Ontario Financial Services Commission - Dispute Resolution Services

The applicant was injured in a motor vehicle accident and sought housekeeping and caregiving benefits from her insurer.

She moved to California shortly after the accident and gave inconsistent medical histories to various health care providers, attributing her injuries to a yoga incident or moving boxes rather than the car accident.

The arbitrator found the applicant lacked credibility and failed to prove on a balance of probabilities that she suffered any disability related to caregiving or housekeeping as a result of the motor vehicle accident.

The claims were dismissed.

The applicant was injured in a motor vehicle accident when he was struck by a minivan while examining his truck on the side of the road.

He applied for statutory accident benefits, claiming he sustained a catastrophic impairment.

The insurer denied the claim, arguing that the applicant's impairments were unrateable due to inconsistent test results and symptom magnification.

The arbitrator preferred the evidence of the applicant's experts, finding that the use of the Gait Derangement Table was appropriate for rating his physical impairments and that his psychological impairments were marked despite invalid psychometric testing.

The arbitrator concluded that the applicant met the definition of catastrophic impairment under both the 55% whole person impairment threshold and the marked mental or behavioural disorder threshold.

The applicant sought production of the insurer's file in a dispute over statutory accident benefits.

The insurer claimed solicitor-client privilege, litigation privilege, and lack of relevance over various documents, including an investigation report previously disclosed.

The arbitrator found that the insurer failed to establish the evidentiary foundation for its privilege claims, noting that the claims investigation phase requires neutrality rather than an orientation toward litigation.

The insurer was ordered to produce the disputed documents, including the dates reserves were set, but not the reserve amounts.

The applicant sought payment for various medical treatment and assessment plans, interest on overdue payments, and a special award following a motor vehicle accident.

The arbitrator found that several claims had already been paid by the insurer, awarding interest on those late payments.

Other claims were denied due to the applicant's failure to attend insurer's examinations without reasonable explanation, and due to significant factual inconsistencies and omissions regarding her pre-existing medical history in the submitted treatment plans.

The claim for a special award was dismissed as there was no evidence of bad faith by the insurer.

Each party was ordered to bear its own arbitration expenses.

The applicant commenced an arbitration application against the insurer but subsequently failed to communicate with her legal representatives, who were granted permission to be removed from the record.

The applicant failed to attend a scheduled pre-hearing conference and did not respond to the arbitrator's notice of intent to dismiss the proceeding.

Finding that the applicant had no interest in pursuing the matter and that the application had become vexatious, the arbitrator dismissed the application without a hearing pursuant to Rule 68 of the Dispute Resolution Practice Code.

The applicant sought attendant care and housekeeping benefits following a motor vehicle accident, claiming services were provided by family members and a lawn care company.

The insurer denied the claims on the basis that the expenses were not 'incurred' under section 3(7)(e) of the Schedule because the family members did not sustain an economic loss and the lawn care company did not provide services in the course of its ordinary employment.

The arbitrator rejected the applicant's expert economic evidence that 'economic loss' includes mere loss of time or opportunity, finding it must relate to a financial or monetary loss.

The arbitrator concluded the family members failed to prove any economic loss and dismissed the claims for benefits and a special award.

The applicant was injured in a motor vehicle accident and claimed she sustained a catastrophic impairment due to a mental or behavioural disorder.

The insurer argued the accident was minor and her impairments were pre-existing or caused by unrelated post-accident stressors.

Applying the three-stage process from Pastore, the arbitrator found that the accident materially contributed to the applicant's diagnosed mental and behavioural disorders, including major depressive disorder and pain disorder.

The arbitrator preferred the evidence of the applicant's experts and the insurer's occupational therapist over the insurer's psychiatrist, concluding the applicant suffered a marked impairment in the sphere of deterioration or decompensation in work or worklike settings.

The applicant was deemed catastrophically impaired.

The applicant sought his expenses of the arbitration after being granted income replacement benefits but denied other claims.

The insurer sought reimbursement of its expenses, arguing the applicant prolonged and obstructed the process.

The arbitrator found no evidence of delay or obstruction by the applicant and noted his modest success entitled him to a modest recovery of expenses.

The arbitrator applied a ratio method to reduce the claimed legal fees and disallowed or reduced several disbursements, including rejecting an expert report that violated the expert's duty to the Tribunal.

The insurer was ordered to pay the applicant $18,918.77 for his arbitration expenses.

Following an arbitration where the insurer successfully defended the applicant's claims for statutory accident benefits, the insurer sought its expenses.

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

Applying a 1:4 ratio for attendance to preparation time, the arbitrator awarded the insurer $13,001.23 in fees, disbursements, and HST.

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

After his counsel withdrew due to a breakdown in communication, the applicant failed to attend a pre-hearing and the motion to dismiss.

The arbitrator found the applicant had abandoned the proceeding and granted the insurer's motion to dismiss the arbitration.

The insurer was awarded $1,000 in costs thrown away.

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

The insurer denied the claims, and the matter proceeded to arbitration.

The applicant failed to attend the pre-hearing and the hearing.

The arbitrator dismissed the application for arbitration due to the applicant's failure to attend and lack of evidence.

The insurer was awarded $750 in expenses.

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

After her representative was removed from the record, the applicant failed to attend a pre-hearing and the scheduled arbitration hearing.

The arbitrator proceeded in her absence and dismissed the application, finding there was no evidence presented and no case for the insurer to meet.

The insurer was awarded $750 in expenses for its preparation and attendance.

The applicant sought income replacement benefits following a motor vehicle accident, claiming she was unable to work as a bottle packer due to physical pain and depression.

The insurer denied the benefits, relying on independent medical examinations by a physiatrist and a neuropsychologist who found no physical or cognitive limitations preventing her from working, and suggested she was feigning impairment.

The arbitrator preferred the evidence of the insurer's assessors over the applicant's subjective complaints and her family physician's support, concluding that the applicant failed to prove on a balance of probabilities that she suffered a substantial inability to perform her employment duties.

The claim for income replacement benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for medical treatment, housekeeping, and the cost of an orthopaedic examination.

The insurer denied the claims based on an insurer's examination which concluded the applicant had sustained an uncomplicated soft tissue injury that did not require further treatment.

The arbitrator dismissed the application, finding the applicant failed to provide objective medical evidence or call treating practitioners to support his claims.

The arbitrator accepted the insurer's expert evidence and found the applicant's evidence regarding his living arrangements and housekeeping needs to be implausible and contradictory.

The applicant, who sustained a serious brain injury after being struck by a dump truck as a pedestrian, brought a motion for interim benefits pending arbitration.

The insurer agreed to pay ongoing attendant care, housing, and assistive devices.

The arbitrator declined to order interim benefits for past attendant care, finding that the applicant had not demonstrated a compelling case or urgency, as there was no evidence that anyone was waiting to be paid for past care.

The appellant insurer sought to withdraw its appeal of an arbitrator's preliminary decisions regarding third-party production and catastrophic impairment, following a relevant Court of Appeal decision.

The respondent insured consented to the withdrawal but sought legal expenses as a condition.

The Director's Delegate permitted the withdrawal and ordered the appellant to pay $6,250 in legal expenses to the respondent, finding that the respondent had been successful in resisting an earlier stay request and that the appellant's conduct warranted an award of costs.

The Applicant sought expenses for an arbitration hearing that concluded in 2008 when the Insurer conceded the issue of catastrophic impairment.

The Insurer argued the Applicant was not entitled to expenses due to a 4.5-year delay in submitting a Bill of Costs, relying on Rule 79.1 of the Dispute Resolution Practice Code and the principle of finality.

The Arbitrator found that Rule 79.1 did not apply because no final arbitration order had been issued.

Given the ongoing dealings between the parties over the years, the delay did not deprive the Applicant of her entitlement under s. 282(11) of the Insurance Act.

The Arbitrator awarded the Applicant $30,972.81 in expenses.

The respondents were injured in a motor vehicle accident and entered into a settlement with their insurer, Aviva Canada Inc., regarding statutory accident benefits.

They later sought to rescind the settlement after the two-day cooling-off period, arguing the Settlement Disclosure Notice (SDN) did not comply with the Settlement Regulation.

The Arbitrator found the SDN deficient and allowed the rescission.

On appeal, the Director's Delegate confirmed the Arbitrator's decision, holding that the SDN failed to provide the mandated information regarding rescission in clear and straightforward language directed towards an unsophisticated person, and that this defect was not merely technical.