Todd J. McCarthy

The plaintiff was injured on a roller coaster in October 1995 and commenced an action in February 2002.

The defendants brought a motion for summary judgment, arguing the six-year limitation period had expired.

The motions judge dismissed the motion, finding the limitation period had not expired.

On appeal, the majority of the Court of Appeal allowed the appeal and dismissed the action, holding that the plaintiff knew or reasonably should have known all elements of her claim in October 1995, and the mere possibility of no causal connection did not delay the limitation period.

The applicant was shot and stabbed by unknown assailants during a carjacking while sitting in his parked vehicle.

He applied for statutory accident benefits, which the insurer denied on the basis that the incident was not an 'accident' under the Schedule.

The arbitrator held that the use or operation of the automobile did not directly cause the applicant's injuries; rather, the assault was an intervening act and the direct cause.

The applicant was therefore precluded from proceeding to arbitration for accident benefits.

Following a settlement of a statutory accident benefits claim for $85,000 plus expenses, the parties could not agree on the quantum of expenses.

The applicant claimed approximately $33,000 in legal fees and disbursements.

The arbitrator assessed the expenses by applying the criteria in the Dispute Resolution Practice Code and the Expense Regulation.

The arbitrator reduced the hours claimed due to late delivery of medical reports and time thrown away by a change of counsel, but allowed the maximum hourly rate of $150 for the applicant's senior counsel due to the excellent result achieved.

The insurer was ordered to pay $20,913.68 in expenses.

The applicant was injured in a motor vehicle accident and received caregiver benefits, which the insurer subsequently terminated.

The applicant requested a Designated Assessment Centre (DAC) assessment but failed to attend or remain for scheduled appointments.

The Arbitrator found that the applicant did not make herself reasonably available for the assessment, rejecting her explanations regarding her mental state and lack of written notice.

As a result, the applicant was precluded from receiving caregiver benefits from the date of termination until she attends a DAC assessment, and barred from pursuing her claim at the upcoming arbitration if she fails to attend before then.

The applicant applied for statutory accident benefits following a motor vehicle accident and subsequently applied for arbitration at the Financial Services Commission of Ontario.

At the scheduled hearing, the applicant failed to attend and was unrepresented.

The arbitrator dismissed the application for arbitration due to the applicant's non-attendance and ordered the applicant to pay $500.00 in expenses to the insurer.

The insurer brought a preliminary motion to dismiss the arbitration because the applicant failed to comply with a prior order to pay $500 in expenses.

The applicant argued she was unable to pay because the insurer had not paid any benefits.

The arbitrator ordered that the arbitration be stayed until the applicant complies with the prior order.

The insurer brought a motion to dismiss the arbitration because the applicant failed to comply with a prior order to pay $500 in expenses.

The applicant argued that he was unable to pay because the insurer had not paid any benefits.

The arbitrator ordered that the arbitration be stayed until the applicant complies with the prior order.

The applicant was injured in a motor vehicle accident and sought payment for chiropractic and rehabilitation treatments from his automobile insurer.

The insurer disputed the necessity and cost of the treatments, and argued that the applicant's extended health insurer was the primary payer.

The arbitrator held that the legal burden of proof lies with the insured to demonstrate what collateral benefits were reasonably available and what balance remains owing by the automobile insurer.

The arbitrator found the treatments were reasonable and necessary, adjusted the allowable costs, and ordered the insurer to pay the outstanding balance of $993.

A special award of $250 was also granted against the insurer for unreasonably delaying payment.

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

The insurer paid a reduced amount for treatment plans and the applicant sought to arbitrate the remaining balance.

The insurer raised a preliminary issue, arguing the arbitration application was filed beyond the two-year limitation period under s. 281(5) of the Insurance Act.

The arbitrator found that the insurer's Explanations of Benefits did not constitute a clear and unequivocal refusal to pay, nor did they provide reasons for the reduction in benefits.

Therefore, the limitation period was not triggered, and the applicant was not precluded from proceeding to arbitration.

The applicant sought statutory accident benefits for psychological treatment, physiotherapy, housekeeping, and the cost of assessments following a motor vehicle accident.

The arbitrator dismissed all claims, finding that the applicant suffered from significant credibility issues, having failed to disclose a prior accident and pre-existing conditions to medical assessors.

The arbitrator relied on the findings of the insurer's examiners and the Med/Rehab DAC assessors, who concluded that further treatment was not reasonable or necessary.

The claims for housekeeping and assessment costs were also dismissed for lack of evidence and medical referral.

Due to the applicant's lack of success and her representative's problematic conduct during the hearing, the parties were ordered to bear their own arbitration expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for nerve block injections, botox injections, massage treatments, and a special award for delayed payment of psychological and vocational assessments.

The arbitrator found that the nerve block injections were a reasonable and necessary treatment for short-term pain relief, ordering the insurer to pay the $800 cost.

However, the claim for botox and massage was dismissed, as the arbitrator accepted expert evidence that botox is an experimental treatment for chronic pain.

The arbitrator also awarded a special award of $1,170 against the insurer for unreasonably denying psychological treatment without requesting a Designated Assessment Centre (DAC) assessment, despite the insurer settling the claim shortly before the hearing.

Following a decision on statutory accident benefits where the applicant achieved minimal success, the parties sought their respective expenses of the arbitration proceeding.

The arbitrator rejected the insurer's proposal to apportion costs 75/25 in its favour, noting that the applicant was justified in proceeding to arbitration given the insurer's low settlement offer.

However, due to the applicant's minimal success, he was awarded only 20% of his arbitration expenses.

The insurer's claim for expenses was dismissed.

The applicant's counsel's hourly rate was set at $73.38 based on the legal aid tariff.

The insurer brought a motion to vary an arbitration order that had directed it to pay for three medical reports as section 24 expenses under the Statutory Accident Benefits Schedule.

The applicant did not appear.

The arbitrator found that the applicant had not formally applied for these expenses under section 24 and that the reports were commissioned primarily to establish his claims in the arbitration process.

The arbitrator varied the order, recharacterizing the medical reports as expenses of the arbitration process rather than section 24 benefits.

The appellant, who suffered a severe brain injury in a motor vehicle accident, appealed an arbitration decision dismissing his claim for payment of 'non-legal' rehabilitative services provided by a law clerk at his legal counsel's firm.

The arbitrator had found that the claim was not proven because the law clerk's dockets did not reliably distinguish between legal and non-legal services, and that the services were redundant given the extensive support provided by the appellant's professional case manager.

The Director's Delegate dismissed the appeal, finding no error in the arbitrator's assessment of the evidence and concluding that the arbitrator reasonably found the expense to be unproven and unnecessary.

The insurer applied to vary or revoke a previous arbitration decision ordering it to pay for the insured's physiotherapy treatment and interest.

The insurer argued the insured was barred from receiving benefits under s. 43(3) of the Statutory Accident Benefits Schedule because he failed to attend a Designated Assessment Centre (DAC) examination.

The arbitrator found that while the insured did fail to make himself reasonably available, this failure occurred after the physiotherapy treatment had already concluded.

Therefore, the exclusion did not apply retroactively to the completed treatment.

The arbitrator also held that the insured was entitled to interest on the overdue benefits, as the Schedule does not provide for the forfeiture of interest due to non-compliance.

The insurer's application was dismissed and interest was ordered.

The applicant sought expenses following an arbitration decision where he was unsuccessful in claiming rehabilitation benefits for the non-legal services of a law clerk.

The insurer opposed the request and sought reimbursement of its assessment fee under subsection 282(11.2) of the Insurance Act.

The arbitrator found that the applicant's claim, while unsuccessful, raised a novel issue and was not manifestly unfounded, frivolous, or vexatious.

The arbitrator awarded the applicant his reasonable expenses and dismissed the insurer's claim for reimbursement of its assessment fee.

The applicant was injured in a motor vehicle accident and received weekly disability benefits until May 1997.

He applied for ongoing disability benefits and reimbursement for three medical reports.

The arbitrator found that the applicant failed to establish a substantial inability to perform the essential tasks of his pre-accident job as a video salesman, as his medical experts did not address his actual job duties.

The claim for ongoing weekly benefits was dismissed.

However, the arbitrator ordered the insurer to reimburse the applicant for the costs of the three medical reports, finding they were reasonably incurred under section 24 of the Statutory Accident Benefits Schedule to establish entitlement to benefits.

This appeal concerned a priority dispute between two automobile insurers over statutory accident benefits payable to a truck driver injured while driving his employer's vehicle.

The court held that the driver was deemed a named insured under the employer's policy by virtue of s. 91(4) of the Statutory Accident Benefits Schedule, with the result that the employer's insurer had priority under s. 268 of the Insurance Act.

The court rejected the argument that the regulation impermissibly altered the statutory meaning of “named insured”, holding that entitlement and priority must be read together.

It further held that s. 91(4) was authorized by the Act's broad regulation-making power.

The applicant was injured in a motor vehicle accident and suffered soft tissue injuries and chronic headaches.

The insurer terminated her weekly income replacement benefits and denied various medical and rehabilitation expenses.

The applicant applied for arbitration.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of her employment due to accident-related headaches and awarded income replacement benefits up to the 104-week mark.

The arbitrator also awarded partial medical and rehabilitation benefits for chiropractic treatment, medication, a psychological assessment, and a brief exercise program, finding them reasonable and necessary.

Claims for transportation, other assessments, and housekeeping were dismissed due to lack of evidence or lack of medical necessity.

A claim for a special award was denied as the insurer's actions were not unreasonable.

The insured person was injured in a motor vehicle accident and commenced both a court action and an arbitration proceeding for statutory accident benefits.

The insurer appealed an arbitration order that allowed the arbitration to proceed despite the concurrent court action.

The Director's Delegate allowed the appeal, finding that the arbitrator erred by focusing only on whether the specific benefits claimed were different, rather than considering the substantial factual overlap between the two proceedings.

Applying the criteria for avoiding multiple proceedings, the Director's Delegate stayed the arbitration pending the outcome of the court action, noting that the court action was broader in scope and involved overlapping medical evidence and causation issues.