Ontario Financial Services Commission - Dispute Resolution Services

The applicant failed to attend her scheduled arbitration hearing.

Her counsel brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship and an inability to contact the applicant.

The arbitrator granted the motion to remove counsel.

The insurer requested that the application for arbitration be dismissed with costs.

The arbitrator dismissed the application due to the applicant's failure to attend and meet her onus of proof, and awarded $1,452.61 in expenses to the insurer.

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits from the Insurer.

After the Insurer paid the outstanding income replacement benefits, the Applicant sought to withdraw the arbitration on a no-costs basis, which the Insurer opposed.

The matter proceeded to an expense hearing.

The Arbitrator found that the Applicant unnecessarily prolonged the proceedings by failing to accept earlier offers to withdraw on a no-costs basis, given the dim prospects of success due to limitation issues and a lack of evidence.

The Applicant was ordered to pay the Insurer's costs fixed at $6,000, and the Applicant's request for costs was dismissed.

The Insurer requested an expense hearing following an arbitration decision where the Applicant was only marginally successful, recovering $7,119.94 out of claims potentially worth millions.

The Arbitrator found that the Insurer was predominantly successful and that the Applicant's conduct, including multiple interim benefit motions and failures to produce documents, prolonged and hindered the proceedings.

Applying a 3:1 ratio for preparation to hearing time, the Arbitrator ordered the Applicant to pay the Insurer's expenses fixed at $18,892.61, inclusive of fees, disbursements, and taxes.

The appellant appealed an arbitrator's denial of certain statutory accident benefits, and the insurer cross-appealed, arguing the arbitrator erred in applying the 'material contribution' test for causation rather than the 'but for' test.

The Ontario Trial Lawyers Association (OTLA) sought to intervene on the issue of causation.

The Director's Delegate granted OTLA's request to intervene, finding that the causation test in accident benefits cases is an important legal issue with broad implications, and that OTLA could provide helpful submissions from a broader perspective.

The Delegate also proposed inviting Canadian Defence Lawyers to intervene to ensure balance.

The appellant insurer appealed an arbitration decision awarding statutory accident benefits and a special award to the respondent.

The appellant failed to provide the required arbitration transcripts, ignored multiple communications from the appeals office, and abruptly attempted to withdraw the appeal without following proper procedures.

The Director's Delegate found that the appellant's course of conduct demonstrated a willful disregard for the appeal process and that the appeal was commenced in bad faith.

The appeal was dismissed without a hearing pursuant to Rule 68.1 of the Dispute Resolution Practice Code.

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

The arbitration hearing was adjourned sine die due to the applicant's medical emergency.

The applicant subsequently died.

The insurer brought a motion to dismiss the application.

The applicant's representative confirmed that no family member or friend had been appointed as an Estate Trustee to proceed with the arbitration.

Both parties agreed the proceeding had become frivolous.

The arbitrator dismissed the arbitration without a hearing pursuant to Rule 68 of the Dispute Resolution Practice Code.

The applicants sought statutory accident benefits following a motor vehicle collision.

The insurer denied further claims and sought repayment of benefits already paid, alleging that the collision was staged and the applicants wilfully misrepresented material facts.

At a preliminary issue hearing, the arbitrator found the applicants to be credible and concluded that any inconsistencies in their evidence were due to the ordinary fragility of memory rather than a conspiracy.

The arbitrator held that the applicants did not wilfully misrepresent material facts and dismissed the insurer's claims for repayment.

Following a decision denying the applicant's claim for statutory accident benefits, the insurer sought its expenses of the arbitration proceeding.

The applicant's representative was removed from the record and the applicant did not participate in the expense hearing.

The arbitrator awarded the insurer $14,101.70 in expenses, reducing the claimed amount due to excessive preparation time, duplication of effort, and unrecoverable disbursements such as court reporter fees.

The applicants, two minors injured in a motor vehicle accident, sought a special award under s. 282(10) of the Insurance Act, alleging the insurer unreasonably withheld or delayed payment of statutory accident benefits.

Prior to the hearing, all substantive issues regarding medical benefits and interest were settled.

The arbitrator dismissed the claim for a special award, finding no evidence that the insurer mishandled the file or acted in bad faith.

The insurer had relied on independent medical examinations that differed from the applicants' family doctor's recommendations, which constituted a mere difference of opinion rather than unreasonable withholding of benefits.

The insurer was awarded its expenses for the arbitration hearing.

The applicant sought to withdraw her application for accident benefits at the start of a preliminary issue hearing.

The insurer consented to the withdrawal but sought expenses, arguing the claim was time-barred, frivolous, and vexatious.

Evidence revealed the applicant had submitted falsified bank statements to support her claim for income replacement benefits, and her paralegal representative had pursued the time-barred claim while failing to comply with production requests.

The arbitrator granted the withdrawal and ordered the applicant to pay $18,871.40 in expenses, while ordering her representative to personally pay $838.96 in expenses for his unprofessional conduct.

The Applicant was injured in a motor vehicle accident and sought income replacement benefits from the Insurer.

At the time of the accident, the Applicant was unemployed and had recently exhausted his severance pay.

He was in the two-week waiting period for Employment Insurance (EI) benefits.

The Insurer denied the claim on the basis that the Applicant was not receiving EI benefits at the time of the accident, as required by section 5(1) of the Statutory Accident Benefits Schedule.

The Arbitrator agreed with the Insurer, finding that the Applicant was not in receipt of EI benefits during the waiting period.

The application for income replacement benefits was dismissed.

The applicant's counsel brought a motion to be removed from the record after the applicant failed to communicate or provide instructions following mediation.

The arbitrator granted the motion to withdraw.

The insurer subsequently brought a motion to dismiss the arbitration as abandoned and vexatious, noting the applicant's failure to attend the pre-hearing or respond to communications.

The arbitrator found that the applicant had effectively abandoned his claims and that continuing the arbitration would be an abuse of process.

The arbitration was dismissed, and the applicant was ordered to pay the insurer's expenses fixed at $2,772.07.

The applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment under the Statutory Accident Benefits Schedule.

The core issue was whether his mental and behavioural impairments, specifically his cannabis dependence and adaptation difficulties, constituted a marked impairment (Class 4).

The arbitrator found the applicant's evidence lacking in credibility and preferred the insurer's expert evidence, concluding that the applicant's impairments were only moderate (Class 3) and his combined whole person impairment did not meet the 55% threshold.

The application was dismissed, and the insurer was awarded partial expenses due to the applicant's conduct prolonging the proceeding.

The applicant, who was injured in a motor vehicle accident, brought a motion seeking the production of documents from the insurer ahead of an arbitration hearing.

The arbitrator found that all documents sought had already been produced, except for clarifications and documents concerning periodic payments of $30.00 and $45.00 related to a housekeeping benefit.

The insurer agreed to produce these documents if they existed.

The arbitrator ordered the insurer to produce any existing documentation regarding these payments by July 4, 2016.

The applicant failed to attend the scheduled arbitration hearing regarding statutory accident benefits.

The insurer brought a motion to dismiss the application for arbitration.

The arbitrator found that the applicant had been notified of the proceedings and was aware that failure to attend would result in a motion to dismiss.

The application was dismissed, and the insurer was awarded $500 in expenses.

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

He sought arbitration for non-earner benefits.

The insurer raised a preliminary issue that the applicant had not mediated the issue of non-earner benefits, as the mediation report only referred to income replacement benefits.

The arbitrator held that mediation of the specific issue is a statutory precondition to arbitration under section 281(2) of the Insurance Act.

The arbitrator rejected the applicant's arguments regarding fundamental breach and relief from forfeiture, finding no jurisdiction to grant relief from forfeiture and that the mediation requirement is not an exclusion clause.

The application for arbitration was dismissed.

The appellant was injured in a motor vehicle accident on October 29, 2010, and claimed statutory accident benefits under a transitional policy.

The arbitrator held that interest on overdue benefits was payable at the reduced rate of 1% per month under the New Regulation.

On appeal, the Director's Delegate found that the arbitrator erred in law by failing to apply the specific transition provisions in the Old and New Regulations, which preserved the 2% per month interest rate for amounts determined under the Old Regulation.

The appeal was allowed, and the appellant was awarded interest at 2% per month, compounded monthly.

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

After her counsel was removed from the record, she failed to attend a scheduled pre-hearing teleconference.

The insurer brought a motion to dismiss the application for arbitration under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator found that the applicant had abandoned her claim and dismissed the application, ordering her to pay $500 in expenses to the insurer.