Neutral Citation: 1999 ONFSCDRS 28
FSCO A96–001023
FINANCIAL SERVICES COMMISSION OF ONTARIO
BETWEEN:
SANDRA ALVAREZ
Applicant
and
ALLSTATE INSURANCE COMPANY OF CANADA
Insurer
REASONS FOR DECISION
Before:
Deena Baltman
Heard:
December 7, 1998, at the Financial Services Commission of Ontario, Toronto Final submissions were received on December 18, 1998.
Appearances:
Joseph A. Raimondo for Mrs. Alvarez
Ian D. Kirby for Allstate Insurance Company of Canada
Issues:
On June 30, 1991, Mrs. Alvarez was ejected from a vehicle travelling on the 401. She sustained many physical injuries and significant psychological trauma.
Over the years since the accident, Allstate has paid various benefits to Mrs. Alvarez, including the cost of extensive psychological treatment from Dr. Jeffrey Price. Midway through 1995, Allstate decided that Dr. Price's treatments were no longer reasonable within the meaning of the Schedule,1 and terminated payments. Dr. Price continued to provide treatments until 1997. This arbitration dealt with the following issues:
Is Mrs. Alvarez entitled to recover the cost of psychological treatments provided by Dr. Price between 1995 and 1997?
Is Mrs. Alvarez entitled to interest on any outstanding accounts?
Is Mrs. Alvarez entitled to a special award on the basis that Allstate unreasonably withheld payment of Dr. Price's accounts?
Result:
Mrs. Alvarez is entitled to recover 50 per cent of the outstanding accounts from Dr. Price, plus interest in accordance with the Schedule.
Mrs. Alvarez is entitled to a special award of $2,500, inclusive of interest.
EVIDENCE AND ANALYSIS:
Background:
The background facts are largely undisputed. Mrs. Alvarez, now 30 years old, was born and raised in Quebec, with French as her first language. After completing Grade 12, she trained as a hairdresser in Quebec City, but moved to Toronto in order to obtain work and improve her English skills. She initially worked as a babysitter, but later obtained employment as a translator and editor for Research House, a market research firm, where she worked until the accident.
Following her move to Toronto, Mrs. Alvarez married Enrique Alvarez. They had one daughter, Shayna, before the accident and have since had a son, Alexander.
Before the accident, Mrs. Alvarez had no significant physical, emotional or marital problems. She never received psychological or marital counselling. She enjoyed