Jamie Robin Pollack

The applicant sought entitlement to a treatment plan for occupational therapy, kinesiology services, and a Samsung tablet following a 2010 motor vehicle accident, as well as an award under Regulation 664 for unreasonable delay.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide compelling contemporaneous evidence to prove the treatment plan was reasonable and necessary.

The Tribunal also relied on an insurer's examination report indicating the applicant was largely independent in his daily activities.

The claim for an award was dismissed as the applicant failed to demonstrate the insurer's actions were excessive or imprudent.

The applicant sought a catastrophic impairment designation for psychological and mental injuries allegedly suffered as a result of her child's motor vehicle accident.

The applicant was not involved in and did not witness the accident.

The Tribunal held that the applicant did not meet the criteria for catastrophic impairment under section 3(2) of the Statutory Accident Benefits Schedule, as her injuries were not directly 'caused by an accident'.

The Tribunal found that the legislature purposely restricted catastrophic impairment designation to those directly injured by the use or operation of an automobile.

The appellant was catastrophically injured in a motor vehicle accident and sought attendant care benefits and a special award from his insurer.

At first instance, the Licence Appeal Tribunal awarded attendant care benefits up to $6,000 per month and a special award.

On reconsideration, the LAT varied the decision, finding the initial adjudicator erred by not applying the mandatory maximum hourly rates for attendant care and by misapplying the test for a special award.

The appellant appealed to the Divisional Court.

The court dismissed the appeal, holding that the reconsideration adjudicator made no errors of law in applying the statutory hourly rate caps or in setting aside the special award based on the established legal test.

The self-represented applicant sought $6.0 million in chiropractic services arising from a 2007 motor vehicle accident.

The respondent insurer brought a preliminary issue motion to dismiss the application.

The Tribunal found it lacked jurisdiction to hear the application because the applicant had not submitted a Treatment and Assessment Plan (OCF-18) as required by section 38 of the Schedule.

Without a submitted plan and a subsequent denial by the insurer, there was no 'dispute' within the meaning of section 280 of the Insurance Act.

The application was dismissed.

The applicant, injured in utero during a motor vehicle accident and born prematurely with cerebral palsy, sought attendant care benefits.

The insurer initially approved the benefits based on a medical report but later sought to raise a causation defence relying on a new report from an obstetrician.

The applicant argued the insurer was precluded from raising causation due to the two-year limitation period and waiver, and sought to exclude the new report.

The Adjudicator held that the insurer was not precluded from arguing causation, finding no waiver and that the limitation period in s. 56 of the Schedule applies to claims, not defences.

The Adjudicator also permitted the insurer to rely on the new medical report, finding it was validly obtained under s. 44.

This motion concerned an application for judicial approval of a settlement for statutory accident benefits (SABS) for a catastrophically injured claimant who lacked capacity to instruct counsel.

The court expressed significant concerns regarding the adequacy of the proposed settlement amount, the fairness and applicability of the contingency fee agreement to a SABS claim, the claimant's capacity at the time of signing the fee agreement and various loans, and the absence of a proper management plan for the lump sum payment.

The court refused to approve the settlement as proposed and referred the matter to the Office of the Public Guardian and Trustee for further input, remaining seized of the matter.

The claimant, an Ontario resident, was catastrophically injured in a motor vehicle accident in Nunavut while driving a Nunavut-plated vehicle insured by the appellant.

The respondent, the claimant's Ontario insurer, paid Ontario statutory accident benefits and sought reimbursement from the appellant under the priority provisions of the Ontario Insurance Act.

The arbitrator and appeal judge ruled in favour of the respondent.

The Court of Appeal allowed the appeal, holding that the appellant was not an 'Ontario insurer' for the purposes of the priority dispute and that the Ontario Insurance Act could not be applied extraterritorially to a Nunavut policy for an accident occurring in Nunavut.

The applicant sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder following a motor vehicle accident.

The adjudicator applied the three-step approach from Pastore and found that while the accident caused a mental or behavioural disorder, the impact on the applicant's life was limited.

Preferring the respondent's medical experts who noted symptom exaggeration and validity concerns, the adjudicator concluded the applicant was only mildly impaired and did not meet the threshold for catastrophic impairment.

The application was dismissed.

An insurer mistakenly believed that a snowmobile was not covered under its automobile insurance policy and persuaded the Motor Vehicle Accident Claims Fund to accept responsibility for paying statutory accident benefits to an injured passenger.

When the coverage error was discovered, the Fund sought reimbursement and the insurer refused, arguing that the Fund had lost its ability to contest priority once it accepted responsibility.

The arbitrator found the insurer was the priority insurer and ordered reimbursement.

The Court of Appeal upheld the decision, holding that the Fund is not an ordinary insurer in priority disputes under the Regulation and is entitled to resile from its acceptance of priority.

The court also clarified that section 7(6) of the Regulation permits an arbitrator to order full reimbursement of benefits paid, not merely impose sanctions.

The applicant sought payment for statutory accident benefits following a motor vehicle accident, specifically four treatment plans for chiropractic services and a functional abilities assessment, which the insurer denied.

The Licence Appeal Tribunal found that two of the treatment plans for passive, facility-based chiropractic services were reasonable and necessary because they relieved the applicant's physical pain, which in turn prevented his psychological injuries from worsening.

However, the Tribunal denied a third treatment plan involving active home-based exercise as it would aggravate his pain, and denied a second functional abilities assessment as duplicative.

The applicant was awarded interest on the approved plans but denied an award for unreasonable delay, as the insurer did not have the critical evidence linking the physical treatment to the psychological injuries until the hearing.

The appellant, Travelers Insurance Company, appealed an arbitrator's decision that it was the priority insurer for statutory accident benefits following an accident in Nunavut.

The arbitrator found Travelers liable because it was an Ontario insurer, had filed a Power of Attorney and Undertaking (PAU) in Ontario, and was the insurer of the car involved.

Travelers argued the arbitrator erred by applying Ontario law to a Nunavut policy without first determining if the policy provided Ontario benefits coverage.

The court upheld the arbitrator's decision, finding that the standard of review was reasonableness and that Travelers, as an Ontario-licensed insurer and PAU signatory, was bound by Ontario's priority laws, precluding it from denying coverage based on the accident's location.

The Minister of Finance appealed an arbitration award that found the Motor Vehicle Accident Claims Fund, not Echelon General Insurance Company, liable for statutory accident benefits (SABs) to an injured pedestrian.

The arbitrator had concluded that the insured's email constituted a valid request to terminate his automobile insurance policy, thereby absolving Echelon of liability.

The Minister argued the arbitrator's decision was unreasonable, contending the email was not a clear request, the context of Echelon's prior ineffective cancellation was ignored, and the decision frustrated consumer protection policies.

The court dismissed the Minister's appeal, finding the arbitrator's interpretation of "request" under the Statutory Conditions was reasonable and consistent with case law, which imposes no formal requirements on an insured's termination request.

The Motor Vehicle Accident Claims Fund (Fund) appealed an arbitrator's decision that allowed it to withdraw its acceptance of priority for accident benefits.

Echelon General Insurance Company (Echelon) had initially notified the Fund that a snowmobile involved in an accident was uninsured, leading the Fund to accept priority.

The Fund later discovered Echelon's policy actually covered the snowmobile and sought restitution.

The arbitrator found Echelon failed to conduct a reasonable investigation as required by O. Reg. 283/95, s. 3.1, making its notice to the Fund improper.

The court upheld the arbitrator's decision, finding that the Fund was not an "insurer" under the regulation and had specific, different treatment, including an exemption from the strict rules preventing withdrawal of priority acceptance.

The court affirmed that Echelon's failure to conduct a reasonable investigation meant no proper priority dispute was raised, and Echelon remained the priority insurer.

Following an arbitration hearing where the applicant was awarded statutory accident benefits, the parties were unable to agree on expenses.

The arbitrator found the applicant was entitled to his expenses given his significant success.

After assessing the claimed legal fees and disbursements for reasonableness, the arbitrator reduced the amounts claimed for expert reports, witness fees, and other disbursements to align with the Expense Regulation maximums.

The applicant was awarded $48,597.95 in total expenses.

The insurer, having successfully defended an appeal regarding a catastrophic impairment determination under the Statutory Accident Benefits Schedule, sought its legal expenses of the appeal.

The insured's counsel did not provide written submissions for the appeal but submitted a bill of costs for comparison.

The Director's Delegate found the insurer was entitled to its expenses and, noting the complexity of the catastrophic impairment issue and the preparation required, fixed the costs payable by the insured to the insurer at $6,000 inclusive of disbursements and HST.

The parties sought expenses following a motion hearing where the insurer successfully moved to remove the applicant's counsel due to the inadvertent disclosure of privileged documents.

The arbitrator found that the insurer was wholly successful on the motions and was entitled to its expenses.

However, the arbitrator declined to order the applicant's former counsel to pay the expenses personally, finding that contesting the removal motion was justified given that removal of counsel is a drastic remedy.

The insurer's expenses were fixed at $3,684.76 based on a global approach to preparation time.

The applicant suffered catastrophic injuries in a 2010 motorcycle accident and sought attendant care and housekeeping benefits.

The respondent insurer argued that the applicant's claims were subject to the definition of 'incurred expense' and the economic loss limitations for family care providers introduced in the SABS-2010 and its 2014 amendments.

The Tribunal held that because the accident occurred prior to September 1, 2010, the applicant's entitlement to and the quantum of benefits are governed by the 1996 Schedule.

The SABS-2010 definition of 'incurred expense' and its subsequent amendments limiting attendant care to the provider's economic loss do not apply retrospectively to this claim.

The Applicant was catastrophically injured in a motor vehicle accident, sustaining a traumatic brain injury and chronic pain.

He applied for statutory accident benefits, including non-earner, attendant care, and housekeeping benefits, which the Insurer denied or underpaid.

The Arbitrator found that the Applicant suffered a complete inability to lead a normal life and awarded non-earner benefits.

The Arbitrator also deemed past attendant care and housekeeping expenses to have been incurred under s. 3(8) of the Schedule, finding that the Insurer unreasonably withheld benefits by failing to advise the impecunious and functionally illiterate Applicant that it would pay for professional services.

However, the Arbitrator declined to order a special award, finding the Insurer's conduct was not sufficiently egregious.

The applicant was injured in a motor vehicle accident and sought attendant care benefits under the Statutory Accident Benefits Schedule.

The applicant hired a Personal Support Worker (PSW) who shared his cultural and linguistic background, but who was not employed as a PSW at the time of the accident.

The respondent insurer refused to pay the benefits, arguing the service provider was not acting in the course of her employment and had not sustained an economic loss.

The Tribunal found that the service provider, who had a PSW certificate and subsequently worked as a PSW, was providing care in her professional capacity.

The Tribunal held that the applicant was entitled to the attendant care benefits and interest, and declined to award costs to the respondent.

The appellant appealed an Arbitrator's decision that he did not suffer a catastrophic impairment following a 2009 motor vehicle accident.

The central issue was whether the appellant suffered a marked impairment in the adaptation domain, largely based on his post-accident cannabis dependence and psychological issues.

The Director's Delegate upheld the Arbitrator's findings that the appellant's pre-accident cannabis use and behavioural issues were similar to his post-accident state, and that his impairment was only moderate.

The appeal was dismissed as the Arbitrator correctly applied the law and her factual findings were not subject to review on appeal.