Jamie Robin Pollack

The insurer appealed an arbitration decision awarding interest on a dependant's death benefit from 30 days after the initial application, arguing the application was incomplete until supporting documentation was provided years later.

The claimant cross-appealed the denial of a special award.

The Director's Delegate dismissed both appeals, confirming that under the SABS-1996, an application does not need to include all supporting documentation for interest to begin running, and that the arbitrator reasonably found the insurer did not unreasonably withhold benefits given the claimant's delay in providing documentation.

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

Following an initial arbitration decision that determined the applicant's residual earning capacity was zero, the parties disagreed on the calculation of amounts owing.

The arbitrator held that the insurer must pay interest on the loss of earning capacity benefits from the two-year mark, as the benefits were overdue.

Furthermore, the tax paid on the applicant's long-term disability benefits must be calculated based on his total post-accident income for the purpose of collateral benefit deductions.

The arbitrator also found that employer pension contributions are not taxable when calculating net weekly income, and that post-accident employee benefits are not deductible collateral benefits.

The applicant and his paralegal representative failed to attend a scheduled pre-hearing discussion without notifying the Commission or the insurer.

The insurer sought its costs thrown away.

The arbitrator found that the representative caused expenses to be incurred and wasted by unreasonable delay without reasonable cause.

The applicant and his representative were ordered to jointly and severally pay $500 in interim expenses to the insurer.

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

The parties proceeded to a preliminary issues hearing regarding the applicant's entitlement to a Loss of Earning Capacity Benefit (LECB).

At the hearing, the parties agreed that the applicant was entitled to an offer of an LECB effective April 30, 2003.

The arbitrator recorded the parties' procedural agreements on outstanding issues, including scheduling a residual earning capacity assessment and producing income loss calculations, and adjourned the main hearing.

The applicant was injured in a motor vehicle accident and sought payment for two treatment plans for massage therapy to treat chronic pain.

The insurer denied the claims, relying on various medical and DAC reports.

The arbitrator found the applicant's testimony credible that massage therapy provided temporary pain relief, which in turn allowed her to engage in active exercise to improve her strength and endurance.

The arbitrator gave little weight to the insurer's medical reports, noting they either did not address massage therapy or lacked sufficient reasoning.

The arbitrator concluded that the massage therapy was a reasonable and necessary medical benefit under section 14 of the Statutory Accident Benefits Schedule and ordered the insurer to pay the claimed amount of $5,190 plus interest.

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

The insurer terminated these benefits based on a Disability Designated Assessment Centre (DAC) report.

The applicant argued the DAC assessment was flawed and did not comply with the guidelines, seeking reinstatement of benefits.

The arbitrator found that the DAC assessment substantially complied with the guidelines and that the termination was valid under section 37 of the Schedule.

The arbitrator also held that the insurer was entitled to conduct further reasonably necessary medical examinations under section 42 to determine entitlement to post-104 week benefits.

The applicant's son was killed in a motorcycle accident.

The applicant applied for a death benefit from the insurer, claiming he was principally dependent on his son for financial support.

The insurer denied the claim, arguing the applicant's own financial resources, including social assistance, were sufficient to meet his needs.

The arbitrator found that the applicant's monthly expenses exceeded his own financial resources and that the deceased son provided the money to make up the shortfall.

The arbitrator concluded the applicant was principally dependent on his son and awarded the $35,000 death benefit, along with interest, but denied a special award.

The applicant was injured in a motor vehicle accident and sought payment for the costs of various medical assessments and treatment plans from a rehabilitation centre under section 24 of the Statutory Accident Benefits Schedule.

The insurer denied the claims.

The arbitrator found that the applicant had withdrawn her treatment plans, breaking the link between the assessments and her claim for accident benefits.

Furthermore, the arbitrator found the assessments to be unreasonable, duplicative, or prepared by individuals not qualified as health professionals.

The claim for examination expenses was dismissed in its entirety.

The appellant, who was injured in a motor vehicle accident, appealed an arbitration decision denying his claim for a special award due to delayed income replacement benefits (IRBs) and medication expense payments.

The appellant argued the arbitrator erred in interpreting the Statutory Accident Benefits Schedule (SABS) to mean that mailing a cheque within the benefit period satisfied the payment requirement.

The Director's Delegate upheld the arbitrator's interpretation, finding that the SABS deems the date of mailing as the date of payment.

The Delegate also found no error in the arbitrator's refusal to grant a special award, noting the lack of precise evidence regarding the amount of delayed medication benefits and the arbitrator's appropriate exercise of discretion regarding the IRBs.

The appeal was dismissed.

The insurer brought a motion for expenses against the applicant's representative, who had commenced an arbitration in the name of a minor without proper authority.

The arbitrator found that the representative was the true applicant and that bringing the unauthorized application constituted an abuse of process.

The arbitrator ordered the representative to personally pay the insurer's expenses of $4,925.38.

The applicant applied for arbitration for statutory accident benefits but failed to attend the hearing.

The insurer presented surveillance evidence showing the applicant working in a restaurant while claiming caregiver and housekeeping benefits.

The arbitrator dismissed the application for benefits due to lack of evidence.

The arbitrator awarded the insurer its expenses of $4,070.03, finding the applicant's abandonment of the claim without notice was an abuse of process.

However, the arbitrator declined to order the applicant to pay the insurer's assessment fee under subsection 282(11.2) of the Insurance Act, as the application was not devoid of merit at the time it was commenced.

The Insurer brought a motion for expenses against Mr. Rod Hare, who had been substituted as the applicant in place of a minor.

The Insurer served its Bill of Expenses by regular mail to Mr. Hare's former business address.

The Arbitrator found that, given evidence that Mr. Hare was no longer at that address, service by mail was insufficient to provide reasonable notice of a claim that could result in personal liability.

The Arbitrator ordered that the Insurer must serve Mr. Hare personally with the motion materials before the claim for expenses would be considered.

The applicant commenced an arbitration for $3,300 in medical assessments following a motor vehicle accident.

At the hearing, her counsel requested an adjournment and production orders, which were denied, and then left the hearing.

The application was subsequently dismissed.

The insurer sought expenses and an award under s. 282(11.2) of the Insurance Act.

The arbitrator found the proceeding was an abuse of process and ordered the applicant to pay $1,000 in expenses and a $3,000 award to the insurer.

The applicant sought a special award under s. 282(10) of the Insurance Act, alleging the insurer unreasonably delayed paying income replacement benefits and setting up a direct payment account for prescription medication following a settlement agreement.

The arbitrator found no unreasonable delay regarding the income replacement benefits, as the applicant had been overpaid.

The arbitrator found the insurer unreasonably delayed setting up the medication account, but dismissed the claim for a special award because the applicant failed to provide any evidence of the cost of the medications, which is required to calculate the award.

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

The insurer denied certain medical benefits and examination costs, and arranged for a Designated Assessment Centre (DAC) assessment.

The applicant withdrew her treatment plans and failed to attend the DAC assessment and an insurer's in-home assessment.

The insurer raised a preliminary issue that the applicant was precluded from proceeding to arbitration under section 50 of the Schedule.

The arbitrator held that the applicant was precluded from arbitrating the section 14 medical benefits because she unreasonably withdrew the treatment plans to avoid the DAC assessment.

However, the applicant was not precluded from arbitrating the section 24 examination expenses, as those expenses are not subject to the DAC or insurer's examination process.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to appear at the arbitration hearing.

The arbitrator found that the applicant had been given reasonable notice of the hearing.

Because the applicant did not appear, he failed to satisfy the burden of proof, and the application was dismissed.

The arbitrator further found that the applicant's conduct in pursuing the arbitration without intending to proceed to a hearing was frivolous and vexatious.

Consequently, the applicant was ordered to pay the insurer $2,500 for the expenses of the arbitration proceeding and $3,000 for the return of the assessment fee under the Insurance Act.

The applicant was injured in a motorcycle accident and received income replacement benefits (IRBs) which were later commuted to loss of earning capacity benefits (LECBs).

The parties disputed the calculation of his pre-accident income, the deductibility of his disability pension, and his residual earning capacity (REC).

The arbitrator held that statutory employee benefits and vacation pay were excluded from gross income, but the normal employer pension cost was included.

The insurer was not entitled to use the section 82 income tables as it failed to prove a proper election.

The applicant's disability pension was found not to be a deductible collateral benefit.

Finally, the arbitrator determined the applicant's REC to be zero, rejecting the DAC's recommendation of Service Advisor and the insurer's alternative of Production Clerk, as neither was medically, personally, or vocationally suitable given the applicant's permanent upper extremity limitations.

The applicant sought payment for the cost of medical assessments under section 24 of the Statutory Accident Benefits Schedule.

Following a previous decision where the arbitrator postponed issuing a final order pending further submissions, no application to reopen the hearing was received.

As the applicant presented no evidence on entitlement to the cost of examinations, she failed to meet her burden of proof.

The application for arbitration was dismissed.

An application for arbitration for statutory accident benefits was filed in the name of a minor by an agent.

The insurer brought a motion to dismiss the application on the basis that the minor lacked the capacity to authorize the proceeding.

The arbitrator found that the retainer agreement was void due to the applicant's minority and that the agent, having acted without valid authorization, was the actual applicant.

The arbitration was dismissed, and the agent was given an opportunity to respond to the insurer's claim for expenses.

The applicant sought payment for medical assessments under the Statutory Accident Benefits Schedule.

At the commencement of the arbitration hearing, the applicant's agent requested an order for further document production and interim expenses.

The arbitrator dismissed the requests, finding the insurer had complied with its production obligations.

The applicant's agent subsequently walked out of the hearing.

The arbitrator postponed issuing a final order to allow the applicant an opportunity to formally apply to reopen the hearing.