Robert A. Kominar

The Applicant was injured in two motor vehicle accidents and applied for income replacement benefits.

The Insurer requested information regarding the Applicant's entitlement to short-term collateral disability benefits.

The Applicant failed to provide this information for over a year.

The Arbitrator held that the Applicant's failure to comply with requests made under section 33 of the Statutory Accident Benefits Schedule precluded him from receiving income replacement benefits for the period of non-compliance.

The applicant sought statutory accident benefits, including income replacement benefits and the cost of an in-home assessment, following a motor vehicle accident.

The applicant failed to attend the arbitration hearing and was unrepresented.

The arbitrator dismissed the claims due to the applicant's failure to meet the burden of proof.

The insurer was awarded $500 in expenses.

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

A dispute arose regarding the calculation of his prior earning capacity (PEC).

The applicant argued that income from his family's business should be included, which would raise his PEC.

The arbitrator found that the applicant was not meaningfully employed by the family business at the time of the accident and that the funds he received were dividend income rather than employment income.

The applicant's PEC was quantified at $247.98 per week based solely on a pre-accident offer of employment from another business.

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

The parties previously entered into a settlement agreement for $3,500, and the Applicant executed a Final Release and Settlement Disclosure Notice.

The Applicant subsequently applied for arbitration for medical and rehabilitation benefits that pre-dated the settlement.

The insurer argued the claims were barred by the settlement.

The arbitrator found that the settlement documentation was clear and unambiguous, and any mistake by the Applicant or his paralegal representative was a unilateral mistake that did not void the agreement.

The Applicant was precluded from proceeding to arbitration.

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

The arbitrator previously dismissed the claims, finding the applicant had entered into a binding full and final settlement prior to retaining his current representative.

In this decision on expenses, the arbitrator considered the criteria under the Expense Regulation of the Insurance Act.

Finding that the insurer was completely successful and that no novel issues were raised, the arbitrator concluded the insurer was entitled to its expenses.

However, the arbitrator reduced the assessed fees by 40% to reflect the applicant's good faith in exploring the validity of the settlement, ultimately awarding the insurer $5,597.93 inclusive of GST.

The applicant was injured in a motor vehicle accident in Texas while working as a co-driver of a tractor trailer.

He applied for and received loss of earning benefits from the Workplace Safety and Insurance Board (WSIB).

He subsequently applied for statutory accident benefits from his auto insurer, arguing he was entitled to benefits not covered by WSIB.

The arbitrator held that under section 59 of the Statutory Accident Benefits Schedule, the applicant was precluded from claiming statutory accident benefits because he was entitled to and received WSIB benefits, and he had not made a valid election to opt out of the WSIB scheme primarily to pursue a tort action.

The applicant was injured while using a rented U-Haul truck.

He submitted an Application for Accident Benefits to U-Haul's insurer, Republic Western, which redirected the application to Wawanesa, the insurer of the applicant's daughter's vehicle.

Both insurers refused to adjust the claim, leading to a preliminary issue hearing to determine which insurer received the first completed application.

The arbitrator found that Republic Western was the first insurer to receive a completed application and that there was a sufficient nexus between the applicant and Republic Western.

Republic Western was ordered to adjust the claim pending any priority dispute resolution and was substituted as the respondent in the arbitration.

The applicant applied for arbitration following the denial of statutory accident benefits by the insurer.

After failing to attend a scheduled pre-hearing and failing to communicate with the Commission or the insurer, the insurer requested that the application be dismissed as frivolous and vexatious.

The arbitrator found the applicant's conduct to be vexatious and dismissed the claims for income replacement benefits, interest, and a special award.

The insurer was awarded its reasonable expenses in the amount of $2,451.76.

The parties settled the substantive issue of entitlement to medical benefits for plastic surgery following a motor vehicle accident.

The only remaining issue was entitlement to expenses.

The insurer sought $1,000 in expenses and $1,500 for half of the Commission's assessment, arguing the arbitration was unnecessary.

The applicant argued the arbitration should be dismissed without costs.

The arbitrator reviewed the criteria under the Expense Regulation and found mixed success, no novel issues, and no vexatious conduct.

The arbitrator concluded that the most reasonable and fair outcome was for each party to bear their own costs.

The arbitration was dismissed.

The applicant sought income replacement benefits, a special award, and interest following a motor vehicle accident.

She claimed to be completely disabled by chronic pain and psychological distress.

The insurer denied the claims, arguing the applicant was not credible and was malingering.

The arbitrator dismissed the applicant's claims, finding her evidence riddled with inconsistencies, including a failure to report pre-existing medical conditions and psychometric test results indicating a lack of effort or intentional poor performance.

The arbitrator preferred the evidence of the insurer's experts and concluded the applicant failed to prove she suffered a complete inability to engage in employment as a result of the accident.

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

He retained a paralegal who negotiated a full and final settlement with the insurer.

The applicant later retained new counsel and sought to arbitrate further claims, arguing he did not understand the settlement or sign all the documents, and that the paralegal mistakenly signed the release.

The arbitrator found that the paralegal had ostensible and actual authority to settle the claim, and the insurer reasonably relied on that authority.

The applicant signed the statutorily required Settlement Disclosure Notice and did not rescind the settlement within the two-day cooling-off period.

The arbitrator concluded the applicant entered into a binding full and final settlement and is precluded from further arbitrating claims arising from the accident.

The applicant was injured in a motor vehicle accident while in the course of his employment.

He applied for statutory accident benefits, which the insurer denied on the basis that he was entitled to workers' compensation benefits.

The applicant argued he had validly elected to opt out of workers' compensation to pursue a third-party tort claim under section 59(2) of the Schedule.

The arbitrator found that the applicant's primary intention in making the election was to claim statutory accident benefits, not to pursue a tort action.

Consequently, the election was invalid, and the applicant was precluded from receiving accident benefits.

All claims were dismissed.

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

The insurer paid medical benefits but denied income replacement benefits.

The insurer sought to amend its Response to the Application for Arbitration to add a defence that the applicant failed to comply with the notice requirements under section 32 of the Statutory Accident Benefits Schedule.

The arbitrator granted the insurer leave to amend its Response, finding no unwarranted prejudice to the applicant.

However, the arbitrator held that the applicant was not precluded from claiming income replacement benefits, as he had a reasonable explanation for the delay.

The insurer had failed to provide the applicant with complete and understandable information about his potential entitlements, inducing him to believe he was not entitled to income replacement benefits.

Following a finding that the applicant materially misrepresented his involvement in a motor vehicle accident, the insurer sought an assessment of its expenses.

The arbitrator approved the insurer's bill of costs in the amount of $13,922.51.

The arbitrator declined to hold the applicant's legal representative personally liable for the expenses under s. 282(11.2) of the Insurance Act, finding insufficient evidence that the representative caused the frivolous claims to be advanced without reasonable cause.

Following an arbitration where the applicant's claims for statutory accident benefits were dismissed, the insurer sought its expenses.

The arbitrator found that the insurer was predominantly successful and that the self-represented applicant's conduct unnecessarily prolonged the hearing.

The arbitrator awarded the insurer its reasonable expenses, including legal fees and disbursements, totaling $15,344.05.

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

The insurer denied the claim on the basis that the applicant was not employed or self-employed.

The applicant argued that the foster parent payments she received from the Children's Aid Society constituted self-employment income.

The arbitrator found that the applicant was self-employed as a foster parent at the time of the accident, as the stipends she received amounted to 'other remuneration or profit' under section 2(5) of the Statutory Accident Benefits Schedule.

The applicant was injured in a motor vehicle accident and sought income replacement benefits, medical and rehabilitation benefits (including a Tempur mattress and a lightweight laptop), and a neuropsychological re-assessment.

The arbitrator found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment, as she continued to work and earn similar income post-accident.

The claims for the mattress, laptop, and re-assessment were dismissed as they were not proven to be reasonable and necessary.

The insurer's claim for repayment of advances was also dismissed due to lack of proper notice within the 12-month limitation period.

The applicant was injured in a motor vehicle accident when she fell from a transit bus.

She sought payment for physiotherapy and acupuncture treatments under the Statutory Accident Benefits Schedule after the insurer denied them.

The arbitrator found that the March 2002 physiotherapy treatment plan was reasonable and necessary, as the applicant was only partially recovered and a gradual reduction in treatment frequency was appropriate.

However, the April 2002 physiotherapy plan was denied because the passive treatments were no longer providing sustained relief.

The claim for acupuncture was dismissed because no treatment plan was ever submitted to the insurer.

Interest was awarded on the approved amount from the date of the decision, as the clinic had failed to advise the applicant of her personal liability or consider independent medical assessments.

The applicant was injured in a motor vehicle accident while in the course of his employment.

He applied for statutory accident benefits from the insurer, claiming he had elected to opt out of the Workplace Safety and Insurance Act (WSIA) scheme to pursue a tort action.

The insurer argued the election was invalid because it was made primarily to claim statutory accident benefits, contrary to section 59(2) of the Schedule.

The arbitrator found that the applicant and his paralegal took no meaningful steps to pursue a tort action for over two years, ignored correspondence from the insurer regarding the tort claim, and only issued a Statement of Claim after the insurer sought repayment of benefits.

The arbitrator concluded the election was not made primarily to pursue a tort action and was therefore invalid, entitling the insurer to repayment of benefits paid.

The applicant was injured in two motor vehicle accidents and claimed statutory accident benefits from the insurer.

The parties engaged in settlement discussions prior to an arbitration hearing and reached an agreement.

The applicant signed a release and settlement disclosure notice but later attempted to rescind the settlement within the two-day cooling-off period.

However, she subsequently withdrew her rescission within the same period, confirming her acceptance of the settlement.

After the cooling-off period expired, she again attempted to reopen her claim.

The arbitrator held that the applicant had entered into a binding, full and final settlement and was therefore precluded from proceeding to arbitration.