FSCO Arbitrations

Charney Lawyers has appeared at the Financial Services Commission of Ontario since its inception in 1990. FSCO is an administrative tribunal that decides claims for Accident Benefits pursuant to an automobile policy which is issued to all drivers in Ontario. Our Group has conducted over 30 Arbitrations at FSCO and many of our cases are leading decisions.

 

 

C.S.K. v. Economical Mutual Insurance Co., [2010] O.F.S.C.D. No. 4
Successfully represented the applicant in recovering caregiver, housekeeping, medical benefits and Section 24 assessments. This case is also notable because the arbitrator granted the applicant housekeeping benefits even though she refused to participate in an in-home occupational therapy assessment. The arbitrator found that the applicant’s right to privacy constitutes a reasonable basis to refuse to participate in an insurer’s in-home occupational assessment. Long discussion on the criteria for recovering caregiver and housekeeping benefits.

C.S.K. v. Economical Mutual Insurance Co., [2010] O.F.S.C.D. No. 102

Suppa v. Motor Vehicle Accidents Claim Fund, [2009] O.F.S.C.D. No.103

 

Suhanic-Knox v. Economical Mutual Insurance Co., [2009] O.F.S.C.D.
Successfully represented the applicant on a motion to compel the insurer to produce all surveillance regardless of whether the insurer intended to rely on it. This decision constitutes a new approach to surveillance production.

Suhanic-Knox v. Economical Mutual Insurance Co., [2008] O.F.S.C.D. No. 188
Successfully represented the applicant on a decision which establishes that the applicant has a fundamental right to control the process, including the right to have the arbitration heard within a reasonable period of time, notwithstanding counsel’s scheduling conflicts. The hearing then took place within six weeks of the pre-hearing.

 

Khaledi v. Allstate Insurance Co. of Canada, [2001] O.F.S.C.I.D. No. 140
Represented the applicant on an appeal where the Director’s Delegate found that insurers do not have to pay interest on medical benefits awarded at arbitration when the DAC assessment previously rejected the expense. Long discussion of the legislative history and purpose of the DAC provisions.

 

Khaledi v. Allstate Insurance Co. of Canada, [2003] O.F.S.C.I.D. No. 106

Khaledi v. Allstate Insurance Co. of Canada, [2000] O.F.S.C.I.D. No. 220

V.J. v. Security National Insurance Co., [2003] O.F.S.C.I.D. No. 70
Successfully represented the insurer in resisting a claim for income replacement benefits and medical benefits.

 

Sidhu v. Security National Insurance Co., [2003] O.F.S.C.I.D. No. 93
Successfully represented the insurer on a motion to compel the applicant to attend a psycho-vocational assessment. Leading decision on principles which will be applied by the Commission to determine whether an insurer is entitled to a Section 42 assessment for the purposes of preparing for an arbitration. “The issue before me is squarely, fairness between the parties and an arbitrator’s duty to control the hearing process”.

 

Panou v. Zurich North America Canada, [2002] O.F.S.C.I.D. No. 140
Successfully represented the applicant on a priority of insurer dispute, where the one insurer named in the arbitration was seeking to dismiss the arbitration on grounds that it was not primary. Leading case on procedure for resolving priority of insurer disputes through the Commission, in contrast to proceeding under Regulation 283/95 Disputes Between Insurers.

 

LeDonne v. Coseco Insurance Co., [2002] O.F.S.C.I.D. No. 59
Successfully represented the insurer in securing the deductibility of long-term disability benefits. Leading decision on collateral benefit deductions.

Graham v. Coseco Insurance Co./HB Group/Direct Protect, [2002] O.F.S.C.I.D. No. 40
Successfully represented the insurer in dismissing a claim brought by an assessment company on grounds that the claim was an abuse of process and constituted venue splitting.

 

Nadem v. Coseco Insurance Co., [2001] O.F.S.C.I.D. No. 68
Successfully represented the insurer in resisting an application for interim expenses. Leading decision on criteria for awarding interim expenses.

 

Randhawa v. Liberty Mutual Insurance Co., [2001] O.F.S.C.I.D. No. 52
Represented the applicant on a claim for income replacement benefits which was partially allowed. The arbitrator found that the insurer’s unsubstantiated allegations of fraud justified an expense award, as such conduct cannot be condoned “especially in a first party relationship where claimants are injured and vulnerable to threats of repayment and allegations of fraud”.

 

Randhawa v. Liberty Mutual Insurance Co., [2000] O.F.S.C.I.D. No. 172

 

M.D. v. Halifax Insurance Co., [2001] O.F.S.C.I.D. No. 71
Successfully represented the insurer in dismissing a claim brought by an assessment company for Section 24 assessments. The insurer was awarded its expenses and filing fee because the proceedings were found to have been an abuse of process. There is also a discussion about principles of contempt of court, in circumstances where a party fails to comply with an Order of the tribunal.

 

M.D. v. Halifax Insurance Co., [2000] O.F.S.C.I.D. No. 138

M.D. v. Halifax Insurance Co., [2001] O.F.S.C.I.D. No. 2

Amoa-Williams v. Allstate Insurance Co. of Canada, [2003] O.F.S.C.I.D. No. 108
Successfully represented the applicants on a test case to determine eligibility for medical and rehabilitation benefits. Amoa-Williams remains the leading case at the Commission, with respect to claims for medical and rehabilitation benefits.

 

Amoa-Williams v. Allstate Insurance Co. of Canada, [2000] O.F.S.C.I.D. No. 93

Amoa-Williams v. Allstate Insurance Co. of Canada, [1999] O.F.S.C.I.D. No. 128

Amoa-Williams v. Allstate Insurance Co. of Canada, [2001] O.F.S.C.I.D. No. 20

Amoa-Williams v. Allstate Insurance Co. of Canada, [2001] O.F.S.C.I.D. No. 153

Pelzner v. Coseco Insurance Co., [2000] O.F.S.C.I.D. No. 81
Represented the insurer on a test case to determine whether unlicensed paralegals can be representatives at the Commission. The hearing arbitrator concluded that access to justice warranted allowing paralegals to represent applicants at the Commission. This decision, together with the decision in Farella vs. Security National (see below), led to legislative changes prohibiting unlicensed paralegals from appearing at the Commission.

 

Corniola v. Zurich Insurance Co., [1999] O.F.S.C.I.D. No. 237
Successfully represented the applicant in dismissing the insurer’s application to broaden the scope of a settlement so as to include the accounts of rehabilitation facilities. Includes a discussion on procedure, when determining the scope of the settlement agreement.

Rano v. Commercial Union Assurance Co., [1999] O.F.S.C.I.D. No. 134
Successfully represented the applicant on a motion to withdraw from arbitration, on grounds that an arbitrator does not have jurisdiction to grant relief from forfeiture.

 

Farella v. Security National Insurance Co., [1999] O.F.S.C.I.D. No. 109
Represented the insurer on a test case to determine the jurisdiction of an arbitrator to award expenses against a non-party to the arbitration. The arbitrator found that there had been an abuse of process, but concluded the Commission did not have jurisdiction to make an award against non-parties. This decision led to legislative changes to regulate paralegals.

 

Francis v. Halifax Insurance Co., [1998] O.I.C.D. No. 20
Successfully represented the insurer on a post 156 week income replacement benefit claim and secured a repayment in the amount of $23,684.40, plus interest on grounds that the applicant provided false or misleading documentation concerning income earned. This case established general principles which are now frequently applied by the Commission, including how to prove quantum for an income replacement benefit, how to assess income from self-employment, how to categorize essential tasks to determine whether there is a substantial inability to perform them, the proper method to value exchange of services when calculating an income replacement benefit, valuing income from numerous business pursuits and how to recognize income from employment in contrast to a return on capital.

 

Francis v. Halifax Insurance Co., [1994] O.I.C.D. No. 124
Successfully represented the insurer on a motion to add issues to the arbitration. This case finally resolved the question of whether an insurer is entitled to add additional issues to an existing arbitration, in this case, a claim for an overpayment and an adjudication of the quantum of the application’s income replacement benefit. The hearing arbitrator found that the added issues “consequentially flow from a determination of the matter submitted to arbitration by Mr. Francis”.

 

Fortin v. Coseco Insurance Co., [1997] O.I.C.D. No. 35
Successfully represented the insurer in dismissing a claim for income replacement benefits and housekeeping benefits.

Sethi v. Allstate Insurance Co., [1996] O.I.C.D. No. 132
Successfully represented the insurer in dismissing a claim for income replacement benefits.

 

Veldhuizen v. Coseco Insurance Co., [1995] O.I.C.D. No. 158
Successfully represented the insurer in dismissing a claim for income replacement benefits on grounds of that the limitation period had expired. Discussion of the general principles applied by the Commission in determining whether the insurer’s denial was clear and unequivocal and whether a limitation period can be revived by additional steps taken by the applicant and/or the insurer.

 

Stoangi v. Royal Insurance Co. of Canada, [1995] O.I.C.D. No. 152
Successfully represented the applicant on a claim for Section 13 weekly benefits and a special award. At the time, this was the largest special award ever imposed upon an insurer. Leading case on principles for special awards.

 

 

“Mr. Charney conducted the Applicant’s case in an exemplary and efficient manner, which was to the benefit of all concerned, his clients, the insurer and myself alike.”

Amoa-Williams v. Allstate Insurance Co. of Canada [2000]

 

“The Applicant was successful in the two pre-hearing issues and assisted the efficient conduct of the arbitration by preparing certain charts summarizing the dates of treatment and other information.”

C.S.K. v. Economical Mutual Insurance Co. [2010]

(Charney Lawyers was counsel to the Applicant, C.S.K.)

 

 

“The Affidavit prepared by Mr. Parsekhian was very well written.”

Faiz v. Wawanesa Mutual Insurance Co. [2007]

(Charney Lawyers was counsel to the Applicant, Faiz)