Other Tribunals - OFSCDRS

The applicant was involved in two motor vehicle accidents in April 2000.

She applied for statutory accident benefits from RBC Insurance for the first accident and from TTC Insurance for the second.

TTC argued that the applicant was required to claim benefits from RBC as the spouse of a named insured under section 268(5) of the Insurance Act.

The arbitrator held that the issue of whether the applicant was a spouse under the RBC policy was a priority dispute outside the jurisdiction of the Financial Services Commission of Ontario.

Pending resolution of the priority dispute in the proper forum, TTC, as the first insurer to receive the completed application for the second accident, was responsible for paying the benefits.

The applicant was injured in a serious motor vehicle accident and received income replacement benefits (IRBs).

The insurer terminated IRBs after the applicant attempted a return to work but had to stop due to severe headaches and vomiting.

The insurer later reinstated benefits and paid arrears on the eve of the arbitration hearing.

The arbitrator found that the insurer unreasonably withheld benefits by ignoring the overwhelming medical evidence from treating practitioners and selectively reading its own experts' reports.

The arbitrator awarded a special award of $25,000, inclusive of compound interest, under s. 282(10) of the Insurance Act.

The insurer appealed an arbitration order that included a special award for unreasonably withholding benefits.

On appeal, the insurer brought a motion to admit new and extrinsic evidence.

The insurer sought to introduce evidence of institutional bias within the dispute resolution system, arguing that the use of full-time arbitrators created a reasonable apprehension of bias.

The Director of Arbitrations allowed this evidence to be admitted as extrinsic evidence, finding that the insurer had not waived its right to raise the issue.

However, the Director refused to admit new evidence regarding the insurer's belief about the insured's knowledge of available benefits, as this evidence could have been adduced at the original hearing.

The insurer brought a motion to vary an arbitration order that had directed it to pay for three medical reports as section 24 expenses under the Statutory Accident Benefits Schedule.

The applicant did not appear.

The arbitrator found that the applicant had not formally applied for these expenses under section 24 and that the reports were commissioned primarily to establish his claims in the arbitration process.

The arbitrator varied the order, recharacterizing the medical reports as expenses of the arbitration process rather than section 24 benefits.

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

The insurer terminated weekly income replacement benefits, and the applicants applied for arbitration.

A preliminary issue arose regarding whether the applicants were required to attend the pre-hearing discussions in person.

The insurer argued their attendance was essential because it intended to apply to disallow their representative from continuing to act for them.

The arbitrator ordered the applicants to attend in person, noting that the absence of parties can hinder settlement discussions and that the arbitrator has discretion to determine the format of the pre-hearing discussion.

Conditional expenses of $200 were ordered against each applicant if they failed to attend.

Following an arbitration and appeal regarding statutory accident benefits, the applicant sought an assessment of his arbitration expenses.

The insurers argued that the appeal automatically stayed the arbitration expenses order, but the arbitrator noted that under the Insurance Act, an appeal does not stay an order unless the Director decides otherwise.

The arbitrator assessed the applicant's claimed legal fees and disbursements, allowing a portion of the preparation time and expert witness fees.

After accounting for set-offs for collateral benefits and the insurers' appeal expenses, Allstate was ordered to pay $3,569.45 and Wellington was ordered to pay $6,381.95.

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

The insurer disputed the hourly rate claimed for the applicant's counsel and the preparation time claimed for expert witnesses.

The arbitrator held that under the applicable regulation in force at the time the application was filed, the maximum hourly rate for legal fees was restricted to the Legal Aid Act rate of $83.75, and expert preparation time was not recoverable.

The arbitrator awarded the applicant $13,100.73 for legal expenses and $8,889.42 for disbursements.

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

The insurer conceded entitlement but disputed the quantum of legal fees and expert disbursements.

The arbitrator assessed the legal fees, allowing the full time claimed by the junior lawyer who had carriage of the file, but reducing the time claimed by the senior lawyer for duplication.

The arbitrator also assessed the disbursements for various medical experts, reducing some hourly rates to the maximum allowed under Schedule F of the Dispute Resolution Practice Code, and reducing the amounts claimed for certain medical assessments and reports.

The total expenses awarded were $18,888.71.

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

Following a main arbitration hearing where the applicant failed to appear, the arbitrator ordered the applicant to pay the insurer's expenses.

At the subsequent expense hearing, which the applicant also failed to attend, the arbitrator reviewed the insurer's bill of costs.

Finding that the applicant's consistent pattern of conduct, including failing to honour production agreements and missing scheduled hearings, prolonged and obstructed the proceeding, the arbitrator awarded the insurer its full claimed expenses of $7,418.04.

The applicant sought an assessment of her expenses following an arbitration for statutory accident benefits where she achieved minor success.

The arbitrator assessed the expenses on a party and party basis, reducing the claimed legal fees and disbursements significantly.

The arbitrator found the applicant's initial demand for expenses unreasonable and reduced her counsel fee to reflect the time the insurer spent responding to it.

The total expenses were assessed at $4,680.18.

The applicant sought an award of his arbitration expenses following a successful claim for statutory accident benefits.

The insurer argued the applicant was only entitled to half his expenses due to partial success.

The arbitrator found the applicant was largely successful, presented his case efficiently, and raised novel and complex issues.

Applying the criteria in s. 12(2) of Ontario Regulation 664, the arbitrator awarded the applicant all of his reasonably incurred arbitration expenses.

The applicant sought reimbursement for disbursements incurred during an arbitration proceeding for statutory accident benefits.

The insurer had paid a portion of the claimed disbursements but disputed several items, including hotel stays, meals, expert witness fees, and medical assessments.

The arbitrator reviewed the disputed items under the Expense Regulation, allowing some travel and expert report fees while disallowing expenses that were more properly characterized as medical benefits or were deemed unreasonable.

The applicant was awarded an additional $180.26 in disbursements.

The applicant was injured in two separate motor vehicle accidents and sought statutory accident benefits from two insurers.

A previous arbitration determined that both insurers were liable for weekly income benefits and that benefits should not be apportioned.

In this arbitration, the insurers disputed liability for care benefits and whether the applicant was limited to the maximum amount under a single policy.

The arbitrator held that the previous decision on liability and apportionment was res judicata and applied to care benefits.

Furthermore, because the accidents were separate and distinct, the applicant was entitled to claim up to the policy limits for each insurer, with the first insurer acting as primary and the second as excess.

The applicant was awarded expenses but denied a special award.

The applicant sought expenses following an arbitration decision that awarded her income replacement benefits.

The insurer disputed the amounts claimed for legal fees and accountants' services as excessive.

The arbitrator assessed the legal fees based on a reasonable ratio of preparation time to hearing time, allowing 24 hours at $125 per hour for the original bill.

The supplementary legal bill was reduced as excessive.

The arbitrator also reduced the claimed disbursements for two accounting firms, noting that one accountant did not testify and part of their report dealt with matters not in dispute.

The applicant was awarded a total of $6,427.07 in expenses.

The applicant sought her arbitration expenses following a decision on her claims for statutory accident benefits.

The insurer argued that most of her claims were frivolous and vexatious, unduly prolonging the hearing.

The arbitrator found that the applicant was almost completely unsuccessful in her claims, which were largely without merit and manifestly unfounded.

Consequently, the arbitrator denied the applicant's request for expenses.

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

They failed to comply with production orders, failed to attend medical examinations, and did not appear at the arbitration hearing.

Their counsel was granted leave to withdraw.

The arbitrator dismissed the claims for lack of evidence and found the arbitration to be an abuse of process, noting significant inconsistencies in the evidence regarding the alleged accident.

The insurer was awarded its expenses of the arbitration and a $3,000 assessment fee.

The insured person was injured in a motor vehicle accident and commenced both a court action and an arbitration proceeding for statutory accident benefits.

The insurer appealed an arbitration order that allowed the arbitration to proceed despite the concurrent court action.

The Director's Delegate allowed the appeal, finding that the arbitrator erred by focusing only on whether the specific benefits claimed were different, rather than considering the substantial factual overlap between the two proceedings.

Applying the criteria for avoiding multiple proceedings, the Director's Delegate stayed the arbitration pending the outcome of the court action, noting that the court action was broader in scope and involved overlapping medical evidence and causation issues.

The insurer appealed an arbitrator's decision that an excluded driver endorsement was valid but only took effect after the first of two motor vehicle accidents.

The insureds cross-appealed, arguing the endorsement was entirely invalid.

The Director's Delegate allowed the cross-appeal, finding that the endorsement was not validly executed because the insured and the excluded driver signed in the wrong places, and the insured, who faced a language barrier, did not have the requisite intent to exclude her husband.

The insurer's appeal was dismissed.

The insured was involved in two separate motor vehicle accidents and commenced multiple court actions against different insurers and tortfeasors.

She subsequently applied for arbitration at the Financial Services Commission of Ontario to claim specific chiropractic and dental expenses from her first insurer, Royal & SunAlliance.

The insurer appealed an arbitrator's preliminary order that allowed the arbitration to proceed and awarded interim benefits.

The Director's Delegate allowed the appeal, finding that the arbitration and court proceedings involved overlapping factual and legal issues, particularly regarding causation.

The arbitration was stayed pending the outcome of the court action to avoid duplicitous proceedings and inconsistent results.

The applicant sought her expenses for an arbitration proceeding regarding statutory accident benefits following a motor vehicle accident.

Although she was awarded only $1,050 on a claim of over $17,000, the arbitrator found she was successful because she had to pursue arbitration to recover her entitlement.

The insurer's settlement offer of $2,500 was given little weight because it required a full release of future medical and rehabilitation claims.

The arbitrator concluded the applicant was entitled to her expenses of the arbitration proceeding.