Sam C. Pitaro

The applicant was struck by a vehicle as a pedestrian and applied for statutory accident benefits from the respondent, who insured the vehicle.

The respondent denied the claim on the basis that the policy had expired prior to the accident.

The Tribunal found that a sufficient nexus existed between the applicant and the respondent, requiring the respondent to adjust the claim and pay benefits pending any priority dispute.

The Tribunal awarded the applicant an income replacement benefit for the period he was off work due to his injuries, but denied his claims for chiropractic services and an ambulance fee due to insufficient evidence.

The applicant requested a reconsideration of a Tribunal decision that found her entitled to income replacement benefits (IRBs) but quantified them at nil.

The applicant argued the Tribunal breached procedural fairness by admitting late-filed expert reports from the insurer's examination (IE) assessors regarding medical entitlement, and erred in law by finding she was self-employed and excluding her prior year's employment income.

The Tribunal granted the reconsideration in part, varying the decision to vacate all findings related to medical entitlement due to the respondent's breach of expert disclosure rules.

However, the Tribunal dismissed the request regarding the quantum of IRBs, finding no error in the determination that the applicant was self-employed and that her IRBs were correctly calculated at nil under the Schedule.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The central issue was whether the applicant, a personal support worker who had recently registered a business at the behest of a staffing agency, was 'employed' or 'self-employed' under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of her employment for a closed period.

However, applying the Schedule's definitions, the Tribunal determined she was solely self-employed at the time of the accident.

Because her business reported no income in the prior fiscal year, and she could not rely on her previous employment income, the quantum of her IRBs was calculated as nil.

The application was dismissed.

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

The Tribunal found the applicant was prohibited from proceeding with two treatment plans due to his failure to attend scheduled insurer examinations without a valid reason.

However, the applicant was permitted to proceed with a February 6, 2020 treatment plan, as the insurer failed to prove the treatment was incurred prior to submission.

On the merits, the Tribunal approved the February 6, 2020 plan for chiropractic and physiotherapy treatment, finding it reasonable and necessary for the applicant's post-concussion symptoms.

A subsequent identical plan was denied as duplicative.

The applicant's claim for a special award was dismissed.

The plaintiff suffered the loss of his left eye when a firecracker was lit and thrown by the defendant Joel Binns.

The defendants Joel Binns and his father Michael Binns were noted in default.

The court granted default judgment, finding Joel Binns liable for the battery/negligence and Michael Binns liable for failing to supervise or warn his son about fireworks.

The court assessed damages, awarding the plaintiff $125,000 in non-pecuniary damages, plus out-of-pocket expenses, lost wages, and interest, totaling $175,708.14, along with partial indemnity costs.

The applicant was catastrophically injured in a motorcycle accident and subsequently moved to Romania, where his family provides round-the-clock attendant care.

The insurer argued that the attendant care benefits should be paid at the Romanian minimum wage rate ($1.30/hour) rather than the Ontario minimum wage rate ($7.75/hour) specified in the Form 1, asserting that 'incurred' expenses means actual cost.

The arbitrator rejected the insurer's argument, holding that the Schedule mandates the use of the prescribed hourly rates in the Form 1 and that 'incurred' does not restrict the benefit to the actual cost when the reasonableness, necessity, and calculated amount are established.

Following a preliminary issue hearing where the insurer successfully argued the applicant was not an insured person, the applicant sought her arbitration expenses.

The arbitrator found that the application was brought in good faith on a novel and significant issue of interpretation, which outweighed the insurer's ultimate success.

The applicant was awarded expenses fixed at $9,197.93, with deductions made for certain pre-arbitration fees, an unnecessary airline ticket for the applicant's mother, and unallowable travel disbursements.

The applicant, a Mexican citizen studying English in Toronto, was injured in a motor vehicle accident in Quebec while a passenger in a vehicle insured by the respondent.

She applied for statutory accident benefits in Ontario.

The insurer denied the claim on the basis that she was not a 'resident of Ontario' and therefore not an 'insured person' under section 2 of the Bill 59 Schedule.

The arbitrator found that the applicant's stay in Ontario was temporary and for a limited purpose, lacking the permanence required to establish residency.

The applicant was found not to be an insured person under the Schedule.