Citation: TF vs. Certas Direct Insurance Company, 2019 ONLAT 18-007021/AABS
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:
[T.F.]
Appellant
and
Certas Direct Insurance Company
Respondent
DECISION AND ORDER
VICE CHAIR: Susan Mather
Appearances:
For the Appellant: Sharon Mackay, Counsel
For the Respondent: Jean-Claude Rioux, Counsel
Heard: In-Person:Hearing: May 1, 2019
Heard: In Writing: Hearing: June 7, 2019
REASONS FOR DECISION AND ORDER
OVERVIEW
1The appellant was involved in an automobile accident on August 27, 2014, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the ''Schedule''). The respondent (“Certas”) terminated the appellant’s income replacement benefit (IRB) of $32.77 per week as of May 26, 2016 on the basis that she no longer suffered a substantial inability to perform the essential tasks of her employment.
2The appellant was also denied certain medical benefits by Certas. She submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”) to have her entitlement to IRBs and medical benefits determined.
3At a case conference held on November 7, 2018, the parties agreed to a combination of a written and in-person hearing and to the witness list for the in-person portion of the hearing. The appellant testified at the May 1, 2019 in-person hearing and called no other witnesses. The respondent’s expert witness Dr. Behzad Taromi was cross-examined by the appellant. The parties submitted final written submissions following the oral hearing.
ISSUES
4The issues in dispute are as follows:
i. Is the applicant entitled to an income replacement benefit in the amount of