M.A. v. Aviva Insurance Canada, 2019 CanLII 101601

I. OVERVIEW

1The applicant [M.A.], was injured in an automobile accident (“the accident”) on January 6, 2016 and sought insurance benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010¹ (the ''Schedule''). He applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (“the Tribunal”) when his claims for benefits were denied by the respondent, Aviva.

2The respondent denied the applicant’s claims because it determined 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 Guideline² (MIG). The applicant’s position is the opposite.

3If the applicant’s position is correct, then I must address the issue of whether the cost of a chronic pain assessment claimed is reasonable and necessary.

4If the respondent’s position is correct, then the applicant is subject to a $3,500.00 limit on medical and rehabilitation benefits prescribed by s.18(1) of the Schedule, and in turn, a determination of whether claimed medical benefits are reasonable and necessary will be unnecessary as the $3,500.00 maximum benefit for minor injuries has been exhausted.

5I must also determine whether the applicant is entitled to weekly non-earner benefits.

II. ISSUES

6Did the applicant sustain predominantly minor injuries as defined by the Schedule? Is his entitlement to benefits limited by the MIG?

7If the applicant’s injuries are not within the MIG, then I must determine the following issue:

(i) Is the applicant entitled to $1,998.80 for the cost of a chronic pain assessment recommended by Alliance Diagnostic Inc. submitted June 20, 2017 and denied August 2, 2017?

8Is the applicant entitled to a non-earner benefit for $185.00 a week for the period from July 6, 2016 to January 6, 2018 submitted January 11, 2016 and