Paul Omeziri

The applicant insurer sought judicial review of a decision by the Director's Delegate of the Financial Services Commission of Ontario regarding the respondent insured's entitlement to income replacement benefits following a motor vehicle accident.

The Director's Delegate had upheld the arbitrator's award of income replacement benefits but remitted other issues for re-hearing due to inadequate reasons.

The insurer argued the Director's Delegate breached procedural fairness and provided inadequate reasons by not remitting all issues.

The Divisional Court dismissed the application, finding no breach of procedural fairness and concluding that the Director's Delegate's reasons were adequate and reasonable.

The applicants, adult children of a woman seriously injured in a motor vehicle accident, sought payment for social worker assessments under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans and requested independent medical examinations, which the applicants failed to attend.

The Tribunal held that the insurer was not automatically required to pay for the assessments under s. 38(11) because they were incurred outside the applicable time period.

Furthermore, the Tribunal dismissed the applications pursuant to s. 55(1) of the Schedule because the applicants failed to attend the required independent medical examinations.

Following the dismissal of the applicant's claim for income replacement benefits, the insurer sought its expenses of the arbitration.

The arbitrator awarded the insurer its expenses, noting that the insurer was wholly successful and that the applicant had engaged in conduct that prolongated and obfuscated the proceeding, including failing to comply with production orders for his company's general ledger.

The insurer was awarded $15,073.22 in expenses and $2,816.88 in disbursements.

Following an appeal and cross-appeal regarding statutory accident benefits where both parties enjoyed mixed success, both parties sought their legal expenses of the appeal.

The Director's Delegate found that neither party enjoyed a significantly greater degree of success that would warrant an award of expenses.

The parties were ordered to bear their own expenses of the appeal and cross-appeal.

Both parties appealed an Arbitrator's decision regarding statutory accident benefits following a motor vehicle accident.

The Director's Delegate found that the Arbitrator breached procedural fairness by failing to provide adequate reasons for awarding attendant care, housekeeping, medical/rehabilitation benefits, and the cost of assessments.

The Delegate upheld the Arbitrator's finding that the accident caused the insured's shoulder injury and the award of income replacement benefits, but found no evidentiary basis for limiting the benefits to a three-month post-surgery period.

The Delegate also found the Arbitrator's dismissal of a special award to be self-contradictory given the finding that the insurer unreasonably withheld benefits.

The unsupported and unreasoned portions of the decision were rescinded and remitted for rehearing.

Following the dismissal of the applicant's claim for statutory accident benefits, the insurer sought partial indemnity expenses of $13,073.98 for the arbitration proceeding.

The arbitrator considered the criteria under Regulation 664, noting the insurer's success and credibility concerns regarding the applicant's testimony.

However, given the brevity of the three-hour hearing and the lack of complexity, the arbitrator fixed the expenses payable by the applicant to the insurer at $5,000.00 inclusive of fees, disbursements, and taxes.

The appellant, a pedestrian struck by a vehicle, appealed an Arbitrator's decision denying his claims for non-earner and housekeeping benefits.

He argued that the insurer's delay in denying the benefits created a presumption of entitlement, that hospital records should have been accepted as prima facie proof of causation, and that the Arbitrator misapplied the causation test.

The Director's Delegate dismissed the appeal, finding that the appellant was still required to prove entitlement despite any procedural breach by the insurer, that the hospital records were hearsay regarding causation, and that the Arbitrator correctly applied the causation tests.

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

A three-day arbitration hearing was scheduled, but neither the applicant nor her counsel appeared.

The insurer moved to dismiss the application.

The arbitrator, satisfied that the applicant had been notified, granted the motion and dismissed the application for arbitration in accordance with Rule 37.9 of the Dispute Resolution Practice Code.

The appellant was injured in a motor vehicle accident and claimed income replacement benefits.

The insurer initially paid benefits but terminated them, incorrectly assuming collateral long-term disability benefits reduced the payable amount to zero.

At arbitration, the arbitrator found the appellant continued to work as a property developer post-accident, earning substantial income that reduced his payable benefits to zero.

The Director's Delegate upheld the arbitrator's decision, confirming that the appellant bore the onus of proving his claim and that his post-accident income negated his entitlement to benefits.

The insurer appealed an Arbitrator's decision finding the insured catastrophically impaired due to a mental or behavioural disorder resulting in a marked impairment in activities of daily living.

The insurer argued the Arbitrator gave insufficient and inconsistent reasons, failed to separate physical pain from mental disorder, and did not follow the accepted method for determining a marked impairment.

The Director's Delegate dismissed the appeal, finding the Arbitrator's preference for the insured's psychiatric expert was inferable and not contradicted by his findings on whole-person impairment.

The Delegate also held the Arbitrator was entitled to take a cumulative approach to pain and mental disorder, and adequately addressed the three-stage process for evaluating catastrophic impairment.

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 appellant insured appealed an arbitrator's order dismissing his claim for statutory accident benefits due to his failure to attend an Examination Under Oath (EUO).

The Director's Delegate allowed the appeal, finding that the arbitrator lacked jurisdiction to stay or dismiss an arbitration proceeding for failure to attend an EUO, as EUOs are part of the insurer's adjusting process, not the adjudicative process.

The appropriate remedy for non-compliance under the Statutory Accident Benefits Schedule is the suspension of benefits for the period of non-compliance, not the dismissal of the arbitration.

The stay was lifted and the matter returned to arbitration.

The appellant insurer sought its legal expenses after successfully appealing a decision regarding its right to conduct an examination under oath.

The respondent insured argued that the parties should bear their own expenses because he had made an offer to settle and the appeal raised a novel issue.

The Director's Delegate found that while the insurer was successful, the issue of whether an insurer must request an examination under oath within 10 days of an application for benefits was novel and subject to conflicting case law.

Balancing success against novelty, the Director's Delegate ordered each party to bear their own legal expenses.

The defendant moved to dismiss a motor vehicle accident action for delay under the Rules of Civil Procedure, relying on the plaintiffs’ failure to comply with a litigation timetable and to set the matter down for trial.

A plaintiff brought a cross‑motion to vary the timetable order previously imposed when the action was reinstated after an administrative dismissal.

The court held that the earlier reinstatement order effectively displaced reliance on the six‑month set‑down requirement and that dismissal for delay was not warranted.

While most of the delay was attributable to the plaintiffs, including missed deadlines and discovery delays partly arising from conflict-of-interest issues among plaintiffs, the court emphasized the preference for resolving civil actions on their merits.

The timetable order was varied and the action permitted to proceed, subject to the defendant’s ability to raise prejudice at trial arising from incomplete medical records.

The Insurer sought its expenses following an arbitration proceeding where all of the Applicant's claims for statutory accident benefits were dismissed.

The Applicant did not participate in the expense hearing.

The Arbitrator found that the Insurer was completely successful and therefore entitled to its reasonable expenses.

After adjusting the hourly rate claimed by the Insurer's counsel to the appropriate Legal Aid rate, the Arbitrator fixed the Insurer's expenses at $12,500.00, inclusive of fees, disbursements, and taxes, and ordered the Applicant to pay this amount.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming he was unable to work and that his business income was passive.

The insurer argued the applicant returned to work immediately, continued to operate his property development business, and earned income exceeding any IRB entitlement.

The arbitrator found that the applicant continued to perform his pre-accident duties, earned substantial post-accident income, and deliberately failed to produce his company's general ledger.

The application for IRBs was dismissed, as the post-accident income reduced the IRB entitlement to zero.

The moving party sought summary judgment declaring that the co-defendant’s insurer was the first loss insurer under s. 277(1.1) of the Insurance Act arising from a single-vehicle accident involving a rented car in New York State.

The motion also sought a declaration that Ontario law governed vicarious liability issues and that the insurer fund the defence.

The court held that there were genuine issues requiring trial, including whether the driver was a renter or co-lessee under the rental agreement and whether New York law governed liability under the lex loci delicti rule.

The court further concluded that the narrow injustice exception to lex loci delicti did not clearly apply at this stage.

The insurer’s cross-motion to amend pleadings to plead New York law was granted because the amendment did not withdraw an admission and caused no non-compensable prejudice.

The applicant was injured in a motor vehicle accident and received income replacement and housekeeping benefits from the insurer.

The insurer subsequently requested an examination under oath, which the applicant attended but refused to answer questions regarding those specific benefits.

The insurer then terminated the benefits.

In this preliminary issue hearing, the arbitrator held that the insurer was precluded from conducting the examination under oath regarding those benefits because it failed to request the examination within 10 business days of receiving the application and disability certificate, as required by s. 36(4)(c) of the Statutory Accident Benefits Schedule.

Consequently, the insurer was not entitled to suspend the benefits under s. 33(6).

The applicant was awarded expenses for the hearing.

The applicants sought accident benefits following a motor vehicle collision where their minivan struck a Honda Civic making a left turn.

The insurer denied the claims, alleging the collision was a deliberate, staged accident orchestrated with the help of an unidentified third vehicle.

The arbitrator found the insurer's witnesses to be inconsistent and unreliable, and preferred the applicants' straightforward evidence that the collision was a genuine left-turn accident.

The arbitrator concluded the incident was an 'accident' within the meaning of the Statutory Accident Benefits Schedule, allowing the applicants to proceed with their arbitration applications.

A rental vehicle owner and its insurer brought a Rule 21 motion seeking a determination of priority of insurance under s. 277(1.1) of the Insurance Act following a motor vehicle accident involving a rented vehicle.

The plaintiffs sued the driver and the rental company but did not name the renter as a defendant, prompting the owner to commence a third‑party claim against the renter for contribution and indemnity.

The renter’s insurer argued that its policy was not “available” because the plaintiffs had not sued the renter directly.

The court held that a liability claim against the renter through a third‑party proceeding is sufficient to trigger the statutory priority rules.

The renter’s policy was therefore required to respond first, consistent with the legislative intent that the renter’s insurance be primary and the rental company’s insurer last in priority.