Jamie Robin Pollack

The applicant sought statutory accident benefits arising from a motor vehicle accident involving her mother when the applicant was seven years old.

The applicant submitted an application for benefits (OCF-1) nearly twelve years after the accident and almost two years after turning eighteen.

The insurer denied the claim due to the delay.

The Tribunal found that the applicant failed to provide a reasonable explanation for the delay in submitting the OCF-1 after reaching the age of majority.

The application was dismissed as the applicant was barred from proceeding under section 55(1) of the Schedule.

The respondent raised a preliminary issue that the applicant was barred from proceeding with her claim for accident benefits due to late submission of her application (OCF-1) under section 32(5) of the Schedule.

In its submissions, the respondent primarily argued late notification under section 32(1).

The Tribunal found that the issue of late notification was not properly before it, as it was not raised at the case conference or in the Case Conference Report and Order.

Regarding section 32(5), the Tribunal found no evidence that the respondent provided the applicant with an accident benefits package, which is required to trigger the 30-day timeline for submitting the OCF-1.

Therefore, the respondent failed to show the applicant did not comply with section 32(5).

The applicant was permitted to proceed with her application.

The applicant sought statutory accident benefits for psychological injuries allegedly sustained during a road rage incident where third parties struck her vehicle and yelled at her.

The respondent denied benefits on the basis that the incident was not an 'accident' under the Schedule.

The Tribunal applied the two-part purpose and causation test and found that the incident did not arise out of the ordinary use or operation of an automobile.

The Tribunal concluded that the verbal and feared assaults constituted an intervening act that broke the chain of causation.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for an attendant care benefit, treatment plans for meal delivery, and a visual skills assessment following a motor vehicle accident.

The Vice-Chair granted the reconsideration in part, finding that the original decision erred by focusing exclusively on the applicant's physical ability to prepare meals while ignoring her documented cognitive and psychological limitations.

The Tribunal varied the decision to award the attendant care benefit of $448.49 per month.

However, while the Tribunal found an error in the original statutory interpretation regarding meal delivery plans, it ultimately confirmed their denial, concluding they were not reasonable and necessary given the approval of the attendant care benefit.

The denial of the visual skills assessment was also confirmed.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that denied her claims for an Income Replacement Benefit (IRB) and various treatment plans following a motor vehicle accident.

The applicant argued the Tribunal erred in law by requiring her to prove IRB entitlement after finding an accident occurred, and by not assessing whether the treatment plans were reasonable and necessary.

The Tribunal dismissed the reconsideration request, finding no error of law, as the applicant failed to meet her evidentiary burden for the IRB and the treatment plans were not incurred.

The Court of Appeal for Ontario considered whether arbitrators may order a higher-priority automobile insurer to reimburse a lower-priority insurer for pre-arbitration expenses incurred in handling a Statutory Accident Benefits (SABs) claim, outside the specific circumstances set out in Ontario Regulation 283/95.

The court held that, except in cases of improper deflection as provided in s. 2.1(7) of the regulation, arbitrators do not have authority to order such reimbursement.

The appeal was allowed, restoring the arbitrator’s decision that Unifund was not required to reimburse Echelon for its pre-arbitration expenses.

The applicant sought statutory accident benefits following an incident where she was assaulted by her husband while driving, causing her to veer off the road and mount a curb.

The Tribunal found that the incident met the definition of an "accident" under s. 3(1) of the Schedule, as the operation of the vehicle was the dominant feature causing her psychological injuries, which exacerbated pre-existing conditions.

Consequently, the applicant's injuries were removed from the Minor Injury Guideline.

However, the applicant's claims for an income replacement benefit, various treatment plans, attendant care benefits, and a special award were dismissed because she failed to provide sufficient medical evidence or establish that the expenses were reasonable, necessary, and incurred.

The applicant sought $19,097.00 for a multidisciplinary catastrophic impairment assessment following a 2012 motor vehicle accident.

The respondent insurer denied the treatment plan, arguing the applicant sustained only minor soft tissue injuries and had a significant pre-existing medical history.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide corroborating medical evidence to support the necessity of the assessments or justify their costs, particularly given the $2,000 cap per assessment under section 25(5)(a) of the Schedule.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment due to mental and behavioural disorders.

The Licence Appeal Tribunal found the applicant sustained a catastrophic impairment under criterion 8, demonstrating marked impairments in activities of daily living, concentration, persistence and pace, and adaptation.

The Tribunal preferred the evidence of the applicant's psychological assessor over the insurer's assessor.

The applicant was also awarded entitlement to six disputed treatment plans for case management services, along with interest on overdue payments.

The appellant was assaulted by her husband while driving, causing her to lose control of the vehicle and strike her head.

She applied for statutory accident benefits.

The Licence Appeal Tribunal found the incident was not an 'accident' because the assault was an intervening act and the dominant feature of the injuries.

On appeal, the Divisional Court held that the adjudicator erred in law by failing to consider the incident in two phases: the assault itself, and the subsequent loss of control of the vehicle.

The appeal was allowed in part, and the issue of whether the injuries from the loss of control constituted an accident was remitted for a hearing.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including treatment plans for physiotherapy, occupational therapy, a chronic pain assessment, and catastrophic impairment assessments.

The respondent denied the benefits.

The Tribunal found that the respondent's notices of denial were compliant with the Statutory Accident Benefits Schedule.

On the merits, the Tribunal held that the applicant failed to prove the treatment plans were reasonable and necessary, noting that the applicant's cognitive impairments were pre-existing and that she had reached maximal medical recovery for her accident-related physical injuries.

The application was dismissed.

The appellant insurer appealed a Licence Appeal Tribunal (LAT) decision finding the respondent eligible for funding for an attendant care benefit assessment.

The respondent suffered minor injuries in a motor vehicle accident but was removed from the Minor Injury Guideline (MIG) due to a pre-existing medical condition.

The insurer argued that because the injuries were minor, the respondent was excluded from attendant care assessments under the Statutory Accident Benefits Schedule (SABS).

The Divisional Court upheld the LAT's interpretation that once a claimant is removed from the MIG due to a pre-existing condition, they are no longer subject to the limits for minor injuries, and the test for services becomes what is reasonable and necessary.

The appeal was dismissed.

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

The insurer denied benefits and requested several insurer's examinations (IEs), which the applicant failed to attend.

The insurer argued the applicant was barred from proceeding before the Tribunal under s. 55 of the Schedule.

The Tribunal found that the notices of examination for issues 1, 2, 3, 4, 7, and 9 were deficient as they failed to provide sufficient medical and other reasons as required by s. 44(5).

However, the notices for issues 5 and 6 were compliant, and the applicant provided no reasonable explanation for failing to attend.

Consequently, the applicant was barred from proceeding with issues 5 and 6, while the remaining issues were permitted to proceed to a substantive hearing.

The applicant requested a reconsideration of a preliminary issue decision which found she was not involved in an accident.

The applicant argued the Tribunal made an error of law or fact by failing to properly apply the causation test and the dominant feature test.

The Tribunal dismissed the request, finding that the applicant was attempting to re-argue her case and introduce new arguments not raised at the initial hearing.

The Tribunal concluded no error of law or fact was made.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming a catastrophic impairment and entitlement to medical benefits for an in-home assessment and an in-patient addiction treatment program.

The applicant passed away shortly after the hearing, rendering the catastrophic impairment issue moot.

The Tribunal found that the applicant's polysubstance abuse disorder was directly caused by the accident due to the prescription of opioid medication for accident-related pain.

The Tribunal granted the $21,450.00 treatment plan for the addiction centre as reasonable and necessary, but denied the $1,709.45 assessment plan because it was incurred before submission.

The claim for an award under Regulation 664 was dismissed as the insurer's position was not unreasonable.

The applicant sought statutory accident benefits after sustaining injuries when her husband assaulted her while she was driving, causing her to lose control of the vehicle and hit a curb.

The respondent insurer raised a preliminary issue of whether the incident constituted an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part purpose and causation test, finding that while the purpose test was met, the causation test was not.

The Tribunal concluded that the assault was an intervening act and the dominant feature of the injuries, breaking the chain of causation from the use or operation of the automobile.

The application was dismissed.

The respondent insurer sought an adjournment of the hearing because it had not completed its insurer examinations regarding the applicant's catastrophic impairment claim.

The adjudicator granted the adjournment orally, prompting the applicant to bring a motion for the adjudicator to recuse herself based on a reasonable apprehension of bias.

The adjudicator dismissed the recusal motion, finding no evidence of bias and noting that the adjournment was necessary to ensure procedural fairness, as the respondent would otherwise be unable to defend the case.

The hearing was adjourned for 120 days.

The applicant was injured in a motor vehicle accident while riding his bicycle and sought various statutory accident benefits, including a determination of catastrophic impairment.

The Licence Appeal Tribunal found that the applicant did not meet the criteria for catastrophic impairment under the Schedule, preferring the insurer's expert evidence that the applicant did not suffer a marked psychological impairment.

However, the Tribunal found the applicant was entitled to non-earner benefits, as his physical injuries caused a complete inability to carry on a normal life.

Claims for attendant care, housekeeping, and certain treatment plans were dismissed as not reasonable and necessary, though an occupational therapy assessment was approved.

The claim for a special award was denied.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claim for a treatment plan and an award under Regulation 664.

The applicant argued the adjudicator erred in law and fact by failing to consider older medical reports, overly relying on the respondent's reports, and failing to consider the claim for an award.

The Vice-Chair dismissed the request, finding that seeking a reweighing of evidence is not a valid ground for reconsideration.

The Vice-Chair also found no error in the original decision's treatment of the medical evidence or the denial of the award, as the applicant had failed to provide sufficient submissions at the initial hearing.

The applicant requested a reconsideration of a decision finding she did not meet the criteria for catastrophic impairment.

She argued the adjudicator erred in finding her emotional impairments were not caused by the accident involving her son, and in interpreting the Statutory Accident Benefits Schedule.

The Vice Chair dismissed the request, finding no errors of law or fact in the original decision's causation analysis or statutory interpretation.