Tribunal File Number: 17-005803/AABS
Case Name: J. B. vs. Coseco 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:
J.B.
Applicant
and
Coseco Insurance Company
Respondent
DECISION
Adjudicator: Christopher A. Ferguson Appearances:
Representative for the applicant: Gregory Brown
Counsel for the respondent: Bruce Keay
Written Hearing Held February 26, 2018
OVERVIEW
1JB, (“the applicant”) was injured in an automobile accident on August 18, 2015, and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 20101 (the ''Schedule'').
2The applicant applied for benefits from the respondent, and applied to the Licence Appeal Tribunal (the “Tribunal”) when the disputed benefits were denied.
DISPUTED BENEFITS
3The issues before me are:
- Are the applicant’s injuries predominantly minor injuries as defined in the
Schedule subject to treatment within the Minor Injury Guideline2 (“the MIG”)?
Is the applicant entitled to the reimbursement of $1,479.63 incurred for treatment, medication, assistive devices, mileage and parking fee pursuant to an Expense Claims Form (OCF-6) dated September 29, 2016 and denied on December 2, 2016?
Is the applicant entitled to interest on overdue payments from the respondent?
Is the respondent liable to pay an award under Regulation 664, Automobile Insurance3 (“Regulation 664”) because it unreasonably withheld or delayed payments to the applicant?
FINDINGS
4The applicant’s injuries are predominantly minor injuries as defined in the MIG.
5On a balance of probabilities, the applicant has not proven that the disputed OCF- 6 expenses are payable by the respondent.
6There are no overdue payments and therefore no interest is owed by the respondent.
7The respondent is not liable to pay an award under Regulation 664.
REASONS
Issue 1 Do the applicant’s impairments fall within the MIG?
8I must decide whether the applicant’s injuries are defined as predominantly minor by the Schedule and thus subject to a $3,500 limit on payable medical benefits, and if they are not, I must determine the applicant’s entitlement to the expenses she claims.
9Section 3(1) of the Schedule defines a minor injury as “one or more of a sprain, strain, whiplash associated disorder (“WAD”), […] and includes any clinically associated sequelae to such an injury.”
10The respondent argues that all of the applicant’s injuries fit the definition of “minor injury” prescribed by s. 3(1) of the Schedule, and therefore, fall within the Minor Injury Guideline (“the MIG”). The applicant’s position is exactly the opposite.
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