Licence Appeal Tribunal
Tribunal File Number: 17-006106/AABS
Case Name: 17-006106 v Intact Insurance Company
In the matter of an Application for Dispute Resolution pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8., in relation to statutory accident benefits.
Between:
M. R. A.
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR: Chris Sewrattan
APPEARANCES:
For the applicant: Self-Represented
Counsel for Intact Insurance: Jessica Abramovitch
HEARD IN WRITING: May 28, 2018
OVERVIEW:
1The applicant was injured in a motor vehicle accident. He sought payment for physiotherapy services under the Schedule1. Intact Insurance Company (“Intact”) denied payment. The applicant appeals for payment to the Licence Appeal Tribunal – Automobile Accident Benefits Service (“Tribunal”).
ISSUES:
2The only issue remaining in dispute is whether the applicant is entitled to interest on the overdue payment of the benefit for physiotherapy services.
3The issue of whether the applicant is entitled to $1,168.02 for physiotherapy services, recommended by physiotherapist Farhan Damji, in a Treatment Plan (OCF-18) dated August 5, 2015 is no longer in dispute because Intact approved the Treatment Plan and paid the applicant prior to the start of the hearing.
RESULT:
4The applicant is entitled to interest on the $1,168.02 payment for physiotherapy services.
DISCUSSION:
5The applicant received payment for the physiotherapy services prior to the start of this hearing. He is entitled to interest on this payment in accordance with s. 51 of the Schedule.
6A brief chronology is required to make sense of the background. On August 5, 2015, the applicant submitted a Treatment Plan for $1,168.02 of physiotherapy services. Intact denied the Treatment Plan on September 18, 2015. The applicant filed an application to the Tribunal to dispute the denial.
7A written hearing was set following a case conference with the Tribunal. The Case Conference Order listed four issues for the hearing: two preliminary issues directly relating to the disputed Treatment Plan, one issue relating to interest, and the issue of whether the applicant is entitled to payment for the physiotherapy services. At that point in the Tribunal’s proceeding, all parties understood that the applicant was self-represented and sometimes required the assistance of a Dari interpreter.
8Intact approved the disputed Treatment Plan prior to the applicant’s deadline for written submissions. The applicant still provided written submissions, addressing other issues: the need for teeth replacement, more physiotherapy, travel payment, and accommodation for medical fees. Intact takes the position that there are no remaining issues to be determined in this hearing and, therefore, the application should be dismissed.
9There is one issue left to resolve − interest − and it is not one that the applicant asked me to decide in his submissions. I can only decide issues that are properly before me. To be properly before me, an issue should be listed in the Case Conference Order, among other things. The Case Conference Order does not list as issues; teeth replacement, additional physiotherapy, travel payment, or the accommodation of medical fees. The applicant may have an opportunity at a later date to address those issues, perhaps with Intact directly, or through an Application to the Tribunal. There are steps that need to be taken to make that happen. However, those issues cannot be determined at this hearing.
10Interest was listed as an issue in the case conference Order. Since Intact admits that the applicant is entitled to $1,168.02 in payment for physiotherapy services, it follows that interest should attach to the time period during in which the payment was overdue.
CONCLUSION:
11The applicant is entitled to interest on the $1,168.02 payment for physiotherapy services. I cannot consider or address the applicant’s submissions for other benefits because those issues are not properly before me in this hearing.
Released: June 20, 2018
Chris Sewrattan- Adjudicator