Financial Services Commission des Commission services financiers of Ontario de l’Ontario
Neutral Citation: 2007 ONFSCDRS 209
FSCO A05-002012
BETWEEN:
MONA HALIM
Applicant
and
SECURITY NATIONAL INSURANCE CO./ MONNEX INSURANCE MGMT. INC.
Insurer
REASONS FOR DECISION
Before: Joyce Miller
Heard: April 16, 18 and 19, 2007, at the offices of the Financial Services Commission of Ontario in Toronto.
Appearances: Samiya Ahmad, Student-at-law, for Ms. Halim Kristi Piekny for Security National Insurance Co./ Monnex Insurance Mgmt. Inc.
Issues:
The Applicant, Mona Halim, was injured in a motor vehicle accident on November 24, 2004. She applied for and received statutory accident benefits from Security National Insurance Co./Monnex Insurance Mgmt. Inc. (“Security National”), payable under the Schedule.1 Security National denied her claims for housekeeping benefits, medical/rehabilitation benefits and the cost of section 24 assessments. The parties were unable to resolve their disputes through mediation, and Ms. Halim 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 Ms. Halim entitled to receive a medical benefit in the amount of $4,419 for treatment provided by Downsview Health Recovery claimed pursuant to section 14 of the Schedule?
Is Ms. Halim entitled to payments for housekeeping and home maintenance services, pursuant to section 22 of the Schedule from January 24 to February 13, 2005?
Is Ms. Halim entitled to payments for the cost of examinations, an In-home assessment ($869.50), a Functional Abilities Evaluation ($1,244.50) and a psychological assessment ($1,384) pursuant to section 24 of the Schedule?
Is Ms. Halim liable to pay $722.25 to Security for the repayment of a Med/Rehab DAC Assessment scheduled with York Rehab for April 12, 2005 pursuant to section 47 of the Schedule?
Is Security National liable to pay Ms. Halim’s expenses in respect of the arbitration under section 282(11) of the Insurance Act?
Is Ms. Halim liable to pay Security National’s expenses in respect of the arbitration under section 282(11) of the Insurance Act?
Result:
Ms. Halim is not entitled to receive a medical benefit in the amount of $4,419 for treatment provided by Downsview Health Recovery claimed pursuant to section 14 of the Schedule.
Ms. Halim is not entitled to payments for housekeeping and home maintenance services, pursuant to section 22 of the Schedule from January 24 to February 13, 2005.
Ms. Halim is not entitled to payments for the cost of examinations for an In-home assessment ($869.50), a Functional Abilities Evaluation ($1,244.50) and a psychological assessment ($1,384) pursuant to section 24 of the Schedule.
Ms. Halim shall pay Security National $722.25 pursuant to subsection 47(1)(e) of the Schedule.
If needed, I may be spoken to on the issue of expenses within 30 days of receipt of this decision.
BACKGROUND:
Ms. Halim testified that on November 24, 2004 she was a passenger in a car, getting a lift home from someone who she did not know very well. The car was traveling at the speed of 50 or 60 kilometres, when it swerved to avoid hitting a cab that seemed to come out of nowhere. The car hit a tree and the airbags deployed. Ms. Halim testified that the air bag hit her head and her knee hit the dashboard.
Ms. Halim stated that she was taken to the hospital by ambulance, where she was examined and then released. She was advised to take Advil and see her family doctor for any pain she may have.
Although Ms. Halim had a family doctor, Dr. Lynda McLean, for eight years, she did not see her doctor. Instead, she first saw a lawyer, Alon Rooz, who sent her to Downsview Health Recovery (Downsview) for treatment.
Ms. Halim did not notify her insurer, Security National, about the accident. On December 2, 2004, Downsview advised Security National that Ms. Halim would be seeking benefits. On December 8, 2004, Ms. Halim sent Security National an application for accident benefits which was not complete.
Security National, wrote numerous letters2 to Ms. Halim and her counsel advising that it could not process her claim because she had not given proper notice of the accident to Security National and had not provided relevant information such as the name of the driver of the car and the license number of the car.
Ms. Halim testified that she never opened any of the letters sent to her by Security National, which included more than a dozen letters asking for relevant information related to her claim for benefits.
Ms. Halim, who lived with her parents in Aurora after the accident, testified that because of body pain she was unable to do her housekeeping. As well, Ms. Halim, who is self employed as an Event Coordinator, stated that she did not work for two months after the accident. She did not, however, pursue a claim for income replacement benefits for her time off work. Ms. Halim testified that at the present time she still gets lower back pain about once a month, that sometimes can last for a few days.
ISSUE 1: Is Ms. Halim entitled to a medical benefit for four treatment plans?
Downsview submitted four treatment plans to Security National on behalf of Ms. Halim. The treatment plans, prepared by Dr. Dimitrios Lianos, a chiropractor, are as follows:
December 1, 2004
$2,498
January 20, 2005
$1,682
March 18, 2005
$1,062
April 28, 2005
$ 782
The four treatment plans were assessed by Med/Rehab DAC3 Assessments.
The first two treatment plans were assessed by Dr. Pringle, a chiropractor, on February 18, 2005. Dr. Pringle concluded that both treatment plans were partially reasonable and necessary in the amount of $2,069 which Security National paid.
In his report Dr. Pringle noted the following:
My examination today revealed no significant objective musculoskeletal evidence of impairment related to the motor vehicle accident of November 24, 2003(sic). Ms. Halim reported to me today that she feels she has fully recovered and she reported that her treatment stopped about 1 week ago.
In his conclusion, Dr. Pringle recommended that “no further facility based rehabilitation is necessary and that Ms. Halim should be discharged to an independent exercise program.”
The third and fourth treatment plans were assessed by Dr. Pisarek, chiropractor, on May 14, 2005. In his report dated June 15, 2005, Dr. Pisarek noted that Ms. Halim stated that she had attended rehabilitation up until approximately two weeks before the DAC and that she felt “ninety percent improved overall.”
In his conclusion Dr. Pisarek stated:
At the time of this assessment, Ms. Halim has received more or less six months of ongoing therapy. Upon physical examination, I could find no objective evidence of any ongoing traumatic pathology. It appears that Ms. Halim has objectively achieved a therapeutic gain of at least an eighty percent level of overall physical improvement with no clinically significant findings of any neuromusculoskeletal impairment related to this subject accident. However, the perception of her pain and disability at the time of this D.A.C. Assessment is not consistent with her physical presentation and stated feeling of ninety percent improved overall.
Dr. Pisarek went on to recommend that Ms. Halim “should discontinue participating in facility-based intervention measures such as passive rehabilitation and physiotherapy modalities as currently they will not ameliorate her condition.”
Findings
Ms. Halim claims $4,419 for treatment she received at Downsview, in respect of four treatment plans, pursuant to section 14 of the Schedule.
Section 14 provides that the insurer shall pay an insured a medical benefit for all reasonable and necessary expenses incurred by or on behalf of the insured person as a result of an accident. Accordingly, the burden of proof rests with Ms. Halim to show that on a balance of probability the treatment she received was reasonable and necessary.
For the following reasons, I find that Ms. Halim has not met her burden of proof. I did not find that Ms. Halim provided sufficient credible or plausible evidence to support her claim that the four treatment plans prepared by Downsview were reasonable and necessary.
Ms. Halim testified that if she had a serious problem she would tell her family doctor. However, Ms. Halim did not visit her family doctor after the accident. Instead, she went to a clinic recommended by her lawyer to seek assessment and treatment.
The first time Ms. Halim saw her family doctor after the accident was on March 25, 2005. Neither at that visit nor at the subsequent 12 visits that she had with Dr. McLean in 2005 and 2006 do the clinical notes and records show that she had advised Dr. McLean of the accident or that she was suffering from back pain. The only note on back pain mentioned in the clinical records was the fourth item noted in a visit that Ms. Halim had with Dr. McLean on October 12, 2006.
Ms. Halim testified that she believed she did not need to tell Dr. McLean about her back pain or any treatment she was receiving at Downsview because she was seeing Dr. Lianos for her car accident injuries. She stated that she only told Dr. McLean about her back pain on October 12, 2006, because she was no longer seeing Dr. Lianos.
I do not find this to be a credible response. First, the evidence shows that Ms. Halim stopped going to Downsview in December 2005 but continued to see Dr. McLean twice in January 2006 and twice in February 2006 and once each time in April, July and August, 2006.
Second, if Ms. Halim was suffering from persistent pain in her lower back, it is not plausible that Ms. Halim would visit her family doctor of eight years on a regular basis - sometimes twice a month, after the accident, and at no time would she mention, even in passing, that she had had a car accident and suffered injuries that required regular treatment.4
One can only conclude from Ms. Halim’s testimony that the accident had a minor effect on Ms. Halim. This is further substantiated by the lack of detail in her description of the alleged treatment she received.
Ms. Halim’s testimony regarding her alleged treatment was very vague. She could not provide the details of when she attended the clinic for treatment. She could not recall when the treatment started and when it stopped or how much treatment she had received. Nor could she provide details of the modalities of treatment she received. She relied almost entirely on the records that were put before her.
These records show that Ms. Halim did not receive the full amount of chiropractic treatment and functional therapy recommended in the treatment plans. For example, Dr. Lianos had recommended 29 chiropractic treatments, when in fact she only received four treatments. She received 37 functional therapy supervised exercise sessions when 50 were recommended. On the other hand, 30 massage treatments were recommended and she received 37 treatments. Twenty seven passive therapy treatments were recommended and 37 were provided.
I give little weight, if any, to Dr. Lianos’ opinion that all four treatment plans recommended were reasonable and necessary.
Dr. Lianos, who testified at the hearing, has been a licensed chiropractor since 2002. He testified that he sees approximately 50 to 60 patients a day.
Dr. Lianos testified that he first saw Ms. Halim on December 1, 2004. At that time he diagnosed her with having: traumatic strain/sprain of the cervical and lumbar paraspinal muscles, ligaments, and joints; sacroiliac joint dysfunction; left shoulder sprain/strain and post traumatic headache.
In examination in chief, Dr. Lianos stated that when he saw Ms. Halim on January 18, 2005, after six weeks of treatment, there was a regression in her range of movement in respect of her neck and lower back. However, under-cross examination, it was pointed out that in his Follow-up Progress Report of January 18, 2005, he states that the active and passive ranges of motion in her cervical and lumbar spine “have improved.”
Dr. Lianos stated that this was a mistake and it should be read as “had not improved.” He said that according to his review of the clinical notes and records there was a reduced range of motion in the cervical and lumber spine.
I give little, if any, weight to Dr. Lianos’ testimony that his report was mistaken. Unlike Dr. Pisarek, the DAC assessor, who also testified at the hearing, Dr. Lianos did not provide his clinical notes and records in respect of his examination of Ms. Halim to support his testimony.
I also give little weight to Dr. Lianos’ testimony, not only because he did not provide his clinical notes and records, but because the DAC reports contradict Dr. Lianos’ testimony that Ms. Halim’s injuries had not resolved within ten weeks of the accident. The DAC report is more in keeping with Dr. Lianos original report, that Ms. Halim’s condition had improved.
As noted above, in Dr. Pringle’s report of February 18, 2005, he stated that Ms. Halim had reported that she feels she has fully recovered and had stopped treatment about a week before the DAC assessment. This was consistent with Dr. Pringle’s examination which revealed that there was no significant objective musculoskeletal evidence of impairment related to the accident.
Dr. Pringle’s findings are consistent with Dr. Pisarek’s findings, when commenting on the third and fourth treatment plans, that there was “no objective evidence on any on going traumatic pathology.”
Dr. Pisarek, who has been a chiropractor for 31 years, examined Ms. Halim on May 15, 2005.5 Dr. Pisarek testified that his session with Ms. Halim lasted for at least an hour. He stated that in his examination of Ms. Halim he did not find any objective evidence of any ongoing traumatic pathology.
Dr. Pisarek testified that he did not find that the treatment plans were reasonable and necessary. It was his view that the proposed amount of treatment, frequency, number of treatment modalities and the cost was excessive for the reported level and mechanism of injury. In his view, the passive modalities were of no use for her at this point. In his view, what Ms. Halim needed was an independent exercise regime where she could go at her own pace.
In weighing and balancing the medical evidence, I prefer the conclusions of the DAC doctors over those of Dr. Lianos. Aside from the fact that Dr. Pisarek, who has been a chiropractor for 31 years, has more experience than Dr. Lianos, it would appear that he spent more time assessing Ms. Halim than Dr. Lianos.
Dr. Lianos testified that he sees 50 to 60 patients a day. This would mean, in a ten hour day, he, only on average, could not have spent more than 15 minutes assessing Ms. Halim. As well, the evidence shows that Dr. Lianos, who only gave Ms. Halim four chiropractic treatments, prepared each of the treatment plans on the same day that he gave his treatment to Ms. Halim. In comparing the depth of the reports presented by Dr. Lianos and the DAC doctors, I give more weight to the DAC doctor assessments and their opinions than to Dr. Lianos’ assessment and opinion.
In the end, I was left with the impression that Dr. Lianos’ opinion was self serving in support of the clinic. Of significance, in coming to this conclusion, is the fact that Dr. Lianos, could have, but chose not to, provide his clinical notes and records to support his testimony. In short, I find that Dr. Lianos did not present objective and reliable evidence to support his opinion.
Accordingly, for these reasons, I find that Ms. Halim is not entitled to a medical benefit in the amount of $4,419 pursuant to section 14 of the Schedule.
ISSUE 2: Is Ms. Halim entitled to housekeeping?
Pursuant to Dr. Lianos’ disability certificate, dated December 1, 2004, Security National paid Ms. Halim eight weeks of housekeeping expenses. Ms. Halim claimed three weeks of additional housekeeping expenses for the period of January 24, 2005 to February 13, 2005, in the amount of $100 a week pursuant to section 22 of the Schedule. This claim was made on April 11, 2005.
Subsection 22(1) of the Schedule provides:
The insurer shall pay for reasonable and necessary additional expenses incurred by or on behalf of an insured person as a result of an accident for housekeeping and home maintenance services if, as a result of the accident, the insured person sustains an impairment that results in a substantial inability to perform the housekeeping and home maintenance services that he or she normally performed before the accident.
The burden of proof rests with Ms. Halim to show on a balance of probabilities that she suffered a substantial inability to perform housekeeping duties and the expense was reasonable and necessary.
For the following reasons, I find that Ms. Halim has not met her burden of proof.
Ms. Halim provided very little evidence to support her claim. In her testimony Ms. Halim was very vague about receiving housekeeping for the period in dispute. She had no independent recollection of receiving housekeeping. She testified that she must have received housekeeping if that is what the records show.
Pursuant to section 24 of the Schedule, Ms. Halim underwent an In-Home Assessment on February 9, 2005 with a chiropractor, Dr. Jeff Sole. In his report, Dr. Sole states that: “The patient reports that since the accident she has had housekeeping help approximately 10 hours per week for a couple of months, but none currently.” In his conclusion, Dr. Sole states that “Ms. Halim reports having no current difficulties with any tasks. She experiences intermittent mild pain, but this does not restrict her in physical capacities or housekeeping responsibilities.”
Ms. Halim did not make her claim for the additional housekeeping in the requisite seven days from when it was allegedly incurred in accordance with subsections 32(1) and 1.1(b) of the Schedule. In fact, she made her claim for housekeeping on April 11, 2005, after the In-Home Assessment, on February 9, 2005, which said she did not need any housekeeping. Except for Dr. Lianos’ disability certificate on December 1, 2004, Ms. Halim did not provide any further medical recommendation or evidence that the additional three weeks of housekeeping was reasonable and necessary.
Accordingly, for these reasons, I find that Ms. Halim did not meet her burden of proof and therefore is not entitled to housekeeping expenses for the period of January 24, 2005 to February 13, 2005.
ISSUE 3: Is Ms. Halim entitled to her costs for a Section 24 In-Home Assessment, a Functional Abilities Evaluation and a Psychological Assessment?
(a) In-Home Assessment
Ms. Halim claims $869.50 for the In-Home Assessment by Dr. Sole conducted on February 9, 2005 pursuant to section 24 of the Schedule.
Subsection 24(1) paragraph 3 of the Schedule provides in part, that the insurer shall pay the reasonable fees to a health professional for an assessment or examination and preparation of a report, if the assessment or examination and the report are reasonably required in connection with a benefit claimed.
Security National submits that at the time of the In-Home Assessment, there were no benefits in dispute. When the request for the In-Home Assessment was made on January 6, 2005, Security National advised Ms. Halim by a letter dated January 17, 2005, wherein it stated “We have not been presented with a claim and as such this request falls outside of the definition in of Section 24(3) and as such we cannot render any approval decision.”
The letter goes on to state: “Please accept this as notice required and we are confirming this request is withdrawn.”
On January 21, 2005, a second request was made for an In-Home Assessment. On January 31, 2005, Security National sent a similar letter to the one sent on January 17, 2005.
Despite the fact that Security National had advised Ms. Halim twice that her request for an In-Home Assessment is withdrawn because there were no outstanding claims, Ms. Halim went ahead with the assessment.
Ms. Halim submits that Security National’s denial on the basis that there were no outstanding claims for benefit was not valid because they had not conducted a DAC.
Findings
The burden of proof rests with Ms. Halim to show on a balance of probabilities that pursuant to section 24(1) of the Schedule, the In-Home assessment was reasonable and necessary.
For the following reasons I find that Ms. Halim has not met her burden of proof.
Ms. Halim did not present any evidence that the In-Home Assessment was “reasonably required,” and as such this would disentitle her from the section 24 expense. In addition, subsection 24(1) paragraph 3 makes it very clear that in order for there to be an assessment there must be a claim for benefits.
Ms. Halim does not deny that she had not made a claim for housekeeping when she asked for the section 24 assessment. Although Security National had twice advised her, with copies to her counsel and Century Assessment and Diagnostic Centre (“Century”), that there was no outstanding claim for a benefit that required an assessment, Ms. Halim nevertheless went ahead with the In-Home assessment on February 9, 3005 and made a claim for housekeeping on April 11, 2005.
I agree with Arbitrator Feldman in the case of Tan and Royal and SunAlliance Insurance Company of Canada6 wherein he states: “that there ought to be an existing claim for a specific type of benefit (at the time approval is sought for the examination or assessment) so that an insurer can make a reasoned decision about whether or not to approve an expense under section 24. . .”
In the present case, Ms. Halim knowingly went ahead with the assessment despite the fact that no benefit had been claimed, contrary to subsection 24(1) paragraph 3 of the Schedule. Although Ms. Halim testified that she did not open the numerous letters Security National sent her, this does not absolve her of her responsibility. In any case, notice was also provided to her counsel and Century.
Accordingly, for these reasons I find that Ms. Halim is not entitled to her claim for an In-Home Assessment, pursuant to section 24 of the Schedule.
(b) Functional Abilities Evaluation (FAE)
Ms. Halim claims $1,244 for a Functional Abilities Evaluation (FAE) conducted on February 17, 2005, pursuant to section 24 of the Schedule.
A request for an FAE was made on January 24, 2005.7 Security National submits that at the time of the request for the FAE, there were no benefits in dispute. In its letter dated January 31, 2005, Security National advised Ms. Halim: “We have not been presented with a claim and as such this request falls outside of the definition of Section 24(3) and as such we cannot render any approval decision.”
The letter goes on to state: “Please accept this as notice required and we are confirming this request is withdrawn.”
Despite the fact that Security National advised Ms. Halim that her request for an In-Home Assessment is withdrawn because there were no outstanding claims, Ms. Halim went ahead with the assessment on February 17, 2004. The report of the assessment, however, was first submitted to Security National on December 8, 2005.
Ms. Halim submits that Security National’s denial on the basis that there were no outstanding claims for benefits, was not valid because they had not conducted a DAC. I disagree.
Findings
The burden of proof rests with Ms. Halim to show on a balance of probabilities that pursuant to section 24(1) of the Schedule, the FAE assessment was reasonable and necessary.
I find that Ms. Halim has not met her burden of proof, for the same reasons given above in respect of her claim for an In-Home assessment, including Arbitrator Feldman’s reasoning in Tan.
In summary, Ms. Halim did not present any evidence that the FAE was “reasonably required,” and as such this would disentitle her from the section 24 expense. Moreover, Ms. Halim knowingly went ahead with the FAE despite the fact that no benefit had been claimed pursuant to subsection 24(1) paragraph 3, and despite the fact that Security National had notified her, with copies to her counsel and Century Assessment, that it was confirming that her request was withdrawn. The fact that Ms. Halim chose not to open the numerous letters Security National sent her, this does not absolve her of her responsibility.
Accordingly, for these reasons I find that Ms. Halim is not entitled to her claim for an FAE pursuant to section 24 of the Schedule.
(c) Psychological Assessment
Ms. Halim claims $1,384 for a Psychological Assessment that she underwent on June 22, 2005.
Security National submits that Ms. Halim’s claim for a psychological assessment is not reasonable or necessary. Security National submits that Ms. Halim signed a form authorizing a psychological assessment on December 1, 2004, when there was no outstanding request for a psychological assessment. The request for a psychological assessment was not made until January 1, 2005.
In addition, once it received a request for the assessment, Security National wrote to Ms. Halim that it was returning her application as there was no information in Part 5(a) of the application to indicate or identify any psychological problems, nor was there any medical referral for a psychological assessment. Accordingly, in accordance with subsections 32(3)(3.1) of the Schedule, Security National advised Ms. Halim that unless she provides the requisite information by January 26, 2004, Security National will consider her request for a psychological assessment withdrawn.
Ms. Halim did not provide the requisite information, but on January 21, 2005 she made a second request for a psychological assessment. On January 31, 2005, Security National wrote a similar letter to its January 17, 2005 letter and returned Ms. Halim’s application for a psychological assessment.
Ms. Halim did not provide the further information that was requested, but proceeded to have the psychological assessment on June 22, 2005.
Ms. Halim submits that Security National did not provide a proper denial as it did not provide a DAC to assess her request.
Findings
The burden of proof rests with Ms. Halim to show on a balance of probabilities that pursuant to section 24(1) the psychological assessment was reasonable and necessary.
For the following reasons, I find that Ms. Halim has not met her burden of proof.
Ms. Halim did not provide any medical evidence to support her position that the June 22, 2005 psychological assessment was reasonable and necessary. Moreover, under cross examination Ms. Halim testified that except for when she underwent the psychological assessment, she never saw or spoke to a psychologist or psychiatrist. She further testified she did not feel the need for psychological assistance nor did she think that she required treatment at any point.
I give little, if any, weight to Ms. Halim’s submission that Security National wrongfully denied her application for the assessment by not providing her with a DAC. Subsection 3(3.1) provides that if an insurer receives an incomplete application for a benefit, the insurer shall notify the person within 14 days after receiving the incomplete application that the application is incomplete and shall indicate the information that is missing.
Security National responded to Ms. Halim’s application within 14 days. It advised Ms. Halim, with copies to her counsel and Century Assessment, on two occasions January 17 and 31, 2005 that her application was incomplete and requested that she provide the requisite information. Ms. Halim ignored these requests. The fact that Ms. Halim chose not to open her correspondence from Security National does not absolve her of her responsibility.
Accordingly, for these reasons I find that Ms. Halim has not met her burden of proof and, therefore, is not entitled to her claim for a psychological assessment pursuant to section 24 of the Schedule.
Issue 4: Is Ms. Halim liable to pay $722.25 to Security for the repayment of a Med/Rehab DAC Assessment scheduled with York Rehab for April 12, 2005 pursuant to section 47 of the Schedule?
Security National submits that it had scheduled a DAC appointment for April 12, 2005 with Med/Rehab DAC Assessment that Ms. Halim failed to attend. Accordingly, Security National submits that pursuant to subsection 47(1)(e) of the Schedule Ms. Halim is liable to repay Security National $722.25 it had to pay for the missed appointment.
Subsection 47(1)(e) provides in part:
A person shall repay to the insurer,
fees paid by the insurer under paragraph 2 of subsection 24(1), if the insured person fails, without a reasonable explanation, to attend a designated assessment that has been arranged…
Ms. Halim did not provide any submissions on this issue. Her only explanation for non attendance for the DAC appointment is that she does not open her mail.
In my view, this is not a reasonable explanation for Ms. Halim’s failure to attend the DAC appointment. The fact that Ms. Halim chose to ignore all correspondence relevant to her accident benefit claim because she does not open her mail, does not absolve her from her responsibility to repay the insurer for her failure to attend at the DAC appointment.
Accordingly, I find that pursuant to subsection 47(1)(e) Ms. Halim is required to pay Security National $722.25 for failing to attend a scheduled DAC appointment on April 12, 2005.
EXPENSES:
If, needed, the parties may speak to me on the issue of expenses within 30 days of receipt of this decision.
October 30, 2007
Joyce Miller Arbitrator
Date
Financial Services Commission des Commission services financiers of Ontario de l’Ontario
Neutral Citation: 2007 ONFSCDRS 209
FSCO A05-002012
BETWEEN:
MONA HALIM
Applicant
and
SECURITY NATIONAL INSURANCE CO./ MONNEX INSURANCE MGMT. INC.
Insurer
ARBITRATION ORDER
Under section 282 of the Insurance Act, R.S.O. 1990, c.I.8, as amended, it is ordered that:
The arbitration is dismissed.
Ms. Halim shall pay Security National $722.25 pursuant to subsection 47(1)(e) of the Schedule.
If needed, the parties may speak to me on the issue of expenses within 30 days of receipt of this decision.
October 30, 2007
Joyce Miller Arbitrator
Date
Footnotes
- The Statutory Accident Benefits Schedule — Accidents on or after November 1, 1996, Ontario Regulation 403/96, as amended.
- December 13, 2004, January 20, Feb 24, March 11, and April 14, 2005
- Designated Assessment Centre
- In a letter from her family doctor dated January 3, 2007, Dr. McLean confirms that she had no knowledge of any car accident: “I have reviewed [Ms. Halim’s] entire chart and have no knowledge of any car accident”.
- As well, he examined her a second time for a 5th treatment plan on February 9, 2006 which is not in dispute at this arbitration.
- (FSCO A04-000656, November 29, 2004)
- It would appear from Security National’s January 31, 2005 letter that this was the second request for an FAE, however, the first letter was not put into evidence.