Frank Benedetto

The applicant and respondent both requested reconsideration of a Tribunal decision that dismissed the application for failing to file submissions.

The parties argued that they had reached a settlement pending court approval and had informed the Tribunal via email, believing no decision would be made.

The Vice-Chair found that there was a misunderstanding of fact based on the email correspondence.

The reconsideration was granted on consent, the previous decision was cancelled, and the file was closed without prejudice pending the outcome of the court approval process.

The applicant and respondent both requested reconsideration of a Tribunal decision that dismissed the application for failure to file submissions.

The parties had previously informed the Tribunal that a settlement had been reached and was awaiting court approval because the applicant is a minor.

The Tribunal found that there was a misunderstanding of fact based on the parties' correspondence, satisfying the grounds for reconsideration under Rule 18.2(b).

The original decision was cancelled and the file was closed without prejudice pending court approval of the settlement.

The applicant sought attendant care benefits following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding it lacked jurisdiction over the first claim because the applicant had previously withdrawn it and failed to notify the insurer of a renewed dispute.

The Tribunal also found the second claim was not properly submitted.

In the alternative, the Tribunal held the applicant failed to prove the attendant care expenses were 'incurred' under the Schedule, as the care was provided by his wife, a retired personal support worker who was not employed at the time of the accident and did not sustain an economic loss.

The applicant was injured in a motor vehicle accident and deemed catastrophically impaired.

He sought ongoing statutory accident benefits for housekeeping and home maintenance, as well as a rent differential to move to a larger apartment.

The Licence Appeal Tribunal found that while the applicant suffered a substantial inability to perform his pre-accident housekeeping tasks, he failed to prove that the claimed housekeeping expenses were actually incurred.

The Tribunal also dismissed the claim for a rent differential, finding insufficient evidence that moving to a larger apartment was a reasonable and necessary medical or rehabilitation expense.

Claims for interest and an award for unreasonable delay were consequently dismissed.

The respondent insurer requested a reconsideration of an interlocutory order requiring it to produce unredacted adjuster's log notes before the applicant provided particulars of her claim for an award.

The Tribunal varied the order to allow redactions for reserves and privilege, noting this was a simple correction of an administrative error that should have been addressed under Rule 17 rather than Rule 18.

However, the Tribunal dismissed the request to reverse the sequence of production, finding no error in law in requiring the insurer to produce the log notes before the applicant particulars her claim for an award.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that found the applicant entitled to Non-Earner Benefits (NEBs) following a motor vehicle accident.

The insurer argued that the Tribunal failed to consider evidence of the applicant's ability to participate in pre-accident activities, improperly focused on only two areas of her life, and ignored her pre-existing psychological trauma.

The Executive Chair dismissed the request, finding that the Tribunal properly applied the legal test, weighed the evidence, and provided sufficient reasons for its conclusion that the applicant suffered a complete inability to carry on a normal life.

The applicant, a minor injured in a motor vehicle accident, sought attendant care benefits for care provided by her father and stepmother.

The insurer paid the benefits but deducted 30% from the claimed economic loss, arguing that the Schedule only indemnifies 'net' income loss, not 'gross' wages.

The arbitrator held that the Schedule does not define 'economic loss' or provide a formula for deducting statutory payroll deductions.

The arbitrator found the insurer's arbitrary 30% deduction was incorrect and unreasonable, ordering the insurer to pay the overdue amount of $1,791.11, plus interest, a 35% special award, and the applicant's arbitration expenses.

The insurer appealed an arbitrator's decision allowing the insured to rescind a 2001 settlement of statutory accident benefits and proceed with arbitration in 2013.

The Director's Delegate upheld the arbitrator's finding that the settlement was voidable because the insurer failed to comply with the disclosure requirements of the Settlement Regulation, specifically regarding the commuted value of benefits and maximum potential benefits.

Furthermore, the insured's claim was not statute-barred because the insurer's original refusal of benefits did not adequately inform her of the dispute resolution process, rendering the refusal invalid to trigger the limitation period under the Insurance Act.

The Limitations Act was also found inapplicable to the statutory right of rescission.

The appellant insurer appealed an arbitrator's preliminary order requiring the production of reserve information, surveillance reports, and investigative reports.

On appeal, the respondent sought to introduce fresh evidence consisting of two letters that were not before the arbitrator.

The Director's Delegate applied the Palmer test and refused leave to file the fresh evidence, finding that the letters could have been adduced at the motion with due diligence and were not determinative of the issues.

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

The insurer denied benefits, and the applicant applied for arbitration at the Financial Services Commission of Ontario.

The insurer brought a preliminary motion to dismiss the arbitration on the basis that the applicant had an ongoing civil action in the Superior Court of Justice involving substantially the same issues.

The arbitrator applied the principles from King and Royal Insurance Company of Canada, finding that the civil action was broader in scope, there was no impediment to the court dealing with the accident benefits claims, and permitting the arbitration to proceed would unduly duplicate proceedings.

The application for arbitration was dismissed.

The insurer brought a pre-hearing motion seeking a stay of the arbitration until the insured attended three requested medical assessments under section 42 of the Statutory Accident Benefits Schedule.

The insured had refused to attend the assessments, which were requested approximately two months prior to the scheduled arbitration hearing.

The arbitrator found that the assessments were not authorized by section 42, as they were requested long after the issue of post-104-week income replacement benefits had crystallized.

The arbitrator concluded that the assessments were sought to buttress the insurer's case rather than to determine entitlement, and that the late request would cause prejudice to the insured.

The motion for a stay was dismissed.

The insurer sought a stay of arbitration under section 50(b) of the Statutory Accident Benefits Schedule until the applicant attended a psychiatric examination under section 42.

The applicant argued the examination was unreasonable because the insurer had already terminated her income replacement benefits based on physical assessments and had acted in bad faith.

The arbitrator found that the applicant had placed her psychological condition in issue by submitting a psychologist's report indicating she was disabled due to psychological impairments.

The arbitrator held that the requested examination was reasonably required and ordered the applicant to attend the assessment before proceeding to arbitration on her income replacement benefits claim.

Following a preliminary issue hearing where the applicant was precluded from proceeding to arbitration due to late notice of his intention to apply for statutory accident benefits, the insurer sought its arbitration expenses.

The arbitrator found that the applicant's conduct, including failing to attend the hearing and delaying the insurer's ability to assess his medical requirements, constituted an abuse of process.

The insurer was awarded its reasonable expenses of $1,473.90.

The applicant, who was a minor at the time, filed an Application for Arbitration for statutory accident benefits.

The insurer raised a preliminary issue arguing the application was a nullity because the applicant lacked capacity to contract for legal services and failed to appoint a litigation guardian under the Dispute Resolution Practice Code.

The arbitrator held that the retainer and application were voidable, not void ab initio, as they were for the applicant's benefit.

The failure to appoint a litigation guardian was a procedural defect that did not invalidate the proceeding.

The applicant was granted time to ratify the application upon reaching the age of majority.

The applicant was injured in a motor vehicle accident but did not notify his insurer of his intention to claim statutory accident benefits until nine months later.

The insurer refused to pay for medical expenses on the basis of late notice.

The applicant argued he had an innate fear of medical professionals and hoped his injuries would subside.

The arbitrator found the applicant's explanation lacked credibility due to inconsistencies in the evidence and his failure to attend the hearing.

The arbitrator concluded the applicant did not have a reasonable explanation for the delay and is precluded from proceeding to arbitration.

The applicant was injured in a motor vehicle accident and received statutory accident benefits.

After the insurer terminated benefits, an application for arbitration was filed on his behalf.

However, the applicant had died prior to the application being issued, and an estate trustee had not yet been appointed.

The insurer argued the application was a nullity.

The arbitrator held that the doctrine of relation back applied to contractual claims for insurance benefits, allowing the subsequently appointed estate trustee to validate the application.

Alternatively, Rule 9.03 of the Rules of Civil Procedure applied to save the proceeding.

The preliminary issue was resolved in favour of the estate, allowing the arbitration to proceed.

The insurer sought to appeal an interim arbitration order requiring it to produce notes and memoranda concerning its decision to deny occupational therapy benefits.

The insured had claimed a special award for unreasonable withholding of benefits.

The Director's Delegate denied leave to appeal, noting that appeals from interim orders are generally prohibited under Rule 46.2 of the Dispute Resolution Practice Code to avoid delay and minimize costs.

The Delegate found no clear error or compelling reason to intrude on the arbitration process, as the production order was limited in scope and relevant to the specific claim.