Tribunal File Number: 16-000097/AABS
Case Name: 16-000097 v RBC Insurance Company
In the matter of an Application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits
Between:
D. D. D.
Applicant
and
RBC Insurance Company
Respondent
DECISION
ADJUDICATOR: Ruth Gottfried
APPEARANCES:
For the Applicant: Sunnish Uppal and Peter Pietraszek
For the Respondent: Shikha Sharma
HEARD: Licence Appeal Tribunal: September 8, 2016
REASONS FOR DECISION AND ORDER
This is an application to the Licence Appeal Tribunal (the “Tribunal”) with respect to the resolution of disputes in respect of an insured person’s entitlement to statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured person is entitled.
OVERVIEW:
1The applicant was injured in a motor vehicle accident on January 4, 2015. She applied for and received benefits under the Statutory Accident Benefits Schedule - Effective after September 1, 2010 (the “Schedule”).
2The respondent, RBC Insurance (“RBC”), approved benefits for the applicant until it received assessments from independent medical examinations carried out by Dr. Alvi (an orthopaedic surgeon) and Dr. Browne (a psychologist), at which time it denied the remaining benefits.
3At the outset of the hearing, both the respondent and the applicant advised me that all benefits in dispute had been resolved with the exception of a benefit for income replacement (“IRB”).
PRELIMINARY ISSUES:
4The respondent raised the issue that several documents remained outstanding from the requested productions of the applicant, including, but not limited to, a decoded OHIP Summary as well as the applicant’s complete employment insurance (“EI”) file. The respondent further put forward that H & A, a forensic accounting firm, had requested additional documents from the applicant that were not provided. I ruled that any documents that had not been produced on time prior to the hearing could not be relied on at the hearing.
5The respondent also cited other documents that had not been produced prior to the case conference and were only produced at the case conference. Its position was that the applicant should not be allowed to rely on those documents at the hearing.
6I ruled that since those documents had been provided in enough time before the hearing and since the respondent could not show that it had suffered any prejudice, I would allow those documents and they could be relied on by the applicant.
7A second preliminary issue raised by the respondent was the unilateral decision of the applicant to dispense with an affidavit from its witness, family doctor Dr. Paul Kwong and have viva voce examination on his clinical notes and records instead.
8The respondent had waited to review the affidavit and was surprised at the hearing to have to question Dr. Kwong on his clinical records only. I ruled that only cross-examination and redirect would be allowed on the clinical notes and records, which had already been submitted into evidence. As the applicant was late in arriving and the doctor’s testimony did not begin until almost two hours after the start of the hearing, the respondent’s counsel advised that it had sufficient time to prepare and would not be prejudiced.
ISSUE:
9As all outstanding issues were resolved before this hearing occurred, the only issue now before the Tribunal is the following:
Is the applicant entitled to an income replacement benefit in the amount of $400.00 per week from August 1, 2015 to March 29, 2016?
RESULT:
10I find