William M. Sproull

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

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to a concussion and a pre-existing back condition.

The Tribunal found insufficient medical evidence to support a concussion diagnosis, noting that the physiotherapists who diagnosed it were not qualified to do so.

The Tribunal also found that the applicant failed to prove his pre-existing back condition precluded his recovery within the MIG limits.

As the applicant's injuries were predominantly minor, he was not entitled to the disputed treatment plans or interest.

The applicant insurer sought repayment of statutory accident benefits paid to the respondent, alleging the motor vehicle collision was a staged accident.

The respondent did not participate in the hearing.

Relying on event data recorder evidence from a forensic engineer, the Tribunal found that the respondent was likely not a passenger in the vehicle and that the collision did not occur as reported.

The Tribunal concluded the respondent was not involved in an 'accident' under s. 3(1) of the Schedule and had wilfully misrepresented material facts.

The insurer was entitled to terminate benefits and the respondent was ordered to repay $3,011.06 plus interest.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming losses from her self-employment business.

The Tribunal found that the applicant failed to prove her business losses were caused by the accident, preferring the respondent's accounting report.

The Tribunal awarded $152,478.03 in past IRBs.

Additionally, while the respondent failed to provide the required notice to claim an overpayment under section 52 of the Schedule, the Tribunal held that the applicant was not entitled to interest on the overpaid amounts, as doing so would create an absurd result.

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

The respondent insurer denied the claims and sought a preliminary determination on whether an 'accident' occurred and whether the applicant wilfully misrepresented material facts.

The applicant failed to attend the hearing.

Relying on engineering reports and crash data retrieval showing the other vehicle was parked and the applicant's airbags did not deploy, the adjudicator found the collision was a staged accident.

The adjudicator concluded the applicant was not involved in an 'accident' under s. 3(1) of the Schedule, wilfully misrepresented material facts, and ordered the applicant to repay $558.55 in benefits.

The applicant sought his expenses for a variation proceeding regarding statutory accident benefits.

The respondent insurer argued for reductions in both legal fees and disbursements, and a further reduction based on divided success.

The Director's Delegate reduced the claimed preparation time to reflect a 3.5:1 ratio to hearing time and reduced several disbursements, but declined to make a further reduction for divided success, noting a hearing was required regardless.

The insurer was ordered to pay $37,582.77 in expenses.

The applicant sought to vary a previous arbitration order to increase his attendant care benefits to cover 24/7 care, alleging a material change in circumstances due to worsening mental and physical health following a 2003 motor vehicle accident.

The Director's Delegate found that while the applicant's mental and behavioural disorders had worsened, constituting a material change, he was far less disabled than he presented.

Relying on surveillance evidence and the respondent's occupational therapist, the Delegate concluded that 24/7 care was not reasonable or necessary, as the applicant did not pose a danger to himself or others and demonstrated independent functionality.

The Delegate increased the attendant care benefits to $1,445.75 per month to account for increased emotional support and cuing needs, but dismissed the claim for a special award.

The applicant sought to vary a previous arbitration order to increase his attendant care benefits to provide for 24/7 care, alleging a material change in circumstances due to worsening mental and behavioral disorders following a 2003 motor vehicle accident.

The Director's Delegate found a material change in circumstances based on a new anxiety disorder diagnosis and worsening psychological symptoms, but rejected the need for 24/7 care, relying on surveillance evidence and an occupational therapist's assessment showing the applicant was less disabled than claimed.

Attendant care benefits were increased to $1,445.75 per month to account for additional emotional support and cuing.

The claim for a special award was dismissed.

Zurich brought a preliminary motion to stay the insured's variation/revocation proceeding, arguing the insured failed to submit to an insurer's in-home occupational therapy examination and failed to produce medical documents.

The Director's Delegate dismissed the motion.

The parties reached an agreement on document production during the hearing.

Regarding the examination, the Delegate found that the insured had sufficiently submitted to the assessment by participating for over three hours, and that the assessor had gathered enough information through formal and informal observations to provide an opinion once the outstanding documents were produced.

Procedural fairness did not require a further examination.

Following an appeal decision that partially allowed the insured's appeal regarding attendant care benefits but dismissed the claim for Botox injections, the parties were unable to agree on the expenses of the appeal.

The Director's Delegate found that the insured had the greater degree of success, as the monthly attendant care benefits were significantly increased.

The insurer was ordered to pay the insured $3,500.00 in appeal legal expenses, inclusive of disbursements and HST.

The Appellant appealed an arbitration decision denying his claim for Botox injections and limiting his attendant care benefits following a 2003 motor vehicle accident.

The Director's Delegate dismissed the appeal regarding the Botox injections, finding no error of law in the Arbitrator's weighing of the medical evidence.

However, the Delegate found two errors of law in the Arbitrator's assessment of attendant care benefits: mischaracterizing hygiene cuing as housekeeping, and incorrectly interpreting section 16 of the Schedule to deny meal preparation assistance simply because the Appellant's wife performed that task prior to the accident.

The Delegate varied the order, increasing the Appellant's monthly attendant care benefits by $500.

Following a decision awarding the applicant attendant care benefits, the parties sought a determination on the accrual date for interest and the quantum of arbitration expenses.

The Arbitrator held that interest on the attendant care benefits accrued from 10 business days after the applicant delivered an Assessment of Attendant Care Needs, rejecting the argument that the insurer's prior knowledge of the need triggered an earlier accrual date.

The Arbitrator awarded the applicant $73,515.94 in arbitration expenses, applying deductions for issues on which the applicant was unsuccessful and for certain unrecoverable disbursements.

The parties were ordered to bear their own expenses for the costs hearing.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, claiming he sustained a catastrophic impairment due to a mental disorder.

The insurer argued the mental disorder was genetically based and not caused by the accident.

The Arbitrator found that the accident caused the applicant's mental disorders, which resulted in a marked impairment of his ability to function, meeting the definition of catastrophic impairment.

The applicant was awarded attendant care benefits at a reduced rate, as he did not require round-the-clock care.

Claims for Botox injections and a special award were dismissed.

Following an unsuccessful personal injury jury trial arising from an automobile collision, the court determined the defendant's entitlement to costs.

The plaintiff recovered nothing and the threshold declaration under the Insurance Act barred non-pecuniary and health care claims.

The court held that none of the parties' settlement offers engaged Rule 49.10, and the plaintiff's conduct, while hard-fought, was not reprehensible so as to justify elevated costs.

Applying the costs factors, indemnity principles, and proportionality, the court awarded the defendant partial indemnity costs of $75,000 plus disbursements of $35,638.18.

Following an eleven-day jury trial where the jury awarded no damages, the defendant brought a motion for a declaration that the plaintiff's claim for non-pecuniary loss and health care expenses was barred by the threshold under the Insurance Act.

The plaintiff claimed to suffer from soft tissue injuries, headaches, and neck pain following a minor rear-end collision.

The court found that the plaintiff's impairments did not substantially interfere with her volunteer activities or usual activities of daily living, and preferred the medical evidence indicating no permanent impairment caused by the collision.

The motion was granted, barring the plaintiff's claims.

The insurer brought a motion to compel the applicant to attend a new psychiatric assessment for catastrophic impairment after the original assessor, Dr. Shapiro, passed away.

The arbitrator dismissed the motion, finding that the insurer failed to provide evidentiary support that a new examination was reasonably necessary under section 44(1) of the Schedule.

The arbitrator noted that Dr. Shapiro's report was already completed and admissible, and the applicant was prepared to waive his right to cross-examine the deceased author.

The appellant insurer sought to appeal an arbitrator's preliminary order denying an adjournment of the arbitration hearing following the death of its expert witness.

The appellant subsequently requested to stay or adjourn the appeal, or alternatively to withdraw it.

The Director's Delegate refused the stay, finding it would run counter to the goal of cost-effective and efficient dispute resolution.

The Delegate permitted the appellant to withdraw the appeal without prejudice, on the condition that it pay the respondent's legal expenses of $881.40.

If not withdrawn within seven days, the appeal would be rejected on the same terms.

The applicant insurer sought to vary an ongoing weekly income replacement benefits order due to the respondent's receipt of collateral benefits.

After a decision on the deductibility of those benefits, both parties sought their legal expenses for the variation application.

The Director's Delegate ordered that each party bear their own legal expenses, finding that while the insurer was successful on the deductibility issue, it had unnecessarily divided its case between the Commission and the courts, and the novel issues raised militated in favour of the insured person.

The insurer applied to vary a previous arbitration order regarding the payment of weekly income replacement benefits, arguing that the insured's receipt of reinstated long-term disability benefits and Canada Pension Plan disability benefits constituted a material change in circumstances.

The Director's Delegate found that both the long-term disability benefits and the CPP benefits were deductible from the income replacement benefits as they constituted payments under an income continuation benefit plan.

However, because the insurer had also commenced a civil action seeking repayment of past benefits, the Delegate stayed the variation proceeding pending the court's determination of the correct quantum and repayment issues to avoid a multiplicity of proceedings and inconsistent results.

The Applicant sought legal expenses following an arbitration hearing regarding statutory accident benefits where he was partially successful.

The Insurer argued each party should bear their own costs due to divided success and an Offer to Settle served shortly before the hearing.

The Arbitrator found the Applicant was entitled to his reasonable legal expenses up to the day before the hearing, 80% of his expenses for the hearing itself, and his post-hearing expenses, as he achieved a significant degree of success and beat the Insurer's Offer to Settle.

The Applicant was awarded $32,044.84 in total legal expenses and disbursements.

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

The parties settled the substantive issues prior to the arbitration hearing, agreeing that the applicant was entitled to reasonable legal expenses.

The arbitrator assessed the applicant's legal expenses, reducing the claimed hours based on a global assessment approach, and fixed the total assessable legal expenses at $16,464.61.