Ralph D'Angelo

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

A priority dispute arose between the insurer of the vehicle she was in (Simcoe & Erie) and the insurer of her sister and brother-in-law's vehicle (Farmers').

The issue was whether the applicant was a dependant of her sister and brother-in-law, with whom she lived.

The arbitrator found that the applicant provided extensive childcare and household services in exchange for room and board, and also earned part-time income.

Relying on expert economic evidence, the arbitrator concluded that the value of the applicant's services and income significantly exceeded the value of the room and board she received.

Therefore, she was not principally dependent on her relatives, and Simcoe & Erie was liable to pay her benefits.

The applicant was struck by a car and claimed statutory accident benefits.

He sought weekly income benefits under section 12 of the Schedule, claiming he was self-employed as a tailor.

The arbitrator found the applicant failed to prove he was employed or self-employed at the time of the accident, as he had declared no income and admitted to avoiding work.

The applicant alternatively claimed ongoing non-earner benefits under section 13.

Relying on consistent specialist medical evidence that the applicant had recovered and was exaggerating his symptoms, the arbitrator concluded the applicant did not suffer a substantial inability to perform his essential tasks.

The claims for ongoing benefits were dismissed, but the applicant was awarded his arbitration expenses.

The applicant's husband, a taxi driver, was murdered in his vehicle while on duty.

The applicant sought funeral and death benefits from the deceased's automobile insurer, arguing his death was an 'accident' because he was targeted for robbery due to his occupation.

The arbitrator dismissed the claim, finding that while the vehicle was the location of the crime, the death was not caused directly or indirectly by the use or operation of the automobile.

The applicant was awarded her arbitration expenses.

The applicant was injured in a motor vehicle accident in November 1990 and received weekly income benefits from the first insurer until October 1992.

She was involved in a second accident in April 1992, involving a second insurer.

The applicant sought further weekly income benefits and rehabilitation expenses, while the first insurer sought repayment from the second insurer for benefits paid after the second accident.

The arbitrator found that the applicant was not substantially unable to perform the essential tasks of her occupation after October 1992 and dismissed the claim for further benefits and rehabilitation expenses.

The first insurer was held liable for benefits paid between the second accident and October 1992, and the applicant was ordered to repay $1,200 for post-accident income received.

The applicant, a taxi driver, was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them.

The applicant sought arbitration to reinstate the benefits and increase the weekly rate.

The arbitrator found that the applicant had a significant pre-existing back condition (ankylosing spondylitis) which he had concealed from medical examiners.

Due to inconsistencies and false evidence regarding his post-accident employment and pre-accident income, the arbitrator concluded the applicant failed to prove a substantial inability to perform his essential tasks.

The claim for further benefits was dismissed, the weekly rate was maintained at the statutory minimum, and no costs were awarded to either party.

The applicant was injured in a motor vehicle accident and received weekly income benefits from the insurer until they were terminated.

The applicant applied for mediation and claimed that the parties reached a settlement to reinstate benefits at $600 per week, as reflected in a Report of Mediator.

The insurer argued that the agreement was contingent on receiving verification of the applicant's pre-accident income.

The arbitrator found that there was an honest misunderstanding between the parties and concluded that no binding settlement was reached regarding the proper amount of the weekly income benefits.

The applicant was awarded expenses for the preliminary issue.

The applicant, a high school student injured in a motor vehicle accident, had a legitimate offer for a summer job at the time of the accident.

The insurer paid increased weekly benefits during the summer employment period but reduced them after the job would have ended.

The applicant sought to have the higher benefit rate continue indefinitely.

The arbitrator held that under section 12 of the Statutory Accident Benefits Schedule, the weekly benefit for an insured with a time-limited employment offer is based on the contract of employment only for the expected duration of that employment.

After the summer job period ended, the applicant's benefits were correctly reduced to the statutory minimum of $185.60 per week.

The applicant was awarded expenses due to the novel legal question.

The applicant sought ongoing weekly income benefits and a special award following a motor vehicle accident.

The insurer terminated benefits after an independent medical examination concluded the applicant's complaints were not genuine and he was fit to return to work.

The arbitrator dismissed the claim for ongoing benefits, finding the applicant's evidence lacked credibility due to his active concealment of a prior similar accident and exaggeration of his symptoms.

The claim for a special award was also dismissed, but the applicant was awarded his arbitration expenses because the claim was not manifestly frivolous.

The Applicant was injured in a motor vehicle accident and received accident benefits until the Insurer allegedly terminated them.

The Insurer argued the Applicant's request for arbitration was barred by the two-year limitation period under s. 281(5) of the Insurance Act.

The arbitrator found that the Insurer failed to prove actual delivery of the notice of denial as required by s. 148(15) of the Insurance Act, rejecting the application of the 'mailbox rule'.

The Applicant was permitted to proceed to arbitration.

The Applicant was injured in a motor vehicle accident and received weekly income benefits.

The Insurer reduced these benefits by the amount of disability insurance payments made by Seaboard Life Insurance Company to Chrysler Credit to repay the Applicant's car loan.

The arbitrator held that the disability payments were not 'payments for loss of income' received by or available to the Applicant under an income continuation benefit plan, as their purpose was to protect the creditor, not to compensate the Applicant for lost earnings.

The payments were therefore not deductible.

The Applicant's claim for a special award was dismissed as the Insurer had a bona fide disagreement regarding the interpretation of the legislation.

The applicants' daughter was killed in a motor vehicle accident.

They applied for death benefits under the No-Fault Benefits Schedule, which the insurer denied on the basis that the daughter was not 'principally dependent for financial support' on her parents.

The arbitrator found that although the parents generously supplemented their daughter's income, she was employed full-time, lived in her own apartment, and was financially able to provide for herself.

The application for death benefits was dismissed, but the applicants were awarded their arbitration expenses.

The applicant was injured in a motor vehicle accident while driving a taxicab and received weekly income benefits until April 26, 1991.

The insurer terminated benefits based on medical assessments indicating the applicant was no longer substantially disabled.

The applicant sought ongoing weekly income benefits, payment for a functional restoration program (F.I.T.), a special award, and expenses.

The arbitrator dismissed the claim for ongoing weekly income benefits, finding the applicant's subjective complaints of pain and depression were exaggerated and unsupported by objective medical evidence.

However, the arbitrator ordered the insurer to pay for the F.I.T. program, concluding it was a reasonable and necessary expense to restore the applicant to his pre-accident condition, and rejected the insurer's argument that the applicant failed to mitigate his damages by abandoning an earlier program.

The request for a special award was denied, but the applicant was awarded his expenses for the hearing.