Jamie Robin Pollack

The respondent was seriously injured in a motor vehicle accident in the United States Virgin Islands.

She applied to her insurer for statutory accident benefits and underinsurance coverage.

The insurer brought an application to deny coverage, arguing the accident occurred outside the territorial limits of the Insurance Act and the policy, which cover the 'United States of America'.

The court found the term ambiguous and applied the doctrine of contra proferentem, concluding that the term includes the United States Virgin Islands for the purposes of coverage.

The insurer's application was dismissed.

The plaintiffs appealed a Rule 21 motion decision determining that where a plaintiff is involved in two motor vehicle accidents and the actions are tried together, the statutory deductible under s. 267.5(7) of the Insurance Act applies to each action individually.

The Court of Appeal agreed with the motion judge that the plain meaning of the provision requires the court to determine general damages for each action and then reduce that amount by the statutory deductible.

The appeal was dismissed.

The appellant insurer appealed a trial judgment awarding the respondent insured statutory accident benefits and $25,000 in damages for mental distress following a motor vehicle accident.

The insurer had terminated housekeeping and transportation benefits based on a superficial independent medical examination, ignoring its own occupational therapist's recommendations.

The Court of Appeal upheld the awards for housekeeping benefits, s. 24 assessments, and mental distress, finding that peace of mind is a reasonably contemplated object of an automobile insurance contract.

The court allowed the appeal only to reduce the quantum of transportation benefits from $7,500 to $2,280 due to a lack of evidence supporting the higher amount.

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

The insurer brought a motion to exclude the applicant from receiving income replacement and housekeeping benefits under s. 30(1)(a) of the Schedule, arguing he knew or ought reasonably to have known he was driving without insurance.

The applicant's policy had been cancelled for non-payment, but he denied receiving the registered cancellation letter or being informed of the cancellation by his broker.

The arbitrator found that the insurer failed to prove the applicant received the cancellation notice or was clearly informed of the cancellation.

The arbitrator concluded the applicant reasonably believed his policy was still in effect and dismissed the insurer's motion.

The applicant was struck by a pickup truck while riding his bicycle, sustaining severe injuries to his left heel and ankle.

He applied for a determination of catastrophic impairment, which the insurer denied.

At arbitration, the arbitrator preferred the evidence of the applicant's experts, finding that his need for two crutches and a short leg brace resulted in a 55% Whole Person Impairment under the AMA Guides.

Furthermore, the arbitrator accepted that the applicant's chronic pain and depression resulted in a Class 4 marked impairment in at least one area of functioning.

The arbitrator concluded that the applicant sustained a catastrophic impairment under both paragraphs 2(1.2)(f) and (g) of the Schedule.

The appellant appealed an arbitrator's preliminary issue finding that she was not injured in an accident pursuant to section 2 of the Statutory Accident Benefits Schedule.

The arbitrator had accepted the respondent's accident reconstruction expert evidence that the damage to the vehicles was inconsistent with the appellant's description of the collision, and found the appellant's testimony not credible.

On appeal, the Director's Delegate found no error requiring a rehearing, concluding that the arbitrator was entitled to weigh the evidence and determine that the appellant had not met her burden of proof to establish that an incident occurred.

The appellant insurer appealed an arbitrator's decision finding that the respondent insured sustained a catastrophic impairment.

The central issue was whether physical and psychological impairments could be combined to reach the 55% whole person impairment threshold under clause 2(1.1)(f) of the Statutory Accident Benefits Schedule.

The Director's Delegate dismissed the appeal, holding that the Schedule is unambiguous and permits the combination of physical and psychological impairments.

The Delegate found that excluding psychological impairments would be inconsistent with the remedial nature of the legislation and the inclusive definition of impairment.

The appellant insurer appealed a trial judgment allowing the Motor Vehicle Accident Claims Fund's action for restitution of statutory accident benefits paid to an injured passenger.

The appellant argued the Fund was required to proceed by arbitration under the Dispute Regulation rather than by a civil action.

The Court of Appeal dismissed the appeal, holding that while the Fund is an 'insurer' under the regulation, this was a 'proper case' for a restitution action because the parties had engaged in informal discussions past the 90-day arbitration notice period, making arbitration impossible.

The Court also held that the notice provisions of the regulation do not apply to civil restitution claims and that judge-made law regarding the Fund's status as an insurer applies retrospectively.

The appellant insurer sought a stay of an arbitrator's decision finding the respondent catastrophically impaired pending its appeal.

The arbitrator had combined physical and psychological impairments to reach the catastrophic impairment threshold.

Applying the Scavuzzo criteria, the Director's Delegate denied the stay, finding that the insurer failed to demonstrate that its hardship outweighed the respondent's hardship, and noting that the arbitrator's decision merely broadened potential benefit coverage rather than ordering immediate payment.

Following an arbitration where the applicant's claim for statutory accident benefits was dismissed, the insurer sought its expenses.

The arbitrator found that the applicant was completely unsuccessful and that the proceeding was vexatious and unnecessary, as objective evidence showed the alleged accident could never have occurred.

The applicant failed to provide submissions for the expense hearing.

The arbitrator awarded the insurer its expenses, assessing legal fees at $6,063.34 and disbursements at $5,570.01, after reducing the hours claimed by one of the insurer's counsel to reflect a reasonable global assessment.

The applicant was injured in a head-on motor vehicle collision and sought ongoing income replacement benefits after the insurer terminated them.

The insurer argued that the applicant's inability to work was due to her significant pre-accident medical history, including a prior accident and depression.

The arbitrator found the applicant credible and preferred the medical evidence demonstrating that the accident caused a disabling chronic pain syndrome.

The arbitrator concluded that the applicant met both the 104-week and post-104-week disability tests under the Statutory Accident Benefits Schedule, entitling her to ongoing income replacement benefits and interest, and dismissing the insurer's claim for repayment.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment.

Her assessor combined physical and psychological impairments to reach a 55% whole person impairment, following the methodology in Desbiens v. Mordini.

The insurer's assessors refused to assign numeric ratings to psychological impairments, finding only a 20% impairment.

The arbitrator held that the Desbiens approach is binding and correct in law, allowing the combination of physical and psychological impairments.

Furthermore, the arbitrator found that issue estoppel applied, as the insurer had previously litigated and lost this exact issue against the applicant before the Director.

The applicant was declared catastrophically impaired.

The appellants appealed an order dismissing their action against the respondent employer.

The Court of Appeal allowed the appeal, finding that the appellants' claim was a separate and independent tort of negligent misrepresentation regarding the process to be followed in pursuing a claim, rather than a claim arising in respect of a worker's injury.

The order dismissing the action was set aside.

The applicant sought to withdraw her arbitration proceeding regarding statutory accident benefits following a motor vehicle accident.

The insurer consented to the withdrawal but sought its expenses and an order requiring the applicant to pay the $3,000 arbitration fee if she recommenced the proceeding.

The arbitrator permitted the withdrawal and ordered the applicant to pay $1,200 in expenses, representing 50% of the insurer's allowable expenses, as well as $3,000 to the insurer only in the event she commences a new arbitration in respect of the same issues.

The insurer requested production of the draft reports and foundation material of the applicant's accounting and occupational therapy experts.

The applicant refused, claiming litigation privilege and arguing that the pre-hearing stage was too early to compel disclosure.

The arbitrator held that by voluntarily disclosing the experts' reports in his pre-hearing brief, the applicant impliedly waived litigation privilege over the foundation material (notes, draft reports, technical data, and test results) relied upon by the experts.

The applicant was ordered to produce this material, but was not required to produce counsel's instruction letters to the experts, as they were deemed irrelevant.

The applicant sought statutory accident benefits, claiming she was injured as a passenger in a rear-end motor vehicle collision.

The insurer denied the claim on the basis that the applicant's involvement in the accident was not credible.

Relying on expert accident reconstruction evidence that demonstrated the damage to the vehicles was entirely inconsistent with the reported collision, the arbitrator found the applicant's version of events lacked credibility.

The arbitrator concluded the applicant failed to prove she was involved in an 'accident' under section 2(1) of the Schedule and dismissed the arbitration.

The applicant sought production of the insurer's adjuster log notes beyond the date of the first Application for Mediation.

The insurer argued that notes created after the first mediation application were protected by litigation privilege and irrelevant.

The Arbitrator ordered production of the log notes up to the date of the last Application for Mediation, finding that the notes were potentially relevant to the applicant's claim for a special award and that the insurer failed to establish litigation privilege over notes relating to issues that were not yet the subject of a mediation application.

The insurer requested that the Director of Arbitrations state a case to the Divisional Court under s. 285(1) of the Insurance Act regarding whether physical and psychological impairments can be combined to determine catastrophic impairment under the Statutory Accident Benefits Schedule.

The Director declined the request, finding that FSCO arbitrators have the specialized expertise to interpret the SABS and that the existing jurisprudence on the issue was not internally inconsistent.

The matter was directed to proceed to arbitration in the normal course.

Following the dismissal of the applicant's arbitration for statutory accident benefits due to his failure to attend pre-hearings, the insurer sought its expenses.

The arbitrator found that the applicant had abandoned his arbitration without explanation, rendering the proceeding frivolous and vexatious.

Applying the criteria under section 12(2) of Ontario Regulation 664, the arbitrator awarded the insurer its requested expenses of $1,511.34.

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

The parties reached a settlement at a pre-hearing, and the Applicant cashed the settlement cheque but failed to execute the settlement documents.

The Applicant and his representative subsequently failed to attend a resumed pre-hearing or respond to communications from the Commission.

The Insurer requested that the arbitration be dismissed.

The Arbitrator found that the Applicant had abandoned the arbitration and dismissed the proceeding as frivolous, vexatious, and commenced in bad faith pursuant to Rule 68.1 of the Dispute Resolution Practice Code.