Dana R. Spadafina

Peter Ekstein was catastrophically injured as a pedestrian.

He had a personal auto policy with Chubb and was the owner/CEO of a company with an auto policy (including optional enhanced benefits and OPCF-47 endorsement) with Continental Casualty Company (CNA).

Chubb began paying statutory accident benefits (SABS) but served a priority notice on CNA.

An arbitrator found CNA to be the priority insurer, deeming Ekstein a "named insured" under the CNA policy due to "regular use" provisions.

CNA appealed.

The Superior Court found the arbitrator erred in deeming Ekstein a "named insured" under the CNA policy, as he never actually used company vehicles.

However, due to the OPCF-47 endorsement, CNA was still obligated to pay both mandatory and optional SABS benefits to Ekstein.

The court clarified that the OPCF-47 endorsement does not alter priority rules between insurers, entitling CNA to reimbursement from Chubb for the mandatory SABS benefits and associated administration costs.

The applicant, who was struck by an automobile while riding a bicycle, sought a medical and rehabilitation benefit of $10,033.92 for a chronic pain program.

The insurer denied the claim based on independent medical examinations suggesting the applicant had reached maximal medical recovery.

The Tribunal found the proposed treatment plan reasonable and necessary, preferring the evidence of the applicant's assessors which demonstrated ongoing pain and functional impairment exceeding physical signs of injury.

The appeal was allowed, and the insurer was ordered to pay the benefit with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, attendant care benefits, and various medical and rehabilitation benefits.

The adjudicator found that the applicant failed to provide compelling evidence to demonstrate a complete inability to carry on a normal life or that her injuries fell outside the Minor Injury Guideline.

Relying on the insurer's medical examinations, the adjudicator concluded the applicant's injuries were minor and dismissed all claims for benefits.

The respondent's request for costs was also denied.

The applicant sought non-earner benefits, medical and rehabilitation benefits, and attendant care benefits following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and she did not meet the test for non-earner benefits.

The Tribunal found that the applicant failed to provide compelling evidence to prove she suffered a complete inability to carry on a normal life.

Furthermore, the Tribunal concluded that the applicant's injuries were minor and she had exhausted the MIG limit, disentitling her to the claimed medical and attendant care benefits.

The application was dismissed.

The applicant applied for arbitration at the Financial Services Commission of Ontario after a dispute with her insurer over statutory accident benefits, including a non-earner benefit and a medical benefit.

The applicant's legal representatives withdrew prior to the pre-hearing due to a breakdown in the solicitor-client relationship.

The applicant failed to attend both the pre-hearing and the scheduled arbitration hearing.

As the applicant did not attend to present any evidence, she failed to prove her entitlement to the claimed benefits.

The arbitrator dismissed the applicant's claims and ordered her to pay $1,500 in expenses to the insurer.

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

After her representative was removed from the record due to a breakdown in the solicitor-client relationship, the applicant failed to participate in subsequent proceedings or communicate with the Commission.

The insurer brought a motion to dismiss the application as frivolous, vexatious, or commenced in bad faith under Rule 68.1 of the Dispute Resolution Practice Code, or alternatively, to deem it withdrawn under Rule 70.

The arbitrator declined to dismiss the application under Rule 68.1, noting that such a finding requires an assessment of the merits, which was not possible here.

However, the arbitrator deemed the application withdrawn under Rule 70 due to the applicant's prolonged failure to participate.

The applicant was ordered to pay $500 in expenses to the insurer.

The applicant was injured in a 2007 motor vehicle accident and claimed she suffered a catastrophic impairment due to a mental or behavioural disorder.

She also claimed various statutory accident benefits.

The arbitrator found that while the accident materially contributed to her mental or behavioural disorder, the impairment was moderate, not marked, largely due to significant pre-existing conditions and functional limitations.

The claim for catastrophic impairment was dismissed, along with claims for attendant care, housekeeping, and income replacement benefits.

However, claims for massage therapy, physiotherapy, a neuro-psychological assessment, speech therapy, psychological therapy, and prescription medication were granted.

A special award was also granted for the insurer's unreasonable delay in paying for the neuro-psychological assessment and psychological therapy.