Tribunal File Number: 18-000819/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. B.

Applicant

and

RBC Insurance Company

Respondent

DECISION

ADJUDICATOR: Thérèse Reilly

APPEARANCES:

For the Applicant: Elena Steinberg, Counsel

For the Respondent: Mark Vella, Counsel

Heard in Writing: September 4, 2018

OVERVIEW

1The applicant was injured in a motor vehicle accident on February 9, 2016 and applied for accident benefits to RBC Insurance Company of Canada (“the respondent”) under the Statutory Accident Benefit Schedule – Effective September 1, 2010 (the “Schedule”).

2The applicant maintains in her written submissions that she has ongoing pain and limitations as a result of the injuries sustained in the accident which she claims are affecting her ability to perform home maintenance activities and achieving maximal recovery. She attended physiotherapy treatment for seven months after the accident. Her physiotherapy treatments stopped in August 2016. She submitted an application seeking a medical benefit for the cost of two physiotherapy treatment plans (the treatment plans) which would provide additional physiotherapy treatment and the sum of $200.00 relating to the completion of an Attendant Care Assessment form (Form 1), which she claims are all reasonable and necessary. The two treatment plans in dispute seek the same treatment.

3The respondent denied all three claims on the basis that they are not reasonable and necessary. It submits the applicant has failed to submit sufficient evidence to support entitlement to the medical benefits being sought and the cost of completing the Form 1. The respondent relies on the reports of its IE assessors which confirm, in its view, that although the applicant reported ongoing pain complaints in her right knee, the injuries suffered are sprains and strains which other than some neck and knee tenderness have resolved. The IE assessment reports dated January and May 2017 conclude that the applicant had reached maximum recovery and as such the additional treatment would not be of therapeutic benefit. The treatment plans in dispute are not reasonable and necessary.

4The applicant bears the burden of establishing that the benefits sought are reasonable and necessary.

5All evidence was submitted by way of written submissions with attached documentary evidence.

ISSUES

6The following are the issues to be decided:

a. Is the applicant entitled to a medical benefit in the amount of $3,454 for physiotherapy treatment recommended by Brampton Civic Care Centre Inc. in a treatment plan dated June 9, 2016 and denied on September 19, 2016?

b. Is the applicant entitled to a medical benefit on the amount of $3,087 for physiotherapy treatment dated August 6, 2016 submitted on August 6, 2016 and denied on September 19, 2016?

c. Is the applicant entitled to the cost of an examination in the amount of $200.00 for the cost of completing an Attendant Care Assessment Form (Form 1), recommended by Ontario Independent Assessment Centre Inc. dated February 22, 2017 and denied May 17, 2017?

d. Is