Neutral Citation: 2002 ONFSCDRS 187
FSCO A02-000084
FINANCIAL SERVICES COMMISSION OF ONTARIO
BETWEEN:
RICHARD PHILLIPS
Applicant
and
GUARANTEE COMPANY OF NORTH AMERICA
Insurer
REASONS FOR DECISION
Before: Beth Allen
Heard: September 24, 2002, at the offices of the Financial Services Commission of Ontario in Toronto.
Appearances: Mr. Phillips, unrepresented, not in attendance Gregory Van Berkel for Guarantee Company of North America
Issues:
The Applicant, Richard Phillips, was injured in a motor vehicle accident on November 13, 2000. He applied for and received statutory accident benefits from Guarantee Company of North America ("Guarantee"), payable under the Schedule.1 Guarantee terminated weekly income replacement benefits on April 22, 2001. The Applicant seeks reinstatement of his income replacement benefits at the established rate, from the termination date until his return to work on September 1, 2001. He also seeks benefits for various medical expenses, housekeeping services, various medical reports and assessments, interest and his arbitration expenses. The Insurer seeks a repayment of income replacement benefits and its arbitration expenses.
The parties were unable to resolve their disputes through mediation, and the Applicant applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended.
The issues in this hearing are:
Is the Applicant entitled to receive weekly income replacement benefits at the rate of $400 per week from April 22, 2001 until he returned to work on September 1, 2001 pursuant to section 4 of the Schedule?
What is the amount of income replacement benefits that the Applicant is entitled to receive pursuant to section 6 of the Schedule?
Is the Applicant liable to repay the Insurer $2,447.72 pursuant to section 47 of the Schedule on the basis of the Insurer's claim that in error it overpaid income replacement benefits between November 20, 2000 and April 22, 2001?
Is the Applicant entitled to receive a medical benefit for chiropractic, physiotherapy and massage expenses of $3,121.70 for services provided by the Spine Clinic from November 22, 2000 to June 20, 2001, claimed pursuant to section 14 of the Schedule?
Is the Applicant entitled to receive a medical benefit for psychological treatment expenses of $1,800 as per the treatment plan prepared by Dr. Raghunan dated February 7, 2001, claimed pursuant to section 14 of the Schedule?
Is the Applicant entitled to a payment of $2,000 for housekeeping services provided by Ms. Stacey Gowland from November 20, 2000 to June 20, 2001, pursuant to section 22 of the Schedule?
Is the Applicant entitled to a payment of $300 for the cost of an examination, namely a report of Dr. Beharry dated August 17, 2001, pursuant to section 24 of the Schedule?
Is the Applicant entitled to payment of $1,000 for the cost of an examination, namely a functional capacity evaluation conducted on July 30, 2001 by the Toronto Assessment Centre, pursuant to section 24 of the Schedule?
Is the Applicant entitled to a payment of $1,080 for the cost of an examination, namely the psychological assessment and report fee of Dr. Raghunan dated February 7, 2001, pursuant to section 24 of the Schedule?
Are the parties liable to pay each other's respective arbitration expenses pursuant to subsection 282(11) of the Insurance Act?
Is the Applicant entitled to interest on overdue benefit payments pursuant to section 46 of the Schedule?
Result:
I dismiss the Applicant's claims in their entirety.
The Applicant is required to repay the Insurer $2,447.72 pursuant to section 47 of the Schedule, which represents an overpayment of income replacement benefits during the period from November 20, 2000 to April 22, 2001.
The Applicant is required to pay the Insurer's arbitration expenses in the amount of $1,742.00 pursuant to subsection 282(11) of the Insurance Act.
The Applicant is required to pay the Insurer $1,000 pursuant to [subsection 282(11.2)](https://www.canlii.org/en/on/laws/stat/rso-1990-c-i8/latest/rso-19