Financial Services Commission of Ontario

FSCO A10 002979

Between

NITA MUJKU Applicant

and

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY Insurer

Reasons for decision

Before

Arbitrator Jeffrey Rogers

Heard

May 7, 8, 9, 10, 14 and 15, 2012 in Hamilton, Ontario

Written submissions were completed on October 26, 2012

Appearances

Mr. Daniel Roncari, solicitor for Mrs. Mujku

Mr. Robert Franklin, solicitor for State Farm Mutual Automobile Insurance Company

Introduction

The Applicant, Nita Mujku, was injured in a motor vehicle accident on November 10, 2005. She claims that the accident caused her to sustain a marked impairment due to mental or behavioural disorder and she is thus catastrophically impaired, within the meaning of section 2(1.2)(g) of the Schedule.

On October 29, 2009, she made an application to State Farm for a determination of catastrophic impairment. State Farm arranged for her to be assessed by a team of medical professionals (CAT assessment team). They concluded that Mrs. Mujku did not meet the test. A team that Mrs. Mujku later retained arrived at the opposite conclusion.

The parties were unable to resolve their dispute through mediation, and Mrs Mujku applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended.

The issues in this hearing are

1. Did Mrs. Mujku sustain a catastrophic impairment, as defined in section 2(1.2)(g) of the Schedule, as a result of a motor vehicle accident on November 10, 2005.
2. Is either party required to pay the other's expenses of this hearing?

Result

1. Mrs. Mujku sustained a catastrophic impairment as defined in section 2(1.2)(g) of the Schedule, as a result of a motor vehicle accident on November 10, 2005.
2. If they are unable to resolve the issue of expenses, either party may make an appointment for me to determine the matter in accordance with Rules 75 to 79 of the Dispute Resolution Practice Code.

For more details: Mujku v State Farm Mutual Automobile Insurance Company

If you or a loved one has been injured, call The Morris Law Group at 905-526-8080 or toll-free at 1-877-464-4466 for a free no obligation consultation with one of our experienced personal injury lawyers. At our law firm we work on a contingency basis, meaning that you don’t pay until your case settles.