Albert Conforzi

The applicant was injured in a motor vehicle accident and applied for a catastrophic impairment designation under the Statutory Accident Benefits Schedule.

The insurer argued the applicant required a below-knee amputation and assessed her as an amputee, resulting in a 35% Whole Person Impairment (WPI) rating.

The applicant's assessors found her to be wheelchair dependent, resulting in an 80% WPI rating under the Gait Derangement Table, and also found significant psychological impairments.

The Arbitrator preferred the applicant's assessors, finding that the insurer's assessors failed to evaluate the applicant as she presented herself.

The Arbitrator concluded the applicant was wheelchair dependent and met the definition of catastrophic impairment.

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 sought a determination from the Financial Services Commission of Ontario that she sustained a catastrophic impairment in a motor vehicle accident.

However, she was concurrently advancing claims for statutory accident benefits in a Superior Court action.

The arbitrator declined to decide the sole issue of catastrophic impairment and stayed the arbitration application, finding that the issue was too closely intertwined with the entitlement issues before the court.

Proceeding with the arbitration would risk a multiplicity of proceedings and inconsistent findings.

The appellant was injured in a motor vehicle accident and received income replacement benefits.

The insurer terminated benefits, arguing the appellant's ongoing disability was due to a pre-existing schizoaffective disorder rather than the accident.

The arbitrator agreed, finding the accident's material contribution to the disability ended by August 2001, and dismissed claims for various assessment expenses.

On appeal, the Director's Delegate upheld the arbitrator's decisions, finding no error of law in the arbitrator's evaluation of the medical evidence, the impact of the appellant's pre-existing condition, or the rejection of assessment expenses.

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

In a previous decision, the insurer successfully defended the claim for income replacement benefits, while the applicant recovered a small amount for a functional capacity evaluation.

On the issue of expenses, the arbitrator found that both parties unnecessarily prolonged the hearing.

The applicant failed to produce hospital records on a timely basis, and the insurer's counsel conducted lengthy and unhelpful cross-examinations regarding the applicant's pre-existing psychiatric illness.

Consequently, the arbitrator ordered that each party bear their own expenses of the arbitration proceeding.

The applicant sought a variation or revocation of an earlier arbitration decision, arguing that the arbitrator mistakenly recorded the date the insurer terminated income replacement benefits as February 1, 2001, instead of February 1, 2002.

The arbitrator acknowledged the error but found it did not affect the substantive conclusion that the applicant's accident-related disability ended on August 28, 2001, after which any disability was due to a pre-existing psychiatric illness.

Because the insurer had already paid benefits beyond August 28, 2001, the original order requiring payment of benefits was revoked and the application for income replacement benefits was dismissed.

Each party was ordered to bear their own expenses for the variation application.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits and medical/rehabilitation expenses.

The insurer terminated benefits, arguing the applicant's disability was due to a pre-existing schizoaffective disorder rather than the accident.

The arbitrator found that the trauma of the accident triggered an episode of the applicant's pre-existing psychiatric illness, entitling him to income replacement benefits for a limited period.

Claims for various assessments were largely dismissed, save for one functional capacity evaluation.

The claim for a special award was dismissed as the insurer's termination of benefits was not unreasonable given the complex medical evidence.

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

The insurer denied the claim and argued at a preliminary issue hearing that the applicant was disentitled to benefits under section 48(1) of the Statutory Accident Benefits Schedule because he wilfully misrepresented the circumstances of the accident.

The insurer relied on an accident reconstruction expert who concluded the vehicle damage was inconsistent with the applicant's statements.

The arbitrator found the expert's analysis contained numerous weaknesses, including reliance on an unreliable speed estimate and photographs taken after a subsequent accident.

The arbitrator concluded the insurer failed to discharge its onus of proving wilful misrepresentation and held the applicant was not disentitled to benefits.

The appellant appealed an arbitration order finding that he had validly settled his claim for statutory accident benefits.

The appellant argued that under the Settlement Regulation, a settlement is not finalized until the insured confirms it after receiving the disclosure notice, and the two-day cooling-off period runs from that point.

The Director of Arbitrations rejected this 'three-step approach', holding that if the parties agree on all terms, the insurer fulfills its obligations by sending the required notice.

Unless the insured rescinds within two business days of receiving the notice, the settlement is binding.

The appeal was dismissed.

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

The insurer denied benefits and raised the preliminary issue of wilful misrepresentation.

The applicant objected to the late service of the insurer's expert reports and argued the insurer failed to provide proper notice of the reasons for denying benefits.

The arbitrator allowed the late expert reports, finding no procedural unfairness or prejudice to the applicant.

The arbitrator also held that the insurer provided sufficient notice of its wilful misrepresentation defence in its Response to the Application for Arbitration, allowing the preliminary issue hearing to proceed.

The insurer brought a motion to compel the insured to attend an independent medical examination by a psychiatrist under section 42 of the Statutory Accident Benefits Schedule.

The insured refused to attend, arguing the examination was for medical-legal purposes rather than determining entitlement to a benefit.

The arbitrator dismissed the motion, finding that arbitrators at the Financial Services Commission of Ontario lack jurisdiction to order an insured to attend a medical examination.

The arbitrator also noted that the insurer's delay in requesting the examination until the eve of the hearing would cause significant prejudice to the insured.

The applicant claimed she was injured in a minor motor vehicle accident and sought income replacement benefits and housekeeping expenses from her insurer.

The insurer denied the claims, arguing the collision was too minor to cause the alleged injuries and questioning the applicant's credibility.

The arbitrator found the applicant's evidence unreliable, noting numerous inconsistencies and implausible explanations regarding the accident and her injuries.

The arbitrator concluded the applicant did not suffer a substantial inability to perform her employment tasks or housekeeping duties as a result of the accident.

All claims for benefits and a special award were dismissed.

The appellant appealed an arbitrator's decision dismissing his claim for further income replacement benefits following two motor vehicle accidents.

The central issue was whether the appellant's essential tasks as a self-employed construction company owner included heavy physical labour or were limited to administrative and supervisory duties.

The Director's Delegate upheld the arbitrator's finding that the appellant's essential tasks were primarily administrative and supervisory, based on evidence of his pre-accident activities and health.

The Director's Delegate also found no error in the arbitrator's refusal to adjourn the hearing pending a Designated Assessment Centre (DAC) assessment, given the appellant's significant delay in pursuing the issue.

The appeal was dismissed.

The appellant was injured in a motor vehicle accident while working and initially claimed workers' compensation benefits.

He later sought accident benefits from his automobile insurer, which delayed processing his claim.

At arbitration, he was awarded outstanding benefits and a $65,000 special award for the insurer's unreasonable delay, but the arbitrator ordered interest only from the dates formal applications or re-elections were made.

On appeal, the appellant argued interest should run from his initial contact with the insurer due to its failure to provide forms and information.

The Director of Arbitrations dismissed the appeal, finding no error in the arbitrator's determination of when the benefits became overdue under the Statutory Accident Benefits Schedule, noting the special award already penalized the insurer for its delays.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including income replacement benefits (IRBs) and housekeeping expenses.

The insurer denied the claims.

At arbitration, the central issue was whether the applicant was an employee or self-employed, which dictated the information required to calculate his IRB.

The arbitrator found the applicant was self-employed and had failed to provide the necessary financial information to calculate the benefit, disentitling him to IRBs under section 33 of the SABS-1996.

However, the arbitrator awarded housekeeping expenses based on medical evidence of his impairments and ordered the insurer to pay the applicant's arbitration expenses.

Surveillance evidence obtained deceptively by the insurer was excluded.

In a supplementary arbitration decision, the applicant sought reimbursement for medical and rehabilitation expenses initially funded by the Workers' Compensation Board (WCB) following a motor vehicle accident.

The insurer had reimbursed most of the amount but withheld $2,901.54, arguing it was covered by OHIP.

The arbitrator found no settlement had been reached between the parties and ordered the insurer to pay the remaining $2,901.54, as it failed to provide sufficient evidence of OHIP coverage.

The arbitrator also awarded interest on the overdue amounts from October 1, 1998, and set the applicant's counsel fee rate at $125 per hour for the arbitration proceeding.

The applicant sought reimbursement for disbursements incurred during an arbitration proceeding for statutory accident benefits.

The insurer had paid a portion of the claimed disbursements but disputed several items, including hotel stays, meals, expert witness fees, and medical assessments.

The arbitrator reviewed the disputed items under the Expense Regulation, allowing some travel and expert report fees while disallowing expenses that were more properly characterized as medical benefits or were deemed unreasonable.

The applicant was awarded an additional $180.26 in disbursements.

The appellant appealed an arbitration order denying her weekly income benefits after the 156-week mark following a motor vehicle accident.

The Director's Delegate dismissed the appeal, finding no error of law in the arbitrator's decision that the appellant's accident-related injuries did not prevent her from pursuing suitable employment.

The appellant was ordered to pay $750 in appeal expenses due to her actions prolonging the proceedings and raising unfounded grounds.

The applicant was injured in two motor vehicle accidents and received income replacement benefits from the insurer.

The insurer terminated the benefits, and the applicant brought a preliminary motion requesting that the insurer arrange a Designated Assessment Centre (DAC) assessment and pay interim benefits pending the assessment.

The arbitrator dismissed the motion, finding that the applicant had delayed raising the issue for over three years and that a DAC assessment would not be useful given the passage of time.

The arbitrator also declined to order interim benefits, noting that the applicant failed to establish a minimal level of disability or urgency.

The insurer sought to compel the applicant to attend a psychiatric examination to determine his ongoing entitlement to income replacement benefits following a motor vehicle accident.

The applicant refused, arguing the insurer had already fully explored the psychological component of his claim through previous assessments and that the request was untimely.

The arbitrator found that because the applicant had recently obtained his own psychiatric report, which his counsel failed to disclose until the submissions on this motion, it was reasonably necessary for the insurer to obtain its own psychiatric opinion.

The insurer's request for the examination was granted.