Elizabeth Nastasi

The applicant was injured in a motor vehicle accident while driving a rental car.

He submitted an Application for Accident Benefits to the Motor Vehicle Accident Claims Fund.

The Fund argued it was not an insurer under section 268 of the Insurance Act and section 2 of O. Reg. 283/95 because there was no sufficient nexus between it and the applicant.

The arbitrator found that the applicant's decision to send the application to the Fund was arbitrary, given his limited efforts to determine the insurer of the rental car.

The arbitrator concluded that the Fund was not required to respond to the application as it was not the first insurer to receive a completed application.

The insurer brought a motion for the production of Children's Aid Society (CAS) files relating to the minor applicant and her two sisters.

The applicant sought attendant care benefits following a motor vehicle accident.

The arbitrator found the CAS files were arguably relevant to determining whether the applicant's attendant care needs arose from the accident or pre-existed it, and to understanding the overlapping care requirements of the siblings who lived together.

The motion was granted, subject to an order restricting the use and dissemination of the files to protect the minors' privacy.

The parties settled the applicant's claims for statutory accident benefits prior to the arbitration hearing.

The applicant sought $15,710.81 in legal fees and disbursements.

The insurer agreed the applicant was entitled to expenses but disputed the amount, arguing the hours claimed were excessive and certain expert reports were not reasonably required.

The arbitrator found the preparation time and correspondence hours reasonable, and accepted that the disputed expert reports were reasonably required.

The arbitrator fixed costs and disbursements at $12,000 inclusive of GST.

The applicant sought statutory accident benefits following an alleged motor vehicle accident on a public transit bus.

The insurer brought a motion regarding the applicant's failure to attend insurer medical examinations and examinations under oath.

The arbitrator found that the applicant failed to attend medical examinations without a reasonable explanation, rendering him ineligible for benefits during the period of non-compliance.

Furthermore, the applicant failed to attend scheduled examinations under oath.

The arbitrator held that the insurer was not liable to pay benefits during the periods of non-compliance and ordered a stay of the arbitration proceedings until the applicant attends an examination under oath, finding that allowing the hearing to proceed would result in an abuse of process.

The applicant was injured in a pedestrian motor vehicle accident and sought a determination that she suffered a catastrophic impairment under the Statutory Accident Benefits Schedule.

The arbitrator found that while the applicant's combined physical and psychological impairments resulted in a 39% whole person impairment, falling short of the 55% threshold under clause (f), she did meet the criteria under clause (g).

Specifically, the arbitrator accepted the CAT DAC assessment that the applicant's pain disorder and physical limitations resulted in a Class 4 marked impairment in her activities of daily living.

The arbitrator held that a single marked impairment is sufficient to meet the definition of catastrophic impairment.

The applicant sought statutory accident benefits, including income replacement and non-earner benefits, following a motor vehicle accident.

The arbitrator found the applicant was not entitled to income replacement benefits because he was not employed or self-employed at the time of the accident, as his pawn shop business had not yet opened.

The claim for non-earner benefits was also dismissed because the applicant failed to prove the accident caused or materially contributed to his impairments, given his extensive pre-existing medical conditions and similar pre-accident complaints.

Claims for a special award and interest were consequently dismissed.

Following the dismissal of her application for statutory accident benefits, the applicant sought her expenses for the arbitration proceeding, arguing that her case raised a novel issue.

The arbitrator found that the issue was not novel, as it was substantially similar to numerous other cases involving assaults in a motor vehicle.

Given that the insurer was completely successful and the issue was not novel, the applicant was not entitled to her expenses.

The insurer did not pursue a claim for its expenses.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The insurer terminated benefits and sought repayment, arguing the applicant was not involved in the accident.

At a preliminary issue hearing, the arbitrator found the applicant's evidence lacked credibility due to inconsistencies with medical records and contradictory testimony from his mother and the occupants of the other vehicle, who testified he was not in the car.

The arbitrator concluded the applicant was not involved in an accident under section 2(1) of the Schedule and held that the insurer was entitled to pursue repayment of benefits paid.

The Applicant sought to withdraw her claim for medical benefits shortly before a scheduled preliminary issue hearing.

The Insurer opposed the withdrawal without an order for costs, arguing the late withdrawal caused unnecessary expenses.

The Arbitrator permitted the withdrawal of the claim and awarded the Insurer its reasonable expenses for preparing for the preliminary issue hearing, capped at Legal Aid rates, totaling $334.59.

The applicant's husband, a taxi driver, was assaulted and murdered in his cab.

The applicant sought death and funeral benefits from the insurer.

The insurer denied the claim on the basis that the death was not the result of an 'accident' as defined in the Statutory Accident Benefits Schedule.

The arbitrator found that the assault was an intervening act and the use of the taxi did not amount to a direct cause of death.

The application for arbitration was dismissed.

Following the settlement of a statutory accident benefits dispute, the parties were unable to agree on the quantum of expenses payable by the insurer.

The applicants sought $32,034.60 in fees and disbursements.

The insurer disputed the time claimed by a second lawyer retained for the hearing, the time claimed for correspondence, and the fees charged for expert reports.

The arbitrator found that retaining alternate counsel due to a scheduling conflict was reasonable and did not result in significant duplication of time.

The arbitrator also found the correspondence time and expert report fees to be reasonable, noting that the FSCO Professional Services Guideline rates do not strictly apply to medical-legal reports prepared for arbitration.

The applicants were awarded their full claimed expenses of $32,034.60.

The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits (IRBs) beyond the 104-week mark, claiming she was completely unable to work due to a temporomandibular joint disorder (TMD) and chronic pain.

The insurer argued the TMD was caused by pre-existing bruxism and stress, not the accident, and that she was not disabled from working.

The arbitrator found the applicant's testimony credible, concluded the accident materially contributed to her TMD, and determined she met the test for post-104 week IRBs.

Claims for a specific dental assessment cost and a special award were dismissed, but the applicant was awarded her arbitration expenses and interest on overdue benefits.

The applicant, injured in a motor vehicle accident, sought production of the insurer's surveillance evidence, the entire accident benefits file up to the date of the second mediation, and the insurer's policy and training manuals.

The arbitrator ordered production of surveillance evidence limited to what the insurer intended to rely on at the hearing, pursuant to Rule 40.1 of the Dispute Resolution Practice Code.

The arbitrator also limited production of the accident benefits file to the date of the first Application for Mediation, finding that subsequent documents were protected by litigation privilege.

The request for policy manuals was denied as the applicant failed to establish their relevance or reasonable necessity.

The applicant's law firm brought a motion to withdraw as solicitors of record due to a breakdown in the solicitor-client relationship.

The applicant did not explicitly consent to the withdrawal.

The arbitrator granted the motion pursuant to Rule 9.8 of the Dispute Resolution Practice Code, finding that the relationship had broken down.

The withdrawal was permitted subject to conditions requiring the firm to complete documentary production obligations and provide the applicant with a full copy of her file.

The applicant's law firm, Mazin Rooz Mazin, brought a motion to withdraw as solicitors of record in a statutory accident benefits dispute, citing a breakdown in the solicitor-client relationship and an inability to obtain meaningful instructions.

The applicant did not explicitly consent to the withdrawal.

The arbitrator granted the motion pursuant to Rule 9.8 of the Dispute Resolution Practice Code, finding that the relationship had broken down.

The withdrawal was permitted subject to conditions requiring the firm to complete its documentary production obligations and provide the applicant with a full copy of his file prior to the upcoming arbitration hearing.

The insurer brought a motion to amend its Response to an Application for Arbitration to include a claim for repayment of benefits under section 47 of the Statutory Accident Benefits Schedule, alleging the insured made misrepresentations.

The insured opposed the motion, arguing the insurer had not sufficiently pleaded the necessary elements of a claim for repayment.

The arbitrator granted the motion, finding that the insurer provided sufficient particulars to establish a genuine issue for the hearing and that the insured would not be prejudiced by the amendment.

The applicant was injured while attempting to board a bus and claimed statutory accident benefits for medical and housekeeping expenses.

The insurer paid benefits for a few months but denied further claims.

At arbitration, the arbitrator found the applicant and his witnesses lacked credibility due to significant inconsistencies regarding his employment status and the extent of his impairment.

Relying on the insurer's medical experts, who found symptom magnification and no objective evidence of ongoing impairment or chronic pain syndrome, the arbitrator dismissed the claims for ongoing medical and housekeeping benefits, as well as the claim for a special award.

The applicant sought statutory accident benefits for housekeeping and attendant care following a motor vehicle accident.

The applicant failed to attend the arbitration hearing and adduced no evidence in support of her application.

The arbitrator found that the applicant abandoned the application and failed to meet her onus of proof.

The application was dismissed, and the insurer was awarded $750 in expenses.

The insurer brought a motion seeking the production of a tort defence medical report (a neurological examination) from the applicant's companion tort action.

The applicant opposed the motion, arguing it would unnecessarily lengthen and complicate the arbitration regarding her entitlement to post-104 week income replacement benefits.

The arbitrator applied the Sandhu factors and found that the insurer already possessed sufficient medical assessments, including two insurer examinations and a Disability DAC assessment.

Ordering production of the tort report would encourage a 'battle of numbers' and duplicate evidence.

The motion for production was dismissed.

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

After failing to resolve disputes through mediation, the applicant applied for arbitration.

The insurer brought a motion to dismiss the arbitration without a hearing because the applicant failed to comply with a previous order and did not attend the pre-hearing.

The arbitrator found the proceeding to be frivolous and commenced in bad faith, dismissing the arbitration and awarding reasonable expenses to the insurer.