Robert A. Kominar

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The parties reached a settlement resolving all substantive issues, including the reinstatement of income replacement benefits.

However, the applicant sought an arbitral order confirming ongoing entitlement, which the insurer refused to consent to, arguing it would improperly shift the burden of proof in any future termination under the variation/revocation provisions of the Insurance Act.

The arbitrator held that proceeding to a hearing when there was no active dispute was unreasonable and stayed the arbitration, with conditions allowing for its resumption if the insurer later sought to terminate the benefits.

The applicant sought income replacement benefits following a motor vehicle accident, claiming she was unable to work as a bottle packer due to physical pain and depression.

The insurer denied the benefits, relying on independent medical examinations by a physiatrist and a neuropsychologist who found no physical or cognitive limitations preventing her from working, and suggested she was feigning impairment.

The arbitrator preferred the evidence of the insurer's assessors over the applicant's subjective complaints and her family physician's support, concluding that the applicant failed to prove on a balance of probabilities that she suffered a substantial inability to perform her employment duties.

The claim for income replacement benefits was dismissed.

The applicant, who had pre-existing mobility and health issues and used a motorized scooter, was involved in two motor vehicle accidents.

She applied for non-earner benefits from the insurers, claiming a complete inability to carry on a normal life.

The arbitrator found that while the applicant experienced pain and some functional limitation for a few months, she continued to live basically the same life as she had prior to the accidents, including driving her scooter, relying on meals on wheels, and eventually returning to social activities.

The application for non-earner benefits was dismissed, as the applicant failed to meet the stringent statutory test of being continuously unable to engage in substantially all of her pre-accident activities.

The applicant, who suffered from pre-existing secondary progressive multiple sclerosis, was injured in a motor vehicle accident.

Following the accident, his mobility rapidly declined, necessitating a wheelchair-accessible vehicle.

The insurer denied the $41,761.45 claim for vehicle modifications, arguing the decline was the natural progression of his disease.

The arbitrator preferred the evidence of the applicant's treating neurologist, finding that the trauma and subsequent hospital deconditioning materially contributed to the rapid functional decline.

The claim for rehabilitation benefits was granted.

The applicants sought expenses following the resolution of an interim benefits motion regarding a motor vehicle accident claim.

The parties had agreed on interim benefits but could not agree on expenses.

The arbitrator reviewed the applicants' Bill of Costs, allowing 30 hours of counsel time at $150 per hour after deducting duplicative and premature claims.

Disbursements for reports were allowed up to the maximum under the Expense Regulation, and photocopying was permitted, while parking was disallowed.

The applicants were jointly awarded $19,846.22 in expenses, inclusive of HST.

The applicant was injured when she fell off a motorized golf cart being driven on a public highway.

She applied for statutory accident benefits, which were denied by the Motor Vehicle Accident Claims Fund on the basis that a golf cart is not an automobile.

On a preliminary issue hearing, the arbitrator held that a golf cart driven on a highway falls within the definition of a 'motor vehicle' under the Highway Traffic Act and is therefore required to be insured under the Compulsory Automobile Insurance Act.

Consequently, it qualifies as an 'automobile' under section 224(1) of the Insurance Act, entitling the applicant to claim statutory accident benefits.

The Applicant sought various statutory accident benefits following a motor vehicle accident.

Despite initiating the arbitration, the Applicant refused to participate in the hearing process or present any evidence.

The arbitrator dismissed all claims, noting that the Applicant bears the burden of proof and failed to establish the merits of his claims on a balance of probabilities.

No costs were awarded.

The applicant was injured in a motor vehicle accident.

The insurer denied statutory accident benefits on the basis that the applicant was in the course of his employment and covered by the Workplace Safety and Insurance Act (WSIA).

The insurer successfully applied to the Workplace Safety and Insurance Appeals Tribunal (WSIAT) under s. 31 of the WSIA, which determined the applicant had no right of action.

The insurer then moved to dismiss the FSCO arbitration as frivolous and vexatious under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator granted the motion, finding that since the applicant had no right to sue, he could not claim accident benefits, and his failure to participate rendered the proceeding vexatious.

The applicant sought a determination that he was catastrophically impaired as a result of a 2001 motor vehicle accident.

In a previous arbitration, it was determined that the accident caused his impairments for the purpose of various statutory accident benefits.

The applicant argued that the issue of causation was res judicata and could not be relitigated in the current catastrophic impairment arbitration.

The arbitrator held that the specific issue of causation as it relates to assigning a percentage of whole person impairment for catastrophic impairment had not yet been adjudicated.

Therefore, the insurer was permitted to argue causation at the upcoming hearing.

Following a preliminary issue hearing where the arbitrator determined the applicant had entered into a binding full and final settlement of all accident benefit claims, the insurer sought its expenses for the hearing.

The arbitrator considered the criteria under the Expense Regulation, noting the insurer's complete success and the lack of novel issues raised by the applicant's mistake argument.

The arbitrator found the insurer was entitled to its reasonable expenses and ordered the applicant to pay $2,366.33.

Following the dismissal of the applicant's claims for statutory accident benefits, the insurer sought its expenses for the arbitration.

The arbitrator found that the applicant was completely unsuccessful and his evidence was unbelievable, but his conduct did not cross the threshold of an improper or vexatious proceeding.

The insurer was awarded its expenses fixed at $8,532.81.

The arbitrator declined the insurer's request to order the applicant's solicitors to personally pay a portion of the expenses, holding the applicant completely liable.

The applicant was injured in motor vehicle accidents and sought payment for 100 sessions of chiropractic and massage therapy under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans, arguing it was unreasonable to approve such extensive treatment without the ability to monitor progress.

The arbitrator found that the applicant had reached maximum medical recovery and that his ongoing need for treatment was equivalent to his pre-accident usage.

The arbitrator concluded that the requested treatment was not reasonable and necessary, as it bypassed the regulatory scheme allowing insurers to review ongoing care.

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

At the scheduled arbitration hearing, the applicant's paralegal representative renewed a previously denied request for an adjournment, citing the unavailability of medical witnesses and incomplete file disclosure.

The arbitrator denied the adjournment, finding that the representative had failed to properly prepare for the hearing, summons witnesses, or secure medical reports in a timely manner.

As the applicant presented no evidence to meet her burden of proof, all claims for benefits were dismissed, and the insurer was awarded its expenses.

The applicant sought statutory accident benefits for caregiving, housekeeping, and medical expenses following a motor vehicle accident.

The arbitrator dismissed the claims, finding the applicant's evidence regarding his inability to perform housekeeping and caregiving tasks lacked credibility, particularly given his continued full-time employment as a transport truck driver and surveillance evidence showing him performing activities he claimed he could not do.

The arbitrator preferred the insurer's medical expert, concluding the applicant's injuries did not warrant treatment beyond the Pre-Approved Framework.

The applicant was injured in a motor vehicle accident and sought interim interim attendant care benefits after fracturing his ankle while awaiting an adjourned interim benefits motion.

The arbitrator found that the applicant was in immediate need of attendant care to prevent further injury and awarded $2,500 per month for two months, pending the full interim motion hearing.

The applicant was injured in a motor vehicle accident in 2004 and sought statutory accident benefits, including income replacement, housekeeping, and rehabilitation benefits for retraining as a massage therapist.

The insurer denied the claims, arguing the applicant's impairments fell within the Pre-Approved Framework (PAF) Guidelines and that her retraining was not reasonable and necessary.

The arbitrator found that the applicant had significant pre-existing chronic pain from prior accidents and that her decision to retrain was for personal insight rather than vocational rehabilitation.

The arbitrator concluded the applicant did not meet the burden of proving entitlement to further benefits beyond the PAF maximums.

All claims were dismissed.

The Applicant sought leave to withdraw her application for arbitration regarding the termination of her caregiver benefits, preferring to pursue the matter in Superior Court alongside a pending tort action.

The Insurer did not oppose the withdrawal but argued it should be allowed to proceed with its claim for repayment of benefits and a preliminary issue hearing on whether the Applicant was actually involved in the accident.

The Arbitrator granted the Applicant leave to withdraw, subject to resolving expenses.

The Arbitrator dismissed the Insurer's claim for repayment without prejudice, finding that the Commission lacks jurisdiction to hear a free-standing claim by an insurer when the applicant has withdrawn all issues from arbitration.

The applicant, a four-year-old who suffered a severe brain injury in a motor vehicle accident, claimed attendant care benefits for care provided by his parents while he was a patient at a rehabilitation hospital.

The insurer denied the claim, arguing that the hospital had OHIP-funded attendant care available which the parents failed to access, making the parents' care not "reasonable and necessary" under section 16 of the Statutory Accident Benefits Schedule.

The arbitrator found that while auto insurers are generally insurers of last resort and available hospital funding should be accessed first, the parents in this specific case were not informed about the available funding and were encouraged to use their auto insurance.

Therefore, it was reasonable for the parents to provide the care themselves.

The insurer was ordered to pay the agreed quantum of $3,418.33 for the attendant care expenses.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied claims for non-earner, caregiving, housekeeping, and attendant care benefits.

The applicant failed to commence mediation within the two-year limitation period following the denials.

At a preliminary issue hearing, the arbitrator found that the applicant offered no reasonable explanation for the delay and had failed to provide the insurer with requested information to assess his claims.

The arbitrator dismissed the applicant's claims for benefits as statute-barred.

The applicants, a husband and wife, sought statutory accident benefits for caregiving, housekeeping, and medical treatment following a motor vehicle accident.

The insurer denied the claims.

At arbitration, the applicants argued they were unable to perform their pre-accident caregiving and housekeeping duties and required ongoing medical treatment.

The arbitrator found the applicants' evidence to be contradictory and implausible, noting they both continued to work and even studied for new careers while claiming to be completely disabled from household tasks.

The arbitrator also drew an adverse inference from their failure to call their alleged service provider as a witness.

The claims for caregiving, housekeeping, medical benefits, and interest were dismissed.