Randy F. Knight

The applicant sought an award under section 10 of O. Reg. 664, alleging the respondent unreasonably delayed or withheld payment of a benefit by failing to provide a response to a psychological treatment plan.

The respondent admitted to making administrative errors in sending the approval to the wrong fax number and email address.

The Tribunal dismissed the application, finding that while the respondent made errors, there was no evidence that payment of a benefit was unreasonably withheld or delayed, as the applicant had not incurred any of the goods or services listed in the treatment plan.

Following an arbitration decision regarding statutory accident benefits, the parties were unable to resolve the issue of expenses.

The insurer claimed success on the post-104-week income replacement benefit issue and three of six medical issues, seeking $22,912.12 in fees and $8,351.16 in disbursements.

The applicant also claimed partial success.

The arbitrator found the insurer was entitled to its expenses but reduced the amount to reflect the applicant's degree of success, principles of reasonableness, consumer protection, and access to justice.

The insurer was awarded $5,000 inclusive of fees, disbursements, and HST.