Decisions

No one can always win but we always fight
Successful appeal for our client after convincing the Appeal officer the Arbitrator erred…

“The Arbitrator’s order shall be amended to reflect the Respondent’s obligation to pay…some interest will be owing…”

Belair Direct Insurance Company v. Green Ontario Superior Court
Mr. Rooz fights the insurance company even after tens of thousands of dollars were paid…

“Mr. Rooz…insisted on being served with a Defence…Mr. Rooz sent Intact’s lawyers a copy of the …judgment…who are just pawns in a dispute not of their making.”

Kisel v. Intact Insurance Company Ontario Superior Court
We win against an insurer that alleged misrepresentation…

“The plaintiff moves for summary judgment, claiming relief because the defendant purported to void the plaintiff’s automobile insurance….further, the defendant has failed to prove the alleged misrepresentation…the plaintiff’s motion is therefore granted…”

Barsheshet v. Aviva Canada Ontario Superior Court
We defend our successful appeal win in the Divisional Court…

“…I would not interfere with the order…the respondent had…success on a highly technical argument…”

BELAIR DIRECT INSURANCE COMPANY vs. GREEN Divisional Court
We successfully convince the Court to allow our client to attend an insurer medical examination with a companion despite the restrictions in the Rules…

“As set out in Rule 33.05…no other person can be present at the IME, unless the court orders otherwise…there is enough evidence…for me to exercise my discretion and allow her to have a support person present for the IMEs”

Lipovetsky v. Sun Life Assurance Company of Canada Ontario Superior Court
Rooz Law wins another appeal for the injured after Arbitrator gets it wrong…

“In conclusion, the Arbitrator did not have the power to either adjourn or dismiss the arbitration proceeding…the appeal is therefore allowed…”

Michaud and State Farm Appeal order, Office of the Director of Arbitrators at FSCO
We win legal fees and expenses after insurer refuses to pay reasonable amounts…

“He submits that his claim is reasonable on the basis that the hearing was scheduled for 4 days…Mr. Rooz asserted privilege…the overarching consideration in the awarding of expenses is reasonableness…I find …Mr. Rooz’s time would have been reasonable…on the basis of the foregoing, I award…$6,628.75”

Jadavji and Security National Arbitrator Ashby, FSCO
Successful defence of another lawyer against claims by an insurance company. Insurance company ordered to pay costs…

“Submissions were filed…to defend against the claim for expenses against him personally and to bring a motion for summary judgment…Alon Rooz wrote …a 16-page written response and motion. This motion for summary judgment was granted…if I find that the conduct of Federation [insurance company] in seeking expenses…was unreasonable…I can award…all or part of his costs…its conduct was not reasonable. I therefore find that Federation should have to pay…”

Seyed and Federation Insurance Arbitrator Feldman, FSCO
Lisa Bishop’s successful appeal confirmed upon reconsideration at the LAT

"In my opinion, the Tribunal considered and weighed all evidence and at the end of the day preferred the applicant’s evidence and found that the applicant met the burden of proof."

A.R v. Aviva General Insurance, 18-00838/AABS Licence Appeal Tribunal, Reconsideration decision
A.R v. Aviva General Insurance, 18-00838/AABS Licences Appeal Tribunal, Decision
Rooz Law wins Accident Benefits, plus interest…

"“I find on all of the evidence that the Applicant is entitled to receive IRBS in the amount of $400.00 per week from September 28, 2016 to October 23, 2016 and from March 12, 2018 to date and ongoing. I find that the Applicant is entitled to Attendant Care Benefits… find that the applicant is entitled to interest…"

J.A. v. Aviva Insurance, 17-001494/AABS Licence Appeal Tribunal, Decision
Ms. Bishop of Rooz Law gets LAT to hold insurance companies accountable…

"this failure means that Aviva effectively denied his NEB claim without reasons- despite having received evidence in the form of the OCF-3 that he met the test for NEBS… DC was entitled to be paid NEBs…"

D.C. v. Aviva Insurance Canada, 17-002921/AABS Licence Appeal Tribunal, Decision
Chronic pain assessment found reasonable and necessary…

"the Applicant has met his onus that on a balance of probabilities that the Treatment Plan in its entirety is reasonable and necessary…the goal is to “evaluate the extent of the patient’s chronic injuries and psychological complaints and to provide a prognosis and recommendations for recovery” to assist the applicant in a return to activities of normal living…"

K.B v. Aviva Insurance Canada – 18-007308/AABS Licence Appeal Tribunal, Decision and Order
Ms. Bishop from Rooz Law succeeds on Appeal for Benefits and Special Award

"there is extensive evidence of the significant emotional distress that the Applicant has experienced since the accident. Therefore, I find that any psychological services recommended by this treatment plan (and then incurred after Oct 17, 2017) are both reasonable and necessary…. I find the respondent’s reliance on Dr. Hanna’s changing opinion was an unreasonable withholding of this assessment…an award, is therefore, merited"

G.R. v. Aviva General Insurance Company – 18-004375/AABS Licence Appeal Tribunal, Arbitration Decision
Psychological injuries are not minor…

"the psychological injury sustained as a result of the motor vehicle accident is not predominantly minor and, as a result, the applicant’s treatment is not subject to the Guideline…the applicant is entitled to the cost of examination for the psychological and chronic pain assessment, respectively… It is reasonable and necessary that the applicant be given an opportunity to explore whether she suffers from chronic pain."

H.M. v. Unifund Assurance Company, 16-002818/AABS Licence Appeal Tribunal, Arbitration Decision
MS. Bishop successfully argued for reconsideration of Tribunal decision…

"I find that the Tribunal violated the rules of nature justice and procedural fairness by failing to address the issues of Unifund’s alleged procedural breaches and the possible import of s.38 of the Schedule in the circumstances…"

T.C. v Unifund Claims Inc., 17-005698/AABS Licence Appeal Tribunal, Reconsideration Decision
.C. v Unifund Claims Inc., 17-005698/AABS Licence Appeal Tribunal, Decision
Chronic pain cannot be treated under the Minor Injury Guideline…

"I find it reasonable and necessary that the applicant be afforded an opportunity to explore the nature of his chronic pain, and be provided a prognosis and recommendations for recovery…"

S.M. v. Aviva Insurance Canada, 17-002957/AABS Licence Appeal Tribunal, Decision (Amended)
Ms. Bishop wins Accident Benefits, plus interest and a Special Award

"the Applicant sustained injuries which fall outside the MIG and the Applicant is not bound by the MIG funding limit… the applicant is entitled to payment of the psychological assessment plan…the applicant is entitled to an award pursuant to Ontario Regulation 664 in the amount of $1,110.95, because the respondent unreasonably withheld payment for the psychological assessment and treatment plans."

T.J. v. Aviva General Insurance, 18-000061/AABS Licence Appeal Tribunal, Decision
Ms. Bishop successfully argued Non-Earner Benefits were payable with interest and Special Award after insurer unreasonably withheld payment…

"T.A. is entitled to an award in the amount of 25% of the amount T.A. is owed from NEBS and for the treatment plan for the psychological assessment in the amount of $2,197.29…I find that Aviva breached its requirement under s.36(4) of the Schedule…"

T.A. v. Aviva General Insurance Company, 18-006820/AABS Licence Appeal Tribunal, Decision
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