Tricia Jane McAvoy

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for caregiver, housekeeping, and medical expenses.

The insurer terminated caregiver and housekeeping benefits based on medical assessments indicating the applicant no longer suffered a substantial inability to perform those tasks.

The insurer also denied further medical benefits and sought repayment of caregiver benefits paid pending a designated assessment centre evaluation.

The arbitrator dismissed the applicant's claims, finding she failed to prove entitlement to the disputed benefits.

The arbitrator ordered the applicant to repay $600 in caregiver benefits to the insurer, as the insurer was justified in terminating the benefits when it did.

The insurer appealed an arbitrator's decision awarding the insured income replacement benefits and was entirely successful.

The insurer subsequently sought its expenses for both the arbitration and the appeal.

The Director's Delegate declined to disturb the arbitrator's order that each party bear their own arbitration expenses, as the insurer had not appealed that specific order.

However, the insurer was awarded $1,000 for its appeal expenses.

The Director's Delegate held that the cost of hearing transcripts is not recoverable as an out-of-pocket expense under the Expenses Regulation.

The applicant was injured in a motorcycle accident and suffered a severe wrist fracture and hip injury.

The insurer terminated his income replacement benefits after 104 weeks, relying on a designated assessment centre report and a transferable skills analysis suggesting he could work in alternative occupations.

The arbitrator found the insurer's vocational assessments flawed as they failed to adequately consider the applicant's physical limitations, the need for extensive retraining, and the significantly lower remuneration of the suggested jobs.

Relying on a vocational assessment obtained by the applicant, the arbitrator concluded that the applicant suffered a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience.

The applicant was awarded ongoing income replacement benefits and interest.

The insurer appealed an arbitrator's decision awarding the claimant income replacement benefits (IRBs) for a psychological impairment.

The arbitrator had found the claimant entirely lacking in credibility and rejected his claims for physical disability, but awarded IRBs based on a psychologist's report.

The Director's Delegate allowed the appeal, finding that the arbitrator committed an error of law.

Because the psychologist's report explicitly relied on the claimant's presumed truthfulness, it could not support an award of benefits given the arbitrator's explicit finding that the claimant was not credible.

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

The insurer denied the claim on the basis that the applicant was not employed or self-employed.

The applicant argued that the foster parent payments she received from the Children's Aid Society constituted self-employment income.

The arbitrator found that the applicant was self-employed as a foster parent at the time of the accident, as the stipends she received amounted to 'other remuneration or profit' under section 2(5) of the Statutory Accident Benefits Schedule.

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

After their counsel was removed from the record, the applicants failed to attend the scheduled arbitration hearing or provide a forwarding address.

The arbitrator proceeded in their absence pursuant to Rule 37.7 of the Dispute Resolution Practice Code.

As the applicants presented no evidence to support their claims, their applications for medical benefits and housekeeping expenses were dismissed.

The applicants were ordered to pay the insurer's expenses fixed at $750 each.

The applicant sought expenses following an arbitration decision where he recovered over $20,000 in income replacement benefits but withdrew fabricated claims for attendant care and housekeeping expenses.

The arbitrator applied the criteria under section 12 of Ontario Regulation 664.

Although the applicant was more successful overall, his claims for attendant care and housekeeping were found to be frivolous and fabricated.

Consequently, the arbitrator ordered that each party bear their own expenses of the arbitration proceeding.

Following the dismissal of the applicant's claim for non-earner benefits, the parties were unable to resolve the issue of expenses.

The arbitrator found that the insurer was entitled to its reasonable expenses as the successful party.

However, because the applicant's claim involved a novel factual issue regarding her ability to practice her religious faith, the arbitrator applied a 40% discount to the insurer's expenses.

The applicant was ordered to pay the insurer's expenses assessed at $4,085.16.

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

The applicant sought further income replacement benefits, arguing he was unable to return to his pre-accident employment as a concrete cutter due to physical and psychological impairments.

The arbitrator found the applicant's physical impairment evidence unreliable, but accepted the psychological evidence that he suffered from major depressive disorder and anxiety which prevented him from working.

The arbitrator preferred the applicant's psychological expert over the insurer's expert.

The applicant was awarded income replacement benefits for the disputed period.

Claims for attendant care and housekeeping were withdrawn, and a claim for the cost of a functional abilities evaluation was denied for failing to seek prior approval.

The applicant was injured in a motor vehicle accident and applied for non-earner benefits.

The insurer denied the claim.

At arbitration, the adjudicator found that the applicant did not suffer a complete inability to carry on a normal life as a result of the accident.

While her life changed post-accident, she continued to engage in substantially all of her pre-accident activities, particularly her religious activities, and her reduced functioning was largely attributable to marital breakdown rather than the accident.

The application for non-earner benefits and interest was dismissed.

The applicant was driving his car when concrete debris fell from a building and struck his vehicle, causing him to hit his head on the roof.

The insurer denied statutory accident benefits, arguing the incident was not an 'accident' under the Schedule because the falling debris was an intervening act.

The arbitrator held that the incident met the definition of an accident, finding that falling debris is a normal incident of the risk created by the use or operation of an automobile, similar to road hazards, and not an intervening act like an assault.

The preliminary issue was resolved in favour of the applicant.

The insurer brought a motion to stay the arbitration pending the applicant's attendance at a psychiatric insurer's medical examination (IME).

The applicant had previously attended a psychological IME arranged by the insurer, which concluded she suffered a complete inability to work due to depression but could not isolate the accident as the primary cause.

The insurer sought a further psychiatric IME to address causation.

The arbitrator dismissed the motion, finding the insurer had already been afforded a fair opportunity to evaluate the applicant's condition and failed to establish that the additional psychiatric assessment was reasonably necessary.

The applicant was awarded her legal expenses for the motion.

The appellants, Ontario residents, were injured during an excursion tour while vacationing in Costa Rica.

They brought an action in Ontario against several defendants, including the Costa Rican company that sold the excursion.

The Costa Rican company successfully moved to stay the action on the basis that Ontario courts lacked jurisdiction and, alternatively, that Costa Rica was the more convenient forum.

The Court of Appeal applied the real and substantial connection test and the principles of order and fairness, concluding that the Ontario courts could not assume jurisdiction over the foreign defendant.

The appeal was dismissed.

The appellants, Ontario residents, brought an action in Ontario against a Tennessee corporation for injuries sustained in a slip and fall at the respondent's restaurant in New York.

The respondent moved to stay the proceedings on jurisdictional grounds.

The Court of Appeal applied the factors from the companion case of Muscutt v. Courcelles and held that Ontario courts could not assume jurisdiction over the out-of-province respondent, as the real and substantial connection test was not met and assuming jurisdiction would violate principles of order and fairness.

The appeal was dismissed.

The applicant was injured in a motor vehicle accident one week after starting a new job as a superintendent.

She applied for income replacement benefits.

The insurer calculated her benefits based only on the $308 she earned in the four weeks preceding the accident, resulting in a weekly benefit of $59.69.

The applicant argued her benefits should be extrapolated to reflect her annual salary of $16,000.

The arbitrator held that under the Statutory Accident Benefits Schedule, the income must be based on the amount actually earned in the four weeks prior to the accident, confirming the $59.69 weekly benefit.

The issues of repayment of caregiver benefits and expenses were adjourned for an evidentiary hearing.

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

The insurer terminated benefits and requested the applicant attend a psycho-vocational assessment.

The applicant refused, arguing it was not an examination by a qualified medical practitioner and was not reasonably required.

The arbitrator found that the proposed assessment was predominantly vocational rather than medical, and therefore did not meet the requirements of section 23(2) of the Schedule.

Furthermore, given the extensive medical evidence already available and the lack of change in the applicant's condition, the request was not reasonable.

The applicant was not precluded from proceeding to arbitration.