Category: Costs

J.T. v. TD General Insurance Company (19-003389)

The claimant filed a request for reconsideration to dispute the finding that he was not entitled to interest, an award, or costs related to an approved treatment plan. The request for reconsideration was denied. Adjudicator Grant found that the LAT had not made a significant error of fact or law in the hearing decision. He agreed that there was no evidence of an agreement between the claimant and the insurer that the insurer would reimburse the claimant for documents produced, and section 33 does not require an insurer to compensate an insured for producing information reasonably required to assist the insurer in determining entitlement to a benefit. Adjudicator Grant found that there was no evidence that the insurer did not pay the approved benefit within the time limit prescribed in the SABS, and without such evidence, no interest can be payable.

J.T. v. TD General Insurance Company (19-003389)

The claimant filed a request for reconsideration to dispute the finding that he was not entitled to interest, an award, or costs related to an approved treatment plan. The request for reconsideration was denied. Adjudicator Grant found that the LAT had not made a significant error of fact or law in the hearing decision. He agreed that there was no evidence of an agreement between the claimant and the insurer that the insurer would reimburse the claimant for documents produced, and section 33 does not require an insurer to compensate an insured for producing information reasonably required to assist the insurer in determining entitlement to a benefit. Adjudicator Grant found that there was no evidence that the insurer did not pay the approved benefit within the time limit prescribed in the SABS, and without such evidence, no interest can be payable.

L.D. v. Gore Mutual Insurance Company (17-002762)

The claimant brought two motions: (1) that Vice-Chair Flude recuse himself from making a decision that he already made on May 27, 2020; and (2) that he then reconsider the same decision. Claimant’s counsel had previous requested that Vice-Chair Flude recuse himself, alleging bias stemming from a comment that was interpreted to be insensitive, for which Vice-Chair Flude apologized for. The claimant also alleged bias over a dismissed motion to compel, which Vice-Chair Flude found moot as the witness had answered the questions she was Ordered to on the day of her cross-examination. The insurer raised issues with the timing of the claimant’s recusal motion, noting that the impugned instances occurred in 2018, but it was not until the claimant received the first unfavorable decision and the motions were then brought some seven months later. The claimant further alleged that it was improper for Vice-Chair Flude to request submissions on costs as neither party had requested them. Vice-Chair Flude noted that the insurer’s materials filed on the motion to strike did request costs. Vice-Chair Flude denied both of the claimant’s requests and gave the claimant 14 days to submit pleadings regarding costs as the insurer had already filed its materials.

L.D. v. Gore Mutual Insurance Company (17-002762)

The claimant brought two motions: (1) that Vice-Chair Flude recuse himself from making a decision that he already made on May 27, 2020; and (2) that he then reconsider the same decision. Claimant’s counsel had previous requested that Vice-Chair Flude recuse himself, alleging bias stemming from a comment that was interpreted to be insensitive, for which Vice-Chair Flude apologized for. The claimant also alleged bias over a dismissed motion to compel, which Vice-Chair Flude found moot as the witness had answered the questions she was Ordered to on the day of her cross-examination. The insurer raised issues with the timing of the claimant’s recusal motion, noting that the impugned instances occurred in 2018, but it was not until the claimant received the first unfavorable decision and the motions were then brought some seven months later. The claimant further alleged that it was improper for Vice-Chair Flude to request submissions on costs as neither party had requested them. Vice-Chair Flude noted that the insurer’s materials filed on the motion to strike did request costs. Vice-Chair Flude denied both of the claimant’s requests and gave the claimant 14 days to submit pleadings regarding costs as the insurer had already filed its materials.

C.B. v. Allstate Canada (18-009967)

The claimant sought an order for the particulars of redaction in the adjuster log notes, the complete files from IE assessors, further log notes after the date of the LAT application related to section 33 requests and further IE requests, an updated payment summary, the particulars of whether the cost claimant’s catastrophic impairment assessments were taken from his medical benefits limits, and the particular amounts paid for IEs. The claimant also sought costs of the motion. Adjudicator Chakravarti ordered the insurer to produce the full AB file including correspondence, emails, draft reports, letters of instructions, notes from IE assessors, and any documentary information the insurer possessed relating to IEs. She also ordered production of log notes and emails related to section 33 requests, and related to the requests for further IEs (subject to solicitor-client privilege and litigation privilege). Costs of $500 was awarded to the claimant because the insurer had failed to provide many records that had been ordered produced in earlier Orders, including a nine month delay in producing the IE file. She found the insurer’s actions rose to the threshold level of being unreasonable and frivolous, and even in bad faith.

A.L. v. The Guarantee Company of North America (19-003474)

The claimant initially sought entitlement to NEBs and the cost of two assessments. The insurer argued that the dispute was time barred. Prior to the preliminary hearing regarding the limitations argument the claimant withdrew her claim; the insurer still sought costs. Adjudicator Johal rejected the claim for costs, even though the claimant had made a total of three FSCO and LAT disputes regarding NEBs. The adjudicator wrote that a claimant is entitled to withdraw an issue in dispute or an entire dispute without consent, and that such behaviour will rarely justify costs. In this case, the claimant was not in breach of any direction or order of the Tribunal nor did she interfere with the Tribunal’s ability to carry out a fair, efficient, and effective process.

N.M. v. The Guarantee Company of North America (18-009017)

The claimant filed for reconsideration of the Tribunal’s award of $1,000 in costs to the insurer. Vice Chair Hunter denied the reconsideration. Costs had been awarded after the claimant twice withdrew his dispute on the eve of the scheduled hearing. He rejected the claimant’s arguments that the Tribunal exhibited bias or that it made its decision based on false or misleading evidence.

L.R. v Economical Mutual Insurance Company (19-005496)

The claimant sought entitlement to a special award, taking the position that the insurer unreasonably delayed the payment of a treatment plan for physiotherapy services because the insurer approved the treatment plan after submission of the LAT Application. The claimant did not make any submissions or provide any evidence in support for an award, as the bulk of submissions focused on whether the claimant was entitled to the $100 filing fee. As such, Adjudicator Msosa concluded that there was no unreasonably delayed payments that would justify an award, noting that the insurer was within its rights to request an IE to determine whether the claimant’s injuries were in the MIG as part of the normal adjusting of the file. With respect to the $100 filing fee, Adjudicator Msosa found no basis for awarding costs in this case. The claimant used the process for resolving disputes, which requires the payment of a filing fee.

I.Y. v. Pembridge Insurance Company (18-006724)

The claimant sought removal from the MIG, and entitlement to various medical benefits and cost of examinations. The insurer, in addition to opposing the claims, argued that the claimant failed to comply with section 33 requests, and sought costs. Adjudicator Ferguson concluded that the claimant had failed to comply with the numerous requests under section 33, and also had failed to provide a reasonable explanation for doing so. Adjudicator Ferguson noted that an explanation for non-compliance must be provided promptly after the reason for inability to provide information is known. Adjudicator Ferguson saw no reason why the claimant could not comply with the requests, and he found no evidence that either the claimant or his counsel attempted to work with the insurer over the course of the claim to gather the information. Adjudicator Ferguson also awarded the insurer costs in the amount of $250, noting that the claimant’s submissions and behaviour “so strain credibility and credulity that they do not support any contention that they are reasonable, good faith contentions, and the proceeding has wastefully consumed … time and resources.

E.M. v. Pembridge Insurance Company (18-011207)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to medical benefits proposed in three physiotherapy and one psychological treatment and assessment plans. Adjudicator Norris found that the claimant’s injuries were predominantly minor and fell within the MIG. He relied on the psychological IE report of Dr. Saunders which found the claimant exhibited mild-to-minimum anxiety and stress. Adjudicator Norris preferred the IE report of Dr. Saunders over the psychological assessment report of N. Dent, as the former reviewed an extensive amount of the claimant’s medical records and provided a clearer and more robust view of the claimant’s condition. Adjudicator Norris awarded costs against the claimant because her hearing submissions were filed late, she omitted medical records from her submissions, and most notably, her representative certified that she served the submissions on counsel for the insurer when in fact she did not.