Ralph D'Angelo

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

The matter proceeded to an arbitration hearing, but the applicant failed to attend or present any evidence.

The arbitrator found that the applicant had received notice of the hearing but failed to meet his burden of proof.

The application was dismissed in its entirety.

The applicant sought judicial review of a decision by the Director of Arbitrations, which upheld an Arbitrator's dismissal of his claim for statutory accident benefits and ordered him to pay arbitration expenses.

The applicant claimed he was injured on a TTC bus, but initially reported it as a subway accident.

The Divisional Court dismissed the application, finding that the Arbitrator's factual findings and costs order were supported by the evidence and not patently unreasonable.

The respondent was severely injured after rolling out of his moving car on Highway 401 and jumping off a bridge onto Bayview Avenue.

The arbitrator found he suffered a panic attack while driving, which directly caused him to exit the car and leap, qualifying as an 'accident' under the SABS-1996.

On appeal, the Director's Delegate found the arbitrator failed to properly explain his preference for hearsay evidence regarding the panic attack and failed to consider the respondent's testimony about his actions after leaving the car.

The appeal was allowed and the matter remitted for a new hearing.

The insurer brought a motion to stay or adjourn the arbitration pending the applicant's attendance at a section 42 medical examination.

The examination was scheduled on the eve of the arbitration hearing, which had been set over a year prior.

The arbitrator found that the insurer had delayed unreasonably in requesting the examination, knowing that post-104 week benefits were in issue, and failed to make reasonable efforts to schedule it at a convenient time.

Granting the request would cause an unjustifiable adjournment and prejudice the applicant's right to a timely hearing.

The motion was dismissed, and the insurer was ordered to pay $600 in expenses.

The applicant suffered a panic attack while driving on Highway 401, causing him to exit his moving vehicle, run to the edge of the highway, and leap off the overpass onto the road below.

The insurer denied his application for statutory accident benefits, arguing the incident was not an 'accident' under the Schedule and that the panic attack was an intervening force.

The arbitrator found that the applicant's panic attack directly caused him to exit the vehicle and jump, with no break in the chain of events.

Applying the 'thin skull' principle, the arbitrator concluded the incident constituted an accident arising out of the use or operation of an automobile, entitling the applicant to claim benefits.

The applicant was injured in a motor vehicle accident while driving on a 400 series highway with a G1 licence.

The insurer refused to pay income replacement benefits, arguing the applicant was driving without a valid licence under s. 30(1)(b) of the Statutory Accident Benefits Schedule.

The arbitrator held that driving on a prohibited highway with a graduated licence constitutes driving without a valid licence.

The applicant failed to adduce evidence of any exception or defence.

The applicant is precluded from proceeding to arbitration for income replacement and housekeeping benefits.

The applicant's claim for statutory accident benefits was previously dismissed, and he was ordered to pay half of the insurer's arbitration expenses.

In this decision on expenses, the arbitrator assessed the quantum of costs.

The arbitrator allowed a preparation-to-hearing ratio of 1.6 to 1, approved a 25% experience premium for the insurer's in-house counsel, and allowed mileage for counsel and a witness.

However, the arbitrator disallowed the cost of a court reporter, finding it was not an allowable disbursement under the Expense Regulation.

The applicant was ordered to pay $2,522.91 in expenses.

The appellant appealed an Arbitrator's decision dismissing his claim for statutory accident benefits and ordering him to pay half of the insurer's arbitration expenses.

The central issue at arbitration was whether the appellant was injured on a TTC bus or a subway train, with the Arbitrator finding his uncorroborated evidence inconsistent and unreliable.

On appeal, the Director's Delegate refused to admit new medical evidence and found no errors of law in the Arbitrator's credibility findings, application of the burden of proof, rejection of the estoppel argument, or award of expenses.

The appeal was dismissed and the appellant was ordered to pay $500 in appeal expenses.

The applicant claimed statutory accident benefits following an alleged incident on a TTC bus.

The insurer denied the claim on the basis that the incident actually occurred on a subway train, which does not meet the definition of an 'automobile' under the Statutory Accident Benefits Schedule.

At arbitration, the arbitrator found that the applicant failed to prove on a balance of probabilities that the incident occurred on a bus, relying on contemporaneous records indicating it occurred on a subway.

The arbitrator also found insufficient medical evidence of an impairment.

The application for benefits was dismissed.

The insurer's request for an award for a frivolous application was denied, but the applicant was ordered to pay half of the insurer's arbitration expenses due to his conduct during the proceeding.

The insurer brought a motion on preliminary issues regarding the format of a pre-hearing discussion and the applicant's failure to attend insurer examinations.

The self-represented applicant requested a teleconference for convenience, while the insurer insisted on an in-person meeting to better assess credibility and facilitate settlement.

The arbitrator ordered the pre-hearing to be held face-to-face, noting that in-person discussions are generally more fruitful for settlement and the applicant lived a reasonable distance from the Commission.

The issue regarding the insurer examinations was withdrawn after the applicant clarified he was only claiming benefits up to a specific date.

The appellant sought indemnity and defence costs under a homeowner's policy after judgment was entered against him for injuries arising from a schoolyard fight.

The Court of Appeal held that the policy's exclusion for bodily injury caused intentionally by or at the direction of an insured barred coverage where the appellant intentionally struck the plaintiff.

The court rejected the argument that only the foreseeable injuries were excluded, holding that once an intentional tort is committed, it is irrelevant that the resulting harm is more serious than expected.

The appeal from the special case judgment was dismissed with costs.

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

A dispute arose regarding the calculation of his pre-accident income from his self-employment at a family-owned car rental and repair business.

The applicant argued that significant personal expenses had been run through the company and should be added back to its profits, of which he claimed 100 percent.

The arbitrator determined the company's 1994 profit was $50,000, apportioned 50 percent to the applicant, and ordered that claim code 1 be used to determine his net income.

The applicant was also awarded expenses and interest on overdue benefits.

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

The insurer terminated these benefits after 121 weeks, having offered a zero loss of earning capacity (LEC) benefit which the applicant was deemed to have rejected.

The applicant sought ongoing income replacement benefits pending the resolution of the LEC dispute.

The arbitrator held that under section 23 of the Statutory Accident Benefits Schedule, the insurer is required to continue paying income replacement benefits unless and until it elects to pay an LEC benefit based on its offer and the residual earning capacity assessment.

The parties appealed an arbitration decision regarding the calculation of loss of earning capacity benefits (LECBs) and the insurer's obligation to continue paying income replacement benefits (IRBs) pending the resolution of the LECB dispute.

The Director's Delegate held that the 1995 amendments to the Statutory Accident Benefits Schedule, which removed the requirement to pay IRBs pending an LECB dispute, applied to the insured's ongoing claim and did not interfere with vested rights.

The Delegate upheld the arbitrator's calculation of pre-accident earning capacity, which considered a post-accident recall notice, and the calculation of residual earning capacity, which considered the insured's vocational preferences.

The insurer's appeal was allowed in part, and the insured's appeal was dismissed.

The appellant, a high school student, was injured in a motor vehicle accident before starting a summer job.

The insurer paid weekly income benefits based on the prospective job's earnings for the duration of the summer contract, but reduced the benefits thereafter.

The Director's Delegate allowed the appeal, holding that under the Statutory Accident Benefits Schedule, once a person qualifies for benefits based on a definite job offer, the gross weekly income calculated from that contract establishes the benefit rate for the entire duration of the disability, not just the term of the contract.

The applicant, a taxi driver, was injured when pinned between two vehicles.

He claimed ongoing weekly income benefits, alleging chronic pain and depression prevented him from working.

The insurer terminated benefits after medical assessments indicated he could return to work.

The arbitrator dismissed the claim for ongoing benefits, finding the applicant lacked credibility, exaggerated his symptoms, and had been working covertly at his brother's store, as revealed by surveillance evidence.

The medical opinions supporting disability were rejected as they relied on the applicant's unreliable subjective reporting.

The applicant was awarded one-third of his expenses.

The applicant was injured in a snowmobile accident and received income replacement benefits (IRBs) for 104 weeks.

The insurer then terminated IRBs and offered a 'nil' loss of earning capacity (LEC) benefit.

The applicant disputed the LEC benefit amount and claimed entitlement to ongoing IRBs pending the dispute's resolution.

The arbitrator held that the pre-1995 version of the Statutory Accident Benefits Schedule applied, entitling the applicant to ongoing IRBs pending resolution.

The arbitrator determined the applicant's pre-accident earning capacity based on his intermittent employment history and his residual earning capacity based on an electronics assembler position, resulting in a weekly LEC benefit of $153.41.

The insurer was ordered to pay the ongoing IRBs, the LEC benefit, and the applicant's arbitration expenses.

The claimant was injured while driving a taxicab insured by Simcoe & Erie.

He also owned a personal vehicle insured by State Farm.

State Farm argued it was not liable to pay statutory accident benefits because its policy excluded coverage while the automobile was used as a taxicab.

The Director's Delegate held that the broad definition of 'insured person' in the Statutory Accident Benefits Schedule prevailed over the exclusionary language in the standard Owner's Policy.

Under the priority rules in section 268(2) of the Insurance Act, the claimant was required to claim benefits from State Farm, the insurer of his personal vehicle, despite the accident involving a taxicab.

The appellant's husband, a taxi driver, was found murdered in his taxi cab.

The appellant claimed statutory accident benefits, including funeral and death benefits, from the respondent insurer.

The insurer denied the claim on the basis that the death was not an 'accident' as defined in the Statutory Accident Benefits Schedule.

The arbitrator agreed, finding no causal connection between the death and the use or operation of the vehicle.

On appeal, the Director's Delegate applied the Supreme Court of Canada's causation test from Amos and upheld the arbitrator's decision, concluding that the available evidence did not establish that the murder was directly or indirectly caused by the use or operation of the taxi cab.

The appellant appealed an arbitrator's decision denying him weekly income benefits following a motor vehicle accident.

The arbitrator had found the appellant's testimony regarding his injuries and prior accidents to be not credible, which compromised the medical evidence relying on his subjective complaints.

The Director's Delegate held that there was sufficient evidence to support the arbitrator's findings of fact and credibility.

The appeal was dismissed, and the appellant was denied his appeal expenses.

The insurer's request for the cost of its assessment was also denied, as the appeal was not found to be frivolous or vexatious.