Licence Appeal Tribunal
Tribunal File Number: 18-003420/AABS
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:
G.A. Applicant
and
The Personal Insurance Company Respondent
DECISION
ADJUDICATOR: Robert Watt
APPEARANCES
For the Applicant: Natalie Shykula-Clarke For the Respondent: Adam Fox
Heard In Writing: April 1, 2019
OVERVIEW
1The applicant was injured in an automobile accident on August 11, 2015 and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the ''Schedule''). The applicant was denied certain benefits by the respondent and submitted an application to the Licence Appeal Tribunal –Automobile Accident Benefits Service (“Tribunal”) on July 4, 2018.
2The parties participated in a case conference and were unable to resolve the issues in dispute.
ISSUES IN DISPUTE
3The issues in dispute are:
i. Did the applicant sustain predominantly minor injuries as defined by the Schedule?
ii. Is the applicant entitled to $97.00 for the unpaid balance of an occupational therapy assessment dated March 16, 2016?
iii. Is the applicant entitled to $99.38 for medical expenses submitted October 21, 2015?
iv. Is the applicant entitled to $142.54 for medical expenses submitted February 2, 2016?
v. Is the applicant entitled to $199.86 for assistive devices submitted April 21, 2016?
vi. Is the applicant entitled to interest on any overdue payment?
RESULTS
4I find that the applicant sustained predominantly minor injuries as defined by the Schedule.
5I find that the applicant is not entitled to $97.00 for the unpaid balance of an occupational therapy assessment dated March 16, 2016.
6I find that the applicant is not entitled to $99.38 for medical expenses submitted October 21, 2015.
7I find that the applicant is not entitled to $142.54 for medical expenses submitted on February 2, 2016?
8I find that the applicant is not entitled to $199.86 for assistive devices submitted April 21, 2016.
9I find that the applicant is not entitled to interest as no benefits are owing.
BACKGROUND
10The applicant was involved in a motor vehicle accident on August 11, 2015. Her car was rear ended by another motor vehicle. She was taken to the Humber River Hospital where she was prescribed pain medication.1 The applicant returned to work that same day on August 11, 2015.
11On January 15, 2016 the applicant visited her family doctor Dr. T. Arndt and was given prescriptions for physiotherapy and massage treatments, for her shoulder and neck pain.
12The applicant attended Dr. H. Winston of the Center for Health and Sports medicine on March 4, 2016. He recommended that the applicant attend manual physical therapy or osteopathy, massage therapy, heating/stretching and modified activity.
13The applicant attended on March 21, 2016 at Ms. Bierbrier, Occupational Therapist who recommended continued use of a cervical pillow, occupational therapy treatment, continuation of physiotherapy and massage therapy treatment, a driving desensitization assessment.2 In her report dated April 20, 20163, the applicant is diagnosed with soft tissue complaints only. The report indicated that the applicant could participate in all her activities of daily living, personal care shopping, light housekeeping and return to work. The applicant was also retuning to the gym two times per week.
14Dr. Winston, the applicant’s family doctor diagnosed the applicant with soft tissue injuries including myofascial tightness, mechanical neck pain, mechanical hip pain and C6/C7 radiculpathy.4 In his report dated June 9, 2016, Dr. Winston indicated that the applicant no longer had the C-7 myotomal weakness.
15Dr. Kevin Cheyne, in his Minor Injury Guideline Determination Report (MIG) dated March 22, 2019, indicated that there were” objective neurological signs”. He opined therefore the MIG do not apply. Dr. Cheyne’s MIG report was based on Dr. Winston’s CNR notation that the applicant continued to document a C6-7 left arm radiculopathy.
ANALYSIS
Did the applicant sustain predominantly minor injuries as defined by the Schedule?
16Section 3(2) of the Schedule defines minor injury as one or more of a sprain, strain,