Frank A. Sabetti

The applicant was injured in a motor vehicle accident and sought payment for chiropractic and rehabilitation treatments from his automobile insurer.

The insurer disputed the necessity and cost of the treatments, and argued that the applicant's extended health insurer was the primary payer.

The arbitrator held that the legal burden of proof lies with the insured to demonstrate what collateral benefits were reasonably available and what balance remains owing by the automobile insurer.

The arbitrator found the treatments were reasonable and necessary, adjusted the allowable costs, and ordered the insurer to pay the outstanding balance of $993.

A special award of $250 was also granted against the insurer for unreasonably delaying payment.

The applicant sought payment for various medical and rehabilitation expenses following a motor vehicle accident.

The insurer denied the claims, arguing in part that the referring physician had an undisclosed conflict of interest regarding one of the treatment centres.

The arbitrator found that while the physician failed to disclose his ownership of the centre, the insurer had not previously approved the treatment plan, meaning the automatic exclusion under section 38(20) of the Schedule did not apply.

However, the arbitrator scrutinized the medical necessity of the treatments, awarding partial costs for acupuncture, the family physician's accident-related services, and certain diagnostic testing, while denying costs for structured physiotherapy.

The arbitrator also awarded overdue interest and dismissed the insurer's claim for repayment of disability benefits due to lack of proper notice.

The applicant sought ongoing statutory accident benefits following a motor vehicle accident, claiming physical and psychological disabilities prevented him from working as a superintendent.

The arbitrator found that the applicant suffered from chronic fatigue and psychological issues prior to the accident, stemming from previous torture in Turkey, which had already impaired his job performance.

Medical opinions supporting the applicant's claim were rejected because the experts were unaware of his pre-accident condition.

The arbitrator concluded the accident did not significantly contribute to the applicant's disability, denying further weekly benefits and the insurer's claim for repayment, but awarded reimbursement for a medical report.

The applicants were injured in a motor vehicle accident and applied for statutory accident benefits from State Farm.

State Farm denied the claims on the basis that the policy had been cancelled prior to the accident.

The applicants initially argued that State Farm was required to pay benefits pending a priority dispute with another insurer under Regulation 283/95.

At the hearing, the applicants conceded that the policy had been cancelled and consented to an order dismissing their claims against State Farm, intending to pursue the other insurer instead.

The arbitrator dismissed the claims on consent without expenses.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them on March 19, 1997.

The applicant disputed the termination and eventually applied for arbitration on August 10, 1999.

The insurer raised a preliminary issue that the application was filed beyond the two-year limitation period.

The arbitrator found that the insurer's notice of termination was clear and unequivocal, and that the insurer was not estopped from relying on the limitation period despite ongoing requests for information regarding the quantum of benefits.

The arbitrator concluded that the application for arbitration was filed more than 90 days after the mediator's report, precluding the applicant from proceeding to arbitration on the issue of ongoing entitlement.

The applicant was struck by a car and claimed ongoing income replacement benefits and physiotherapy expenses.

The insurer terminated benefits, arguing she could return to her job as a light duty cleaner and sought to deduct alleged post-accident income.

The arbitrator found the applicant suffered a substantial inability to perform the essential tasks of her job due to accident-related knee tendinitis, entitling her to ongoing income replacement benefits.

The arbitrator also found no evidence of actual post-accident income to deduct, and allowed only one month of the claimed physiotherapy expenses, finding the remainder unreasonable.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on an occupational medicine examination.

The applicant was subsequently involved in a second motor vehicle accident but only sought benefits related to the first.

The arbitrator found that the applicant's evidence was inconsistent and that multiple medical specialists noted exaggerated pain behaviour and illness behaviour.

The arbitrator concluded that the applicant did not suffer a physiological or anatomical impairment from the first accident that disabled her from working, and that her psychological impairment did not prevent her from performing the essential tasks of her employment.

The application for arbitration was dismissed.

The appellant was injured in a motor vehicle accident and claimed weekly income benefits for chronic pain and depression.

The arbitrator denied the claim, finding the appellant not credible based on alleged pre-existing conditions, surveillance evidence, and hearing observations.

On appeal, the Director's Delegate found that the arbitrator made serious factual errors regarding the pre-accident medical records and misapprehended the surveillance evidence.

Because these errors undermined the core credibility findings, the appeal was allowed, the arbitration order was rescinded, and the matter was remitted for a new hearing before a different arbitrator.