

The arbitrator found that the applicant raised a novel issue under a complex schedule and her proceeding was not manifestly unfounded.

The applicant was awarded her expenses, while the insurer's claim for expenses was denied to avoid discouraging legitimate disputes.

The applicant was injured in a motor vehicle accident and inquired about other disability benefits.

The insurer clearly refused the benefits on October 4, 1995, on the basis that collateral benefits reduced her entitlement to zero.

The applicant did not apply for mediation until March 1998, more than two years after the refusal.

The arbitrator held that the claim for other disability benefits was barred by the two-year limitation period under s. 281(5) of the Insurance Act and s. 72(1) of the Statutory Accident Benefits Schedule.

The applicant sought statutory accident benefits, claiming she was injured when her vehicle was rear-ended.

The insurer denied the claim on the basis that no accident occurred.

At arbitration, the drivers of the vehicles behind the applicant testified that their vehicles collided but did not strike the applicant's vehicle.

The arbitrator found the applicant's testimony inconsistent and unreliable, preferring the evidence of the other drivers.

The arbitrator concluded that the applicant's vehicle was not rear-ended and she did not sustain an impairment.

The application was dismissed, and the applicant was ordered to pay the insurer's arbitration expenses due to the vexatious nature of the claim.

The applicant was injured in a motor vehicle accident and applied for arbitration after a dispute over weekly income benefits.

He subsequently disappeared, failing to attend the pre-hearing or the hearing, and failing to comply with production orders.

The arbitrator found that the applicant had constructively withdrawn his application and that his conduct amounted to an abuse of process.

The application was stayed, and the applicant was ordered to pay the insurer's $2,000 assessment fee and $500 in expenses.

The appellant was injured in a motorcycle accident and claimed income replacement benefits.

He argued that the profit from the sale of a residential property should be included in his pre-accident income as business income from self-employment.

The arbitrator found that the appellant was not self-employed in relation to the property and that the profit was a capital gain, but awarded him arbitration expenses due to the complexity of the case.

Both parties appealed.

The Director's Delegate dismissed both appeals, upholding the arbitrator's findings on self-employment and the award of expenses.

The appellant insurer appealed an arbitration decision holding it responsible for paying the respondent's statutory accident benefits, valuing the respondent's fringe benefits for income calculation, and refusing to deduct CPP disability benefits.

The Director's Delegate dismissed the appeal, finding that the respondent was not a 'named insured' under the garage policy of his father's company despite being listed in an endorsement.

The Delegate also upheld the arbitrator's factual findings regarding the valuation of the respondent's payment-in-kind and confirmed that CPP benefits were not deductible.

The applicant sought statutory accident benefits following a single-vehicle accident.

The insurer disputed the claim, alleging the applicant was not a passenger in the vehicle at the time of the accident, relying on a police report that listed a different individual and a polygraph examination suggesting the applicant was deceptive.

The arbitrator found the polygraph evidence to be of no weight due to a lack of evidence regarding its reliability.

Concluding that the insurer's theory of a complex fraud was highly unlikely, the arbitrator held on a balance of probabilities that the applicant was indeed a passenger in the vehicle and awarded expenses to the applicant.

The applicant was injured in a motor vehicle accident and claimed ongoing weekly and lump sum education disability benefits under the Statutory Accident Benefits Schedule.

She argued that her back injuries prevented her from pursuing her intended career as a nurse, constituting a substantial inability to continue her education.

The arbitrator held that the Schedule does not compensate for loss of future career opportunity and found she was able to continue her post-secondary education in other fields.

However, the arbitrator found she suffered a partial inability to carry on a normal life for a limited period due to restrictions on her mobility activities, awarding weekly benefits for that closed period.