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:
K.P.
Appellant(s)
and
Security National Insurance Company
Respondent
DECISION
ADJUDICATOR:
APPEARANCES:
Raj Sharda
For the Applicant:
Ardi Deti, Paralegal
For the Respondent:
Kamil Podleszanski, Counsel
Held in writing and decision released on
April 29, 2019
OVERVIEW
1The applicant was involved in an automobile accident on June 13, 2017 and sought medical benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (“Schedule”)1. The applicant was denied benefits by the respondent and submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”).
2The parties participated in a case conference but were unable to resolve all the issues in dispute. Hence this matter proceeded to a hearing in writing.
3The applicant states she suffered injuries to her neck, shoulders, chest, abdomen and lower back arising from the accident. Post-accident the applicant states that psychologically she suffers from anxiety and is quick to anger, she has a hard time getting going in the mornings and completing tasks.
ISSUES IN DISPUTE
4The issues before the Tribunal are:
i. Are the applicant’s impairments of a nature that they fall within the Minor Injury Guideline?
ii. Is the applicant entitled to a medical benefit for $3,129.48 for psychological services recommended by Pilowsky Psychological Professional Corporation submitted December 19, 2017 and denied January 22, 2018?
iii. Is the applicant entitled to a medical benefit for $1,977.05 for chiropractic services recommended by Mckenzie Medical Rehabilitation Centre submitted October 28, 2017 and denied November 14, 2017?
iv. Is the applicant entitled to the cost of an examination for $2,200.00 for a psychological assessment recommended by Pilowsky Psychological Professional Corporation submitted November 14, 2017 and denied November 23, 2017?
v. Is the applicant entitled to an award for unreasonably withheld or delayed payments under section 10 of Ontario Regulation 664?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
5For the reasons below, I order as follows:
a) That the applicant should not be removed from the MIG;
b) That the two treatment plans for Psychological services issues 4 (ii) and (iv) are denied.
c) The Treatment plan issue 4 (iii) is approved to the extent that funding remains up to the $3,500.00 Limit. Any payment beyond the $3,500.00 limit for this treatment plan is denied.
d) No Interest is applicable; and
e) No award is warranted in this matter.
ANALYSIS
Do the applicant’s injuries fall within MIG?
6Minor Injury
i. “a “minor injury” means one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae.”
ii. Pursuant to s. 18 of the Schedule, the sum of medical and rehabilitation benefits payable to an insured person who sustains a predominantly minor injury is limited to $3,500.00. Impairment is defined in s. 3 of the schedule to mean:” loss or abnormality of a psychological Physiological or anatomical structure or function.
iii. The $3,500.00 limit does not apply if the insured person provides compelling evidence documented by a health practitioner before the accident that he or she has a pre-existing medical condition that will prevent maximum medical recovery if he or she is subject to the $3,500.00 limit. In addition, certain accident related medical impairments (e.g. a diagnosis of chronic pain or a psychological impairment) can remove an individual from the MIG in certain circumstances.
Evidence relied upon
7The evidence from both sides confirms that the applicant did suffer predominately minor physical injuries.
8The applicant however, argues that she has sustained psychological injuries as a result of the accident and as such should be removed from the MIG guidelines.
9The Applicant predominately relies upon an Dr. Pilowsky’s OCF- 18, and a psychological assessment of January 16, 201