Theodore P. Charney

The applicants were injured in a motor vehicle accident and sought payment for chiropractic and rehabilitation expenses from their insurer under the Statutory Accident Benefits Schedule.

The insurer refused to pay the full amounts billed by the treatment facilities, arguing the treatments were excessive and the fees unreasonable.

The arbitrator found that the frequency and duration of treatments for the husband were excessive, while the wife's treatments were largely reasonable.

The arbitrator also significantly reduced the hourly rates and block fees charged by the facilities, finding them unsupported by professional guidelines or market rates.

The applicants were awarded partial payment of the claimed expenses plus interest, but their claim for a special award was dismissed.

The insurer brought a preliminary motion to remove the applicants' representative, arguing that he was acting in contravention of sections 397 and 398 of the Insurance Act because he was neither a licensed adjuster nor a lawyer.

The arbitrator dismissed the motion, finding that section 10 of the Statutory Powers Procedure Act (SPPA) allows a party to be represented by an agent.

Under section 32 of the SPPA, its provisions prevail over the Insurance Act in the event of a conflict.

Therefore, the representative was permitted to continue acting for the applicants.

The insurers brought a motion to combine or hear together nine separate arbitration proceedings involving eleven applicants who received treatment from affiliated clinics.

The insurers argued the cases shared common issues regarding the reasonableness of the clinics' fees and alleged conflicts of interest.

The arbitrator dismissed the motion, finding that the cases involved distinct factual inquiries into each applicant's injuries and treatment needs, and that combining them would be unmanageable.

Instead, the arbitrator ordered that one case proceed first to provide guidance for the remaining cases, which were adjourned pending that decision.

The applicant sought statutory accident benefits, including weekly income benefits and housekeeping expenses, following a 1991 motor vehicle accident.

The insurer terminated benefits in 1994.

The arbitrator found the applicant lacked credibility due to contradictory statements made to the Workers' Compensation Board, the insurer, and her doctors regarding the cause of her disability.

The arbitrator concluded that the applicant failed to establish she was disabled as a result of chronic pain caused by the accident, and that her cognitive impairment was more likely due to prescription drug dependency than a traumatic brain injury.

The claims for benefits were dismissed, but the applicant was awarded 75% of her reasonable legal fees and all disbursements.

The applicant sought weekly income benefits following a motor vehicle accident.

The insurer terminated benefits after approximately two and a half years, arguing her ongoing physical complaints were due to a pre-existing condition rather than the accident.

The arbitrator found the applicant lacked credibility, noting she deliberately misrepresented her extensive pre-accident medical history and the severity of her initial injuries to various medical practitioners.

Relying on the insurer's physiatrist, the arbitrator concluded the applicant's pain magnification was conscious and deliberate, and that she failed to establish a causal connection between the minor accident and her alleged disability.

The application for benefits and expenses was dismissed.

The applicant was injured in a motor vehicle accident and received weekly income benefits until they were terminated by the insurer.

The applicant applied for arbitration to determine his ongoing entitlement to benefits and sought an order reinstating them at the original quantum.

At a preliminary hearing, the applicant sought to exclude the insurer's claim for repayment of alleged overpayments made prior to the termination date.

The arbitrator held that the insurer's claim for repayment consequentially flowed from the applicant's claim for a specific quantum of benefits, and therefore the repayment issue would be included in the arbitration hearing.