Ontario Financial Services Commission - Dispute Resolution Services

Wawanesa appealed an arbitration expenses order awarding the respondent $46,918.59 in legal costs following a successful claim for statutory accident benefits.

The Director's Delegate dismissed the appeal, finding that the insurer's submissions focused on the Arbitrator's findings of fact and exercise of discretion, which are entitled to significant deference and not subject to review absent an error of law.

The Arbitrator's decision was affirmed, and Wawanesa was ordered to pay $3,000 in appeal costs.

The appellant insured's appeal regarding catastrophic impairment and income replacement benefits was previously dismissed.

The successful respondent insurer sought its appeal costs in the amount of $18,742.02.

The Director's Delegate reviewed the criteria under Rule 75.2 of the Dispute Resolution Practice Code, noting that the overriding consideration in fixing arbitration expenses is reasonableness.

Finding the claimed lawyer hours excessive for a non-complex appeal and the transcript costs unrecoverable, the Director's Delegate fixed the insurer's appeal expenses at $4,000.00 inclusive of disbursements and HST.

The insurer applied to vary an appeal order that required the insured to repay interim benefits but failed to specify the quantum.

The insured argued the Director's Delegate lacked jurisdiction as the omission was not a mere typographical error.

The Director's Delegate held that issuing an unenforceable order without a quantum was an 'error in the order' under Rule 61.1(c) of the Dispute Resolution Practice Code.

The order was varied to require the insured to repay $41,919.18 in interim benefits.

However, the insurer's request to include benefits paid after a subsequent arbitration order was dismissed, as there was no error in the original appeal order regarding those payments.

The applicant's representatives brought a motion to withdraw as solicitors of record in a statutory accident benefits dispute.

The representatives demonstrated that they had made numerous unsuccessful attempts to contact the applicant and had been unable to obtain instructions for the upcoming preliminary issue hearing.

The arbitrator found that there had been a complete breakdown in the solicitor-client relationship and granted the motion to withdraw.

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

The matter proceeded to a preliminary issue hearing to determine whether the incident constituted an 'accident' under the Statutory Accident Benefits Schedule.

The applicant's legal representatives withdrew from the record on the day of the hearing, and the applicant failed to appear.

The arbitrator dismissed the application due to the applicant's failure to attend and prove his case.

The applicant was ordered to pay $1,500 in expenses to the insurer.

The appellant appealed an Arbitrator's decision denying her claims for catastrophic impairment, attendant care, caregiver, medical, and housekeeping benefits following a 2009 motor vehicle accident.

The appellant argued the Arbitrator provided inadequate reasons, applied incorrect legal tests for burden of proof and causation, and erred in weighing evidence and assessing credibility.

The Director's Delegate dismissed the appeal, finding that the Arbitrator's reasons were adequate, the correct legal tests were applied, and the credibility findings were supported by ample evidence.

The Arbitrator's decision was confirmed and costs of $3,390 were awarded to the respondent.

The appellant insurer appealed an arbitrator's decision that the denial of the respondent's caregiver benefit was invalid and that she was entitled to elect her preferred weekly benefit.

The insurer argued that the OCF-1 application form constituted an application for all weekly benefits, allowing it to deny all benefits without an election, relying on recent case law.

The Director's Delegate dismissed the appeal, finding that the arbitrator correctly distinguished the case law because the insurer had actual knowledge that the respondent might qualify for more than one benefit, triggering the election requirement under section 36(2) of the Statutory Accident Benefits Schedule.

Because the insurer failed to provide the required election form, the limitation period did not commence, and the respondent could still make her election.

The insurer appealed an arbitrator's decision finding the insured catastrophically impaired and entitled to medical benefits following a 2013 motor vehicle accident.

The insured had significant pre-existing physical and psychological impairments from prior accidents in 2002.

The Director's Delegate allowed the appeal, finding that the arbitrator erred in law by applying a 'material contribution' test for causation instead of the required 'but for' test.

The Delegate noted that the insured was already catastrophically impaired prior to the 2013 accident, meaning the accident could not have caused the catastrophic impairment.

Furthermore, the arbitrator breached principles of fundamental justice by refusing to even consider the insurer's request for an adjournment after the insured served a 90-page medical report just 31 days before the hearing, improperly fettering her discretion based on the impending closure of the tribunal.

The insured's claims were dismissed and costs were awarded to the insurer.

Following an arbitration where the insurer was entirely successful in dismissing the applicant's claims for statutory accident benefits, the insurer sought its expenses.

The arbitrator considered the criteria under Ontario Regulation 664, noting the insurer's complete success and the applicant's rejection of a $2,500 settlement offer.

The arbitrator awarded the insurer its expenses, reducing the claimed preparation time to a 2:1 ratio relative to the 25 hours of hearing time, and disallowing the cost of a court reporter.

The applicant was ordered to pay the insurer $10,082.68 in expenses.

The appellant's appeal was dismissed after being deemed abandoned, as she filed only a Notice of Appeal and requests for time extensions.

The respondent sought $4,992.40 in legal expenses for the appeal proceeding.

The Director's Delegate found the respondent's claimed expenses to be exaggerated and not commensurate with the effort required to obtain a dismissal, noting the appellant's arguments were largely generic.

The Director's Delegate ordered the appellant to pay $750.00 in legal expenses to the respondent.

The applicant was injured in a motor vehicle accident and his claims for statutory accident benefits were dismissed in a prior arbitration decision.

In this subsequent decision on expenses, the insurer sought its costs of the proceeding.

The arbitrator found the insurer was entirely successful and therefore entitled to its expenses.

Applying a 2:1 ratio for preparation to hearing time, and allowing disbursements for expert witnesses while disallowing conduct money for uncalled witnesses and court reporter fees, the arbitrator ordered the applicant to pay the insurer's expenses fixed at $21,387.48.

The Appellants sought their legal appeal expenses following a successful appeal regarding their housekeeping and home maintenance claims.

The Director's Delegate awarded the Appellants their appeal expenses, allowing paralegal fees at $70 per hour rather than the claimed $150 per hour.

The claim for transcript costs was denied, as transcript costs are not recoverable under the Expense Regulation.

The total amount awarded was $4,200, inclusive of disbursements and HST.

The insurer, having successfully defended an appeal regarding statutory accident benefits, sought over $41,000 in appeal expenses.

The Director's Delegate found the claimed legal fees and disbursements to be excessive and unreasonable, noting that the appeal was not complex and did not require five different legal professionals.

Applying the criteria under Rule 75.2 of the Dispute Resolution Practice Code, the Director's Delegate fixed the insurer's appeal expenses at $5,000 inclusive of disbursements and HST.

The insurer, having successfully resisted the claimant's appeal of an arbitration decision denying statutory accident benefits, sought its legal appeal expenses.

The claimant did not respond to the insurer's Bill of Costs.

The Director's Delegate found the insurer was entitled to its expenses based on success.

While the insurer claimed $9,387.89 inclusive of HST and disbursements, the Director's Delegate found this amount somewhat high for a short and uncomplicated appeal, and fixed the costs payable by the claimant at $6,500.

The insured and the insurer both appealed an arbitration decision regarding statutory accident benefits arising from multiple motor vehicle accidents.

The Director's Delegate found that the Arbitrator breached the rules of natural justice by admitting late affidavits from the insurer without allowing the insured to cross-examine the affiant, and by failing to address the insured's submissions on limitation periods.

Furthermore, the Arbitrator's reasons for finding the insured catastrophically impaired were deemed conclusory and inadequate, as they failed to apply the 'but for' causation test or the proper three-stage process under the AMA Guides for assessing psychiatric impairment.

The appeal and cross-appeal were allowed, and the matter was remitted to arbitration for a fresh re-hearing.

The appellant appealed two arbitration orders denying her claims for non-earner benefits, medical benefits, and a special award, and ordering her to pay HST on the insurer's disbursements.

The Director's Delegate dismissed the appeal, finding no errors of law.

The Arbitrator correctly applied the test for non-earner benefits, properly concluded medical benefits were not incurred, and correctly applied the legislative requirement that treatment plans be signed.

The Delegate also refused to admit a new invoice as fresh evidence because it could have been adduced at the arbitration hearing.

Finally, the Delegate upheld the order requiring the appellant to pay HST on expert witness disbursements.

The appellant appealed an arbitrator's decision regarding arbitration expenses and interest on retroactive attendant care and housekeeping benefits.

The Director's Delegate dismissed the appeal, finding that the arbitrator correctly concluded that solicitor/client costs are not prescribed expenses under the Insurance Act and reasonably exercised his discretion in reducing the claimed hours.

The Delegate also upheld the arbitrator's finding that, pursuant to Grigoroff, interest on attendant care benefits only begins to run 10 business days after the insurer receives a Form 1 assessment, not from the date the insurer is merely aware of the need.

The insurer appealed an arbitrator's preliminary decision finding the insured catastrophically impaired.

The insurer argued the arbitrator lacked jurisdiction to make a stand-alone catastrophic impairment determination when no specific accident benefits were claimed.

The Director's Delegate dismissed the appeal, holding that a catastrophic impairment determination is a necessary gateway issue within an arbitrator's jurisdiction under the Insurance Act.

The Delegate also found no error of law in the arbitrator's preference for the insured's expert evidence over the insurer's experts, nor in the arbitrator's application of the AMA Guides regarding the assessment of pain in mental and behavioral disorders.