Financial Services Commission of Ontario

Commission des services financiers de l’Ontario

Neutral Citation: 2006 ONFSCDRS 1

FSCO A05-000403

BETWEEN:

SHANNON PINTO

Applicant

and

ALLSTATE INSURANCE COMPANY OF CANADA

Insurer

REASONS FOR DECISION

Before: Maggy Murray

Heard: December 22, 2005, at the offices of the Financial Services Commission of Ontario in Toronto.

Appearances:

Sharla Bandoquillo for Mr. Pinto

Grant R. Dow for Allstate Insurance Company of Canada

Issues:

The Applicant, Shannon Pinto, was injured in a motor vehicle accident on July 18, 2004. He applied for and received statutory accident benefits from Allstate Insurance Company of Canada ("Allstate"), payable under the Schedule.¹ Allstate refused to pay for various medical benefits.

The parties were unable to resolve their disputes through mediation, and Mr. Pinto 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:

1. Is Mr. Pinto precluded under section 50 of the Schedule from commencing an arbitration proceeding in respect of the Treatment Plan dated September 25, 2004?

2. If Mr. Pinto is not precluded under section 50 of the Schedule from commencing an arbitration proceeding in respect of the Treatment Plan dated September 25, 2004, is he entitled to receive a medical benefit pursuant to section 14 of the Schedule in the amount of $1,312.90 for chiropractic therapy, acupuncture, massage therapy and laser treatment provided by East Sheppard Rehabilitation Company from July 20, 2004 to December 8, 2004?

3. Is Mr. Pinto entitled to interest for the overdue payment of benefits pursuant to section 46(2) of the Schedule?

4. Is either party entitled to its expenses in respect of the arbitration under section 282(11) of the Insurance Act?

Result:

1. Mr. Pinto is precluded under section 50 of the Schedule from commencing an arbitration proceeding in respect of the Treatment Plan dated September 25, 2004 because it was not received by Allstate until February 7, 2005.

2. In the alternative, Mr. Pinto is not entitled to receive a medical benefit pursuant to section 14 of the Schedule in the amount of $1,312.90 for treatment provided by East Sheppard Rehabilitation Company from July 20, 2004 to December 8, 2004.

3. No interest is payable by Allstate to Mr. Pinto.

4. The issue of expenses is deferred.

EVIDENCE AND ANALYSIS:

Issue One (Section 50):