Licence Appeal Tribunal
Tribunal File Number: 16-004616/AABS
Case Name: 16-004616/AABS v Aviva Insurance Canada
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:
Applicant
Applicant
and
Aviva Insurance Canada
Respondent
DECISION
ADJUDICATOR: Khizer Anwar
WRITTEN SUBMISSIONS BY:
For the Applicant: Michael Wentzel, legal representative
For the Respondent: M. Jennifer Cosentino, counsel
Heard in writing on: July 31, 2017
OVERVIEW
1[The Applicant] (“the applicant”) was injured in an automobile accident on September 2, 2011 (“the accident”), and sought benefits from her auto insurer (“the respondent”) pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (“Schedule”).
2The applicant submitted four treatment and assessment plans (“OCF-18”) to the respondent, requesting funding for physiotherapy/chiropractic services, psychological services and an orthopaedic assessment. In addition, the applicant also requested payment for the expense of an OCF-3. The respondent denied funding for chiropractic services and the orthopaedic assessment, as well as payment for an OCF-3, as it deemed these requests to be not reasonable and necessary but provided partial funding for psychological services.
3The applicant disagreed with the respondent’s decision on all three treatment and assessment plans and submitted an application for dispute resolution services to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”).
4The parties participated in a case conference but were unable to resolve the issues in dispute.
ISSUES TO BE DECIDED
5The issues in dispute identified by the parties in their submissions and to be decided are:
- Is the applicant entitled to a medical benefit in the amount of $1,418.00, for physiotherapy and chiropractic services, as outlined in the OCF-18 dated April