Ontario Financial Services Commission - Dispute Resolution Services

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

At the hearing, the applicant's legal representative successfully moved to withdraw due to a breakdown in the solicitor-client relationship.

The applicant failed to attend the hearing.

As no evidence was presented to support the claims, the application was dismissed as abandoned.

The insurer was awarded $2,500 in expenses due to the unnecessary costs incurred by the applicant's repeated failure to participate.

The appellant sought to appeal an arbitrator's preliminary decision finding that the parties had not reached a settlement, and requested a stay of the upcoming arbitration hearing.

The Director's Delegate declined to exercise discretion to hear the interlocutory appeal, finding that it did not finally decide all issues in dispute and that hearing it would not facilitate the most cost-effective resolution.

The Delegate also refused to stay the arbitration hearing, noting the absence of special circumstances to take control of the process away from the hearing arbitrator.

The appeal was rejected without prejudice to renewing it after all issues are finally determined.

The applicant sought statutory accident benefits, including income replacement benefits, following a motor vehicle accident.

The applicant and his paralegal representative failed to appear at the scheduled arbitration hearing.

The arbitrator dismissed the application for arbitration because the applicant failed to meet the burden of proving his claim.

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

The Insurer requested an adjournment of the arbitration hearing after receiving new expert reports from the Applicant near the end of the 30-day period preceding the hearing.

The Arbitrator granted the adjournment to allow the Insurer to respond to the evidence.

The Applicant subsequently sought expenses incurred as a result of the adjournment.

The Arbitrator dismissed the Applicant's request for expenses, finding that while the Applicant complied with the strict timelines, serving the reports at the last possible moment severely prejudiced the Insurer's ability to respond.

As the Insurer was successful in obtaining the adjournment and did not request its own expenses, the Arbitrator ordered each party to bear its own costs.

The insurer was entirely successful in an arbitration regarding the applicant's claim for weekly caregiver benefits.

The insurer sought its expenses of the arbitration proceeding under the Expense Regulation.

The arbitrator found that the insurer's complete success entitled it to its reasonable expenses.

Applying a 2:1 ratio for preparation to hearing time and allowing for one counsel, the arbitrator awarded the insurer $5,600.00 for fees and $1,350.00 for disbursements, for a total of $6,950.00 inclusive of HST.

The Applicant applied for statutory accident benefits following a motor vehicle accident, but the Insurer denied various medical and rehabilitation benefits and cost of examination expenses.

The Applicant failed to attend the arbitration hearing and presented no evidence to support her claims.

The arbitrator dismissed the Applicant's claims for failing to meet the burden of proof.

The Insurer was awarded $1,500 in expenses due to the Applicant's conduct prolonging the proceeding.

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

After failing to resolve disputes through mediation, the applicant applied for arbitration.

However, the applicant failed to appear at the pre-hearing and the hearing, and his counsel was removed from the record due to an inability to locate him.

The arbitrator dismissed the application for arbitration due to the applicant's failure to pursue it.

The insured was injured in a motor vehicle accident and received income replacement and housekeeping benefits.

Years later, the insurer requested an examination under oath (EUO).

The insured attended but refused to answer questions regarding those benefits, arguing the request was out of time under the Statutory Accident Benefits Schedule.

The insurer suspended benefits.

The arbitrator found the insurer was precluded from requesting the EUO because it had already paid the benefits.

On appeal, the Director's Delegate reversed the decision, holding that the time limits in sections 35/36 apply only to the initial determination of benefits, and do not restrict the insurer's ongoing right to request an EUO under section 33 to determine continuing entitlement.

The insurer was successful in its appeal of an arbitration decision that had found the insured suffered a catastrophic impairment.

The Director's Delegate subsequently determined the issue of costs for both the arbitration and the appeal.

Applying the Dispute Resolution Practice Code, the Delegate found the insurer was entitled to its costs due to its success and the insured's conduct which prolonged the proceedings.

The Delegate awarded the insurer $20,000 in total costs, inclusive of disbursements and HST, rejecting the insurer's claim for over $64,000 and noting that transcript costs are generally not recoverable.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries fell outside the Minor Injury Guidelines (MIG) due to chronic pain and psychological impairments.

The arbitrator found the applicant lacked credibility, having provided inconsistent and inaccurate information to various medical assessors, including failing to disclose a subsequent eye surgery.

The arbitrator concluded the applicant did not prove his injuries fell outside the MIG.

Consequently, the claims for multidisciplinary treatment plans and a psychological assessment were dismissed.

The applicant was also ordered to repay an erroneous payment of $135.60 to the insurer.

The Applicant was injured in a motor vehicle accident and received Non-Earner Benefits until the Insurer terminated them on November 30, 2011, issuing an Explanation of Benefits (OCF-9) on November 23, 2011.

The Applicant applied for mediation on March 13, 2014, beyond the two-year limitation period.

The Applicant argued the OCF-9 was invalid because it cited the wrong section of the Statutory Accident Benefits Schedule.

The Arbitrator held that the refusal was clear, unequivocal, and sufficient to trigger the limitation period, as perfection is not required.

The Applicant is therefore statute-barred from proceeding to arbitration for further Non-Earner Benefits.

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

The insurer paid the maximum limit allowable.

The applicant's litigation guardian repeatedly failed to attend pre-hearings and had filed a parallel tort claim in the Superior Court of Ontario duplicating the issues.

The insurer moved to dismiss the arbitration application.

The arbitrator dismissed the application for arbitration forthwith, finding the proceeding frivolous or vexatious under Rule 68.1 of the Dispute Resolution Practice Code due to the litigation guardian's actions and failure to appear.

The applicant's legal representative brought a motion to be removed from the record due to an inability to obtain instructions from the applicant.

The insurer brought a countermotion to dismiss the application for arbitration and sought expenses.

The arbitrator granted the motion to remove the legal representative from the record.

The arbitrator also dismissed the application for arbitration without a hearing under Rule 68 of the Dispute Resolution Practice Code, finding it frivolous, vexatious, or commenced in bad faith due to the applicant's failure to participate.

The insurer was awarded $500.00 in expenses.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment.

The insurer's assessors concluded he did not meet the threshold, and the applicant sought funding for rebuttal reports.

The insurer denied funding, arguing the new SABS eliminated this right and the applicant failed to meet the timelines under the old SABS.

The arbitrator found the applicant was not entitled to substantive interim benefits for the reports under either SABS.

However, applying the 'whole case approach,' the arbitrator awarded $10,500 as an interim expense to fund the rebuttal reports, citing the applicant's financial distress and the need for procedural fairness to answer the insurer's expert reports.

The applicant was injured in a motor vehicle accident and exhausted her medical and rehabilitation benefits.

She applied for funding for a Catastrophic Impairment Assessment to access the next tier of benefits.

The insurer denied the request, arguing that the assessment costs were subject to the exhausted $50,000 limit under section 18 of the Statutory Accident Benefits Schedule.

The Arbitrator held that a catastrophic impairment determination is a process, not a benefit, and the assessment expenses are payable under section 25 of the Schedule, independent of the section 18 limits.

The insurer was ordered to pay the $9,492 assessment expense.

The applicant's legal representative brought a motion to be removed from the record due to an inability to communicate with the applicant.

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

The applicant failed to attend the pre-hearing and the preliminary issue hearing despite receiving notice.

The arbitrator granted the motion to remove the representative from the record and dismissed the application for arbitration without costs due to the applicant's failure to participate.

The appellant appealed an Arbitrator's variation order that allowed the insurer to deduct Canada Pension Plan disability benefits from his income replacement benefits.

The Director's Delegate allowed the appeal, finding that the Arbitrator breached procedural fairness by deciding the variation application on the record without issuing a Notice of Hearing.

Furthermore, the Director's Delegate found no legal basis for the variation, as the evidence of the CPP disability benefits was known to both parties before the end of the original arbitration hearing and therefore was not 'evidence not available on the arbitration' under section 284(3) of the Insurance Act.

The variation order was rescinded and the application for variation dismissed.

The insurer, having successfully defended an appeal regarding its standing to participate in an arbitration despite failing to file a timely response, sought its expenses of the appeal in the amount of $1,582.

The Director's Delegate declined to award expenses to either party.

Although the insurer was successful, the Delegate found that the insurer's nearly year-long delay in filing a response and the novelty of the legal issue regarding standing justified a departure from the general rule that costs follow the event.