Safety, Licensing Appeals and Standards Tribunals Ontario Licence Appeal Tribunal Automobile Accident Benefits Service Mailing Address: 77 Wellesley St. W., Box 250, Toronto ON M7A 1N3 In-Person Service: 20 Dundas St. W., Suite 530, Toronto ON M5G 2C2 Tel.: 416-314-4260 1-800-255-2214 TTY: 416-916-0548 1-844-403-5906 Fax: 416-325-1060 1-844-618-2566 Website: www.slasto.gov.on.ca/en/AABS
Tribunaux de la sécurité, des appels en matière de permis et des normes Ontario Tribunal d'appel en matière de permis Service d'aide relative aux indemnités d'accident automobile Adresse postale : 77, rue Wellesley Ouest, Boîte no 250, Toronto ON M7A 1N3 Adresse municipale : 20, rue Dundas Ouest, Bureau 530, Toronto ON M5G 2C2 Tél. : 416 314-4260 1 800 255-2214 ATS : 416 916-0548 1 844 403-5906 Téléc. : 416 325-1060 1 844 618-2566 Site Web : www.slasto.gov.on.ca/fr/AABS
RECONSIDERATION DECISION
Before: Linda Lamoureux, Executive Chair
File: 17-001670/AABS
Case Name: V.S. v. Travelers Insurance Company of Canada
Written Submissions By:
For the Applicant: Kiro Soliman
For the Respondent: Emma Duggan
Overview
1After receiving the Licence Appeal Tribunal’s decision, the applicant, V.S., requested a reconsideration under Rule 18. In short, he argued that the Tribunal made a number of errors in deciding that he is not entitled to treatment outside of the Minor Injury Guideline (“the MIG”). As part of his request, V.S. takes issue with the Tribunal’s findings with respect to the manner in which his insurer, Travelers Insurance Company of Canada (“Travelers”), denied two treatment and assessment plans.
2Travelers has since approved both treatment plans and removed V.S. from the MIG, leaving a single issue to be decided: whether V.S. is entitled to interest on Travelers’ payments of the outstanding benefits. For the reasons below, I find that V.S. is entitled to interest.
Background
3V.S. was involved in a motor vehicle accident on October 31, 2016. As a result, he applied to Travelers for accident benefits under the Statutory Accident Benefits Schedule – Effective September 1, 2010, O. Reg. 34/10 (“the Schedule”).
4In a letter dated December 14, 2016, Travelers indicated to V.S. that he was approved treatment within the MIG. V.S. then received treatment within the MIG, after which Travelers denied payment for treatment plans that exceeded the MIG limit. V.S. applied to the Tribunal for dispute resolution with respect to two of those treatment plans. The first plan, dated December 21, 2016, included benefits in the amount of $1,294.03, while the second plan, dated February 13, 2017, included benefits totalling $2,075.48.
5The Tribunal held a case conference on May 18, 2017. The issues in dispute were as follows: 1) whether the MIG applies to V.S.’s injuries 2) whether V.S. is entitled to payment for the two treatment plans and 3) whether V.S. is entitled to interest and an award under Regulation 664.
6The case conference did not resolve the issues and, accordingly, the application proceeded to a written hearing on July 20, 2017.
7Ultimately, the Tribunal held that V.S.’s injuries were properly within the MIG. The Tribunal disagreed with V.S.’s submission that he has a pre-existing condition documented by a health care practitioner before the accident that will prevent him from achieving maximal recovery under the MIG. Additionally, the Tribunal found that Travelers initial denial of the treatment plans provided V.S. with the necessary “medical reasons” required under s. 38(8).
Discussion and Reasons
8V.S. requested that I reconsider the Tribunal’s decision, submitting that the Tribunal made a number of significant errors of law that are “material to the [Tribunal’s] conclusion”. V.S. asks that I vary the decision to establish: 1) his injuries fall outside of the MIG; 2) he is entitled to payment of both treatment plans; and 3) he is entitled to interest on both treatment plans.
9In an email, dated April 3, 2018, counsel for Travelers advised counsel for V.S. and the Tribunal that Travelers revised its position on the substantive issues on the request for reconsideration. Travelers has now approved full payment for both treatment plans and removed V.S. from the MIG.
10A significant focus of V.S.’s reconsideration request was on Travelers’ alleged failure to deny the second treatment plan in accordance with s. 38(8). According to V.S., certain errors in the notice and a lack of “medical reasons” in the denial render the notice invalid and, more importantly, trigger s. 38(11), thereby prohibiting Travelers from taking the position that the MIG applies to his injuries. Practically speaking, V.S. has received the same relief from Travelers’ concession: in addition to approving the treatment plans at issue, Travelers has removed him from the MIG.
11Given this development, the only issue remaining is whether V.S. is entitled to interest. Pursuant to ss. 51(1) and (2) of the Schedule, an insurer is required to pay interest on any overdue payments of a benefit. Travelers has agreed that the amounts of the treatment plans are payable. In my view, therefore, it is also required to pay interest in accordance with the Schedule on any overdue payments.
Conclusion
12This request for reconsideration is granted in part. Travelers is required to pay interest in accordance with the Schedule on the treatment plans dated December 21, 2016 and February 13, 2017.
Linda Lamoureux
Executive Chair
Safety, Licensing Appeals and Standards Tribunals Ontario
Released: April 26, 2018