Tamara Tomomitsu

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant had a reasonable explanation for the late submission of his Application for Accident Benefits (OCF-1).

The insurer argued that the adjudicators erred in their assessment of the applicant's credibility and the reasonableness of his explanation, specifically regarding when he retained counsel and his post-accident medical complications.

The Tribunal dismissed the request for reconsideration, finding that the insurer was attempting to re-litigate findings of fact and had failed to establish any error of law or fact that would warrant varying the decision.

The applicant sought statutory accident benefits after injuring his right leg while being placed in the back seat of a police vehicle.

The respondent insurer denied the claim, arguing the incident was not an 'accident' and that the applicant was statute-barred for providing late notice.

The Tribunal found that the incident met the definition of an accident, as being a seated passenger in a police vehicle is an ordinary use, and the vehicle's use was the dominant feature of the injury, which ultimately led to a below-the-knee amputation.

The Tribunal also found the applicant had a reasonable explanation for the late notice due to his severe medical complications and lack of sophistication.

The applicant was awarded $2,200.00 for an orthopaedic assessment.

The applicant was struck by a police vehicle while walking in a parking lot and sought non-earner benefits and medical benefits under the Statutory Accident Benefits Schedule.

The insurer denied the claims, arguing the applicant's impairments stemmed from a prior 2010 motor vehicle accident and a physical assault that occurred immediately before the 2011 accident.

The arbitrator found that the applicant failed to establish that the 2011 accident caused an impairment that continuously prevented him from engaging in substantially all of his pre-accident activities.

The arbitrator noted the applicant's expert admitted his diagnosis might have changed had he known about the applicant's prior chronic pain.

The application for benefits and a special award was dismissed.

In a pedestrian–streetcar collision action, a transit authority brought a summary judgment motion seeking dismissal of the plaintiff’s claim against its municipal co‑defendant.

The moving party argued that it would assume responsibility for maintenance of trees on a median that allegedly obstructed the streetcar operator’s view and relied on statutory provisions of the City of Toronto Act.

The court held that the summary judgment rules could permit a defendant to seek dismissal of a claim against a co‑defendant, but the evidentiary record revealed genuine issues requiring a trial regarding responsibility for the median and trees.

Ownership of the land remained with the municipality and the statutory provision did not bar claims where the property was not the transit authority’s.

The motion was dismissed and costs were awarded to the plaintiff.

The plaintiffs appealed a Rule 21 motion decision determining that where a plaintiff is involved in two motor vehicle accidents and the actions are tried together, the statutory deductible under s. 267.5(7) of the Insurance Act applies to each action individually.

The Court of Appeal agreed with the motion judge that the plain meaning of the provision requires the court to determine general damages for each action and then reduce that amount by the statutory deductible.

The appeal was dismissed.

The insurer brought a motion to stay the arbitration proceeding until the applicant attended three insurer examinations under section 42 of the Statutory Accident Benefits Schedule.

The applicant had refused to attend the examinations, arguing they were solely to determine if his impairment was catastrophic, which was not an issue in the arbitration.

The arbitrator found that two of the examinations were primarily for determining catastrophic impairment and were not proper under section 42.

However, the arbitrator ordered the applicant to attend the third examination with a neurologist, as it was reasonably necessary to assess the ongoing claim for income replacement benefits.

The motion was allowed in part, but the request to stay the arbitration was denied.

The insurer brought a motion for an order compelling the applicant to produce medical and financial documents, and to add the applicant's entitlement to ongoing income replacement benefits (IRBs) as an issue in the arbitration.

The applicant agreed to provide consents for the release of the requested medical documentation.

The arbitrator found that it was premature to add the IRB issue to the arbitration because the parties were still awaiting a Designated Assessment Centre (DAC) report, and it was unclear if there would continue to be a dispute over the IRB payments.

The issue of expenses for the motion was left to the discretion of the hearing arbitrator.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The insurer terminated benefits and sought repayment, alleging the applicant was not in the vehicle and had misrepresented his employment.

The applicant did not attend the arbitration hearing.

The arbitrator found, based on police and witness evidence, that the applicant was not in the vehicle and had submitted false employment information.

The applicant's claims were dismissed.

The insurer was awarded repayment of benefits paid, its arbitration assessment fee, and its expenses of the arbitration.