Rosemary Muzzi

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement, attendant care, housekeeping, and medical benefits.

The insurer denied the claims, arguing the accident did not occur as described and the applicant was untruthful.

The arbitrator found the applicant proved the accident occurred and was entitled to income replacement benefits due to a substantial inability to perform his pre-accident employment.

However, the claims for attendant care, housekeeping, and medical benefits were dismissed due to insufficient, unreliable, and exaggerated evidence.

The applicant was awarded interest on overdue payments, and both parties were ordered to bear their own arbitration expenses.

The applicant was injured in a motor vehicle accident and applied for arbitration after the insurer denied a treatment plan.

The insurer brought a motion to dismiss the application because the applicant failed to participate in the arbitration process, including missing two pre-hearings and the motion hearing itself.

The arbitrator dismissed the application due to insufficient evidence and the applicant's failure to participate in any meaningful manner.

The insurer was awarded $350 in expenses.

The applicant was injured in a motor vehicle accident and sought a determination that he suffered a catastrophic impairment due to a mental or behavioural disorder, as well as entitlement to attendant care benefits.

The arbitrator applied the three-stage test from Pastore v. Aviva Canada Inc. and found that the accident materially contributed to a cognitive disorder that significantly impaired the applicant's daily life.

The arbitrator concluded the applicant had a marked impairment in concentration, persistence, pace, and work adaptation, meeting the threshold for catastrophic impairment.

The arbitrator awarded a monthly attendant care benefit of $3,036.82, finding the applicant required some supervisory care but not the constant supervision claimed.

The applicant failed to attend the scheduled hearing for her accident benefits claims.

Her counsel brought a motion to be removed from the record, citing a breakdown in the solicitor-client relationship due to an inability to contact the applicant.

The arbitrator granted the motion to remove counsel.

The insurer sought dismissal of the arbitration and expenses.

Noting that the applicant had never appeared at the Commission despite multiple scheduled pre-hearings, the arbitrator dismissed the application for arbitration and ordered the applicant to pay $2,000 in expenses to the insurer.

The applicants sought accident benefits following a motor vehicle accident, claiming that Ms. Hoey was driving the vehicle.

The insurer terminated benefits, alleging that Mr. Vera, whose license was suspended, was actually driving and that the applicants wilfully misrepresented this material fact.

Following a preliminary issue hearing, the arbitrator found that the preponderance of evidence, including independent witness testimony and Mr. Vera's actions at the scene, established that Mr. Vera was the driver.

The arbitrator concluded that both applicants wilfully misrepresented material facts, disentitling them to benefits, and awarded the insurer its reasonable expenses.

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

The applicant failed to appear at the pre-hearing and the scheduled arbitration hearing, and had not communicated with his counsel or the Commission for months.

Counsel's request to be removed from the record was granted.

The insurer's request to dismiss the arbitration on a without costs basis was granted due to the applicant's failure to appear and provide instructions.

The applicant failed to attend a preliminary issue hearing regarding whether she was involved in a motor vehicle accident.

Her counsel appeared to request removal from the record due to a loss of communication, noting that the applicant had failed to complete settlement documents and her contact numbers were disconnected.

The arbitrator granted counsel's request to be removed.

The insurer requested that the arbitration be dismissed with expenses.

Given the applicant's failure to attend or communicate, the arbitrator dismissed the application for arbitration and ordered the applicant to pay the insurer's expenses fixed at $1,500.

The applicant, injured in a 2003 motor vehicle accident, sought a determination of catastrophic impairment at the Financial Services Commission of Ontario.

The insurer argued the arbitration should be stayed because the applicant had a pending 2005 court action for non-earner and medical benefits, and the issues should be joined to avoid a multiplicity of proceedings.

The arbitrator found that the issues in the arbitration and the civil action were distinct, with different legal tests and relief sought.

The arbitrator concluded there was no risk of undue duplication, delay, or inconsistent results, and allowed the applicant to proceed with the arbitration.

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

The matter proceeded to an arbitration hearing, but the applicant failed to attend, communicate with the Commission, or provide instructions to his counsel.

As no evidence was presented to prove the applicant's claims, the arbitrator dismissed the arbitration.

The insurer was awarded its reasonable expenses and disbursements, assessed at $3,384.26, after a reduction for efficiencies gained from a related consolidated matter.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, a physical rehabilitation treatment plan, and the costs of two assessments.

The arbitrator dismissed the application, finding the applicant's evidence regarding his employment status, income, and continuing disability to be inconsistent and unreliable.

The arbitrator also found that the proposed treatment plan and assessments were not reasonably required or necessary.

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

The insurer denied the claims because the applicant failed to provide sufficient income information and failed to attend scheduled insurer medical examinations.

The arbitrator found that the applicant eventually provided sufficient income information by April 1, 2009, but failed to provide a reasonable explanation for the delay, limiting his entitlement period.

The applicant also failed to attend all scheduled medical examinations without a reasonable explanation, further limiting his entitlement to April 24, 2009.

The claim for medical benefits was dismissed as the applicant failed to prove the treatment was reasonable and necessary.

The applicant sought statutory accident benefits after slipping and falling on ice in a Canadian Tire parking lot while walking back to her vehicle to retrieve a broken windshield wiper blade for replacement.

The insurer denied benefits on the basis that the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The arbitrator found that the fall did not arise out of the use or operation of an automobile, and even if it did, the use or operation did not directly cause the impairment.

The application for arbitration was dismissed.

The applicant sought additional statutory accident benefits for housekeeping services following a motor vehicle accident.

After the first day of the arbitration hearing, the applicant failed to appear for the continuation.

The arbitrator dismissed the claim on the merits, finding insufficient evidence that the applicant incurred reasonable and necessary additional expenses for housekeeping services or that he actually required them beyond the period already paid by the insurer.

The insurer was awarded its expenses for the arbitration.

The applicant was injured in a motor vehicle accident and sought payment for a psychological assessment and two treatment plans from the insurer.

The arbitrator found the psychological assessment was not reasonable and necessary given the applicant's pre-existing psychological treatment and the early stage of rehabilitation.

The claim for the Osler treatment plan was denied due to lack of evidence.

However, the Chesswood treatment plan was found to be reasonable and necessary as it provided beneficial care after the applicant left the previous clinic.

The insurer was ordered to pay $2837.97 for the Chesswood plan plus interest.

The applicant was injured in a motor vehicle accident while riding his bicycle and sought a determination of catastrophic impairment.

The arbitrator found that the applicant suffered a marked impairment due to a mental or behavioural disorder, satisfying the criteria under section 2(1.2)(g) of the Statutory Accident Benefits Schedule.

However, the arbitrator concluded that the applicant did not meet the 55% whole person impairment threshold under section 2(1.2)(f), as the combined physical and psychological impairments amounted to 48%.

The applicant was injured on a bus when it came to an abrupt stop.

She applied for statutory accident benefits, including income replacement, housekeeping, attendant care, and medical benefits.

The insurer terminated benefits, arguing she was not employed at the time of the accident, lacked credibility, and had pre-existing conditions.

The arbitrator found that the applicant was employed at the time of the accident and that her injuries, including chronic pain and depression, were caused by the accident.

The arbitrator ordered the insurer to pay ongoing income replacement benefits, as well as specified amounts for housekeeping, attendant care, and medical benefits.

Claims for the full cost of a psychiatric assessment and a special award were dismissed.

The applicant was seriously injured in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder.

The insurer argued that her marked impairment was a manifestation of malingering or factitious disorder, pointing to an initial period of improvement followed by deterioration.

The arbitrator reviewed extensive medical and lay evidence, finding that the applicant's current presentation of severe depression, anxiety, and pain focus was a direct result of the accident.

The arbitrator rejected the insurer's allegations of malingering, noting the lack of pre-existing conditions and the consistency of the applicant's presentation over time.

The arbitrator concluded the applicant suffered a catastrophic impairment.

The applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment based on a mental or behavioural disorder.

The insurer's assessors concluded she had only a moderate impairment, while her own assessors found a marked impairment in the area of adaptation.

The arbitrator found that the applicant's inability to work was too narrow a basis for finding a marked impairment in adaptation.

Considering her overall ability to cope with pain and manage daily activities, the arbitrator concluded the applicant had only a moderate impairment in all four areas of function and therefore did not meet the definition of catastrophic impairment.

The applicant was injured in a motor vehicle accident in 1995 and received income replacement benefits until 1997.

In 1998, the parties entered into a settlement agreement for $140,500.

The applicant later sought to rescind the settlement, claiming he did not receive a proper disclosure notice, and filed for arbitration in 2000, which he subsequently withdrew in 2001.

In 2010, he filed a new application for arbitration.

The arbitrator held that the applicant was precluded from proceeding because the 1998 settlement agreement was valid and he had received proper notice.

Furthermore, the arbitrator found that re-filing the application after a ten-year delay, without a reasonable explanation or special circumstances, prejudiced the insurer and constituted an abuse of process.

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

After failing to attend a pre-hearing discussion and a subsequent hearing for disposition, despite proper notice, the arbitrator found the applicant had abandoned his claims.

The arbitration was dismissed under Rule 37.7 of the Dispute Resolution Practice Code, and the insurer was awarded $750 in costs for its attendance.