Tribunal File Number: 16-004309/AABS
Case Name: 16-004309/AABS v Allstate 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:
Applicant
Applicant
and
Allstate Insurance Company
Respondent
DECISION
ADJUDICATOR: Blaine Baker
APPEARANCES:
For the Applicant: Andrej Rondas, paralegal
For the Respondent: Sara Azghadi, counsel
HEARD: Written Hearing: June 14, 2017
Overview:
1This is an application by [applicant] (the “applicant”) to the Licence Appeal Tribunal (the “Tribunal”) for the resolution of disputes in respect of an insured person’s entitlement to statutory accident benefits.
2The applicant was injured in an automobile accident on November 15, 2014, and sought benefits under the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the “Schedule”). The applicant applied for non-earner and other benefits. The respondent, Allstate Insurance Company (“Allstate”), commenced payment of non-earner benefits to the applicant at the conclusion of the statutory six-month waiting period following her accident, and continued those payments until November 13, 2015. It then concluded on the basis of a series of insurer’s examinations that the applicant did not meet the test for that benefit, and now asks that the Tribunal retroactively terminate those benefits as of May 15, 2015. Allstate also refused to pay for certain medical benefits.
3The applicant disagreed with the respondent’s decisions and applied to the Tribunal for resolution of the dispute.
Issues to be decided:
4The following issues are in dispute:
(i) Is the applicant entitled to a non-earner benefit of $185 per week from May 13, 2015 to date, and ongoing?
(ii) Is the applicant entitled to a medical benefit in the amount of $2,646.40 for physiotherapy that was recommended by Midland Wellness Centre in a treatment plan submitted to the respondent on October 20, 2015 and denied on October 26, 2015?
(iii) Is the applicant entitled to a medical benefit in the amount of $2,413.60 for physiotherapy that was recommended by Midland Wellness Centre in a treatment plan submitted to the respondent on March 9, 2016 and denied on April 1, 2016?
(iv) Is the applicant entitled to interest on the overdue payment of benefits?
Result:
5Based on the totality of the evidence before me, I find that:
(i) The applicant is not entitled to a non-earner benefit from November 13, 2015 to date and ongoing, but was entitled to that benefit during the May 14, 2015 to November 13, 2015 during which it was paid by