Aldo Picchetti

The plaintiff insurer brought an action against the defendants for fraud, fraudulent misrepresentation, unjust enrichment, and conspiracy, alleging an elaborate insurance fraud scheme involving fraudulent medical assessments.

The defendants moved to strike the conspiracy claim under Rule 21, arguing it was redundant and merged with the nominate torts based on the doctrine of merger.

The motion judge dismissed the motion, finding it was not plain and obvious that the conspiracy claim was redundant.

On appeal, the Divisional Court affirmed the decision, holding that the doctrine of merger should not be applied at the pleadings stage and should be left for the trial judge to determine on a full evidentiary record.

The applicant, who suffered from chronic pain following a motor vehicle accident, sought $62,877.65 from his insurer for the cost of constructing a residential therapy pool.

The insurer had previously approved and funded aqua therapy at a community pool.

The arbitrator found that while aqua therapy was beneficial for the applicant's re-conditioning, a custom residential pool was not a reasonable and necessary medical expense.

The evidence indicated that the applicant's treatment goals could be met through community pool sessions and other forms of exercise, and the high cost and convenience factors did not justify the expense.

The application for the medical benefit was dismissed.

The applicant, a pedestrian struck by a motor vehicle, sustained a traumatic brain injury and multiple skull fractures.

She applied for catastrophic impairment designation under the Statutory Accident Benefits Schedule based on a Glasgow Outcome Scale (GOS) score of 3 (severe disability).

The insurer denied the designation, relying on a neurologist who found no physical neurological deficits.

The arbitrator rejected the insurer's narrow interpretation of the GOS, preferring the applicant's physiatrist who considered cognitive and behavioural impairments that rendered the applicant dependent on daily support.

The arbitrator found the applicant catastrophically impaired, awarded past and ongoing attendant care benefits for services provided by her husband, approved most of the disputed medical and rehabilitation treatment plans, and held the insurer liable for a special award for unreasonably withholding benefits.

Following a successful arbitration for statutory accident benefits, the applicant sought her expenses.

The arbitrator found the applicant was entitled to expenses based on her degree of success and an unaccepted offer to settle.

The arbitrator awarded $15,360.72 in legal fees and $12,025.07 in disbursements, reducing some claimed amounts for expert fees and photocopying to align with the Schedule to the Expense Regulation, for a total award of $27,385.79.

The moving party defendants sought leave to appeal an order dismissing their motion to strike the plaintiff insurer's conspiracy claim.

The defendants argued the conspiracy claim should be struck based on the doctrine of merger, as it was redundant to the tort of fraudulent misrepresentation.

The Divisional Court granted leave to appeal on the merger issue, finding that there were conflicting decisions on whether the doctrine of merger could be applied at the pleadings stage, satisfying the test under Rule 62.02(4)(a).

The parties settled a dispute over income replacement benefits on the morning of the arbitration hearing.

The applicant sought $51,976.80 in expenses, arguing the insurer's aggressive and obstructionist tactics unnecessarily prolonged the process.

The arbitrator found that the insurer's failure to meaningfully consider the applicant's earlier settlement offer caused unnecessary preparation work.

The arbitrator awarded the applicant $35,389.06 in expenses, allowing full legal fees for the period after the settlement offer but reducing disbursements for expert reports to the maximum allowable amounts and denying expert attendance fees since no hearing took place.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs), transportation expenses, and the cost of a medical assessment.

The insurer denied the benefits, arguing the applicant had returned to work and did not meet the disability tests.

The arbitrator found the applicant suffered a substantial inability to perform her pre-accident employment for the first 104 weeks and a complete inability to engage in suitable employment thereafter until she commenced a new career.

The arbitrator awarded the IRBs, transportation expenses, and assessment costs.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award because it unreasonably withheld IRBs by failing to have its accountant review updated financial information that would have revealed flaws in its initial denial.

An automobile insurer commenced an action alleging that medical assessment centres and their principals conspired to submit fraudulent statutory accident benefits claims and supporting documentation, causing the insurer to pay over $500,000 in benefits.

The defendants moved under rule 21.01(b) of the Rules of Civil Procedure to strike the fresh as amended statement of claim for failure to disclose a reasonable cause of action.

The court held that the claims for fraudulent misrepresentation, negligent misrepresentation, negligence, unjust enrichment, and conspiracy were adequately pleaded and provided sufficient particulars.

The court rejected the defendants’ argument that the conspiracy claim merged with the tort claims at the pleadings stage, holding that the merger doctrine should not be used to strike a conspiracy claim before trial.

The only portion struck was the allegation that the defendants breached the Criminal Code, which was held to be scandalous in a civil pleading.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, housekeeping, and attendant care benefits, which the insurer had terminated.

The insurer argued the applicant had removed herself from the workforce prior to the accident due to pre-existing psychological issues.

The arbitrator applied the material contribution test and found that the accident materially contributed to the applicant's pain disorder and exacerbated her depression and anxiety, resulting in a complete inability to engage in employment.

The arbitrator awarded ongoing income replacement benefits and partial housekeeping benefits, but denied attendant care benefits and a special award, finding the insurer's reliance on its medical assessments was not unreasonable.

The applicant was injured in a motor vehicle accident and claimed post-104 week income replacement benefits.

The insurer suspended benefits after the applicant failed to attend scheduled insurer examinations, and later formally refused benefits after the examinations were completed.

The insurer argued the arbitration application was time-barred under section 281.1 of the Insurance Act, relying on the initial suspension as the trigger for the limitation period.

The arbitrator held that the initial suspension was a temporary procedural stoppage, not a clear and unequivocal refusal, and lacked required information about the dispute resolution process.

Therefore, the limitation period was not triggered until the later formal refusal, making the applicant's mediation and arbitration applications timely.

The applicants sought statutory accident death benefits after the deceased was crushed by a truck flatbed while dismantling it for parts in a scrap yard.

The insurer denied the claim on the basis that the incident was not an 'accident' under section 2(1) of the Statutory Accident Benefits Schedule.

The arbitrator held a preliminary issue hearing to determine if the incident met the definition of an accident.

Applying the purpose and causation tests, the arbitrator found that dismantling a flatbed for parts is not an ordinary and well-known activity to which automobiles are put.

Furthermore, the deceased's actions with a torch and pry bar constituted an intervening act that broke the chain of causation.

The arbitrator concluded that the deceased was not fatally injured as a result of an accident and dismissed the claim for benefits.

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

After mediation failed, the applicant applied for arbitration but subsequently failed to attend two pre-hearings, a motion by his solicitors to be removed from the record, and the arbitration hearing itself.

The arbitrator found that the applicant had abandoned his claim and dismissed the arbitration without a hearing pursuant to Rule 68.1 of the Dispute Resolution Practice Code.

The insurer was awarded $1,000 in costs for its expenses.

The applicant's counsel brought a motion to be removed as solicitors of record due to a breakdown in the solicitor-client relationship and a lack of meaningful instructions.

The applicant failed to attend previous pre-hearing conferences and could not be reached by his counsel or the arbitrator.

The arbitrator granted the uncontested motion, removing the law firm as solicitors of record.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the insurer.

The insurer terminated the IRBs and the applicant requested a Designated Assessment Centre (DAC) assessment.

The insurer argued the applicant failed to provide an updated Disability Certificate, and thus the two-year limitation period to apply for mediation had expired.

The Arbitrator found that the applicant had already provided a valid Disability Certificate covering the termination date, and was not required to provide a new one.

Because the insurer failed to arrange the DAC, there was no valid termination of benefits, and the limitation period did not preclude the applicant from proceeding to arbitration.

The applicant sought a special award after the arbitrator previously found the insurer unreasonably withheld income replacement benefits.

The insurer's unreasonable conduct included negligently misfiling a psychological report and relying on a medical opinion that failed to address central issues.

Applying the Persofsky framework, the arbitrator balanced the blameworthiness of the insurer's conduct against the need for deterrence and proportionality.

Finding the insurer's actions fell short of the intentional and egregious conduct seen in cases warranting maximum penalties, the arbitrator ordered a special award of $20,000.

The applicant sought her expenses of the arbitration following a successful claim for statutory accident benefits.

The insurer did not dispute entitlement but challenged the disbursements claimed for the attendance of two expert witnesses.

The arbitrator found the legal fees reasonable and reduced the expert witness attendance fees to comply with the maximum hourly rate prescribed by the Expense Regulation under the Insurance Act.

The applicant was awarded total expenses of $11,526.32.

The applicant was struck by a vehicle while walking across an intersection and sustained physical and psychological injuries.

The insurer terminated her income replacement benefits based on an orthopaedic assessment.

The applicant sought arbitration, arguing she suffered from chronic pain with a significant psychological component that prevented her from working.

The arbitrator found that the applicant was completely unable to engage in any employment for which she was reasonably suited, preferring the evidence of her psychological experts over the insurer's assessors.

The arbitrator also granted a special award, finding that the insurer unreasonably withheld benefits by misfiling and ignoring a key psychological report that supported her claim.

The respondent pedestrian was injured when she tripped and fell while hurrying to get out of the way of an oncoming fire vehicle that was sounding its siren and travelling in the wrong lane.

The appellant insurer denied statutory accident benefits, arguing the incident did not meet the definition of an 'accident' under the Schedule.

The arbitrator found that the use and operation of the fire vehicle was the direct cause of the respondent's injuries.

On appeal, the Director's Delegate upheld the decision, finding no error of law.

The Delegate concluded that the fire vehicle was the dominant feature setting in motion an unbroken chain of events, satisfying both the purpose and direct causation tests.

The Applicant sought expenses following a preliminary issue hearing where it was determined she was injured in an 'accident' under the Statutory Accident Benefits Schedule.

The Insurer did not contest the disbursements but argued the claimed legal hours were excessive.

The Arbitrator agreed with the Insurer's submission of 18 hours, which the Applicant did not dispute, and awarded $1,396.08 in legal fees and $252.04 in disbursements.

The appellant insurer filed a Notice of Appeal from an arbitrator's preliminary decision finding that the respondent was injured in an accident.

The Director's Delegate extended the time for filing both the Notice of Appeal and the Response to Appeal.

The Delegate also allowed the appeal from the preliminary order to proceed, noting that a successful appeal would completely dispose of the proceeding, making it the most efficient and cost-effective approach.

The parties were directed to request an adjournment of the scheduled arbitration hearing.