Licence Appeal Tribunal
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:
N. K.
Applicant
and
Primmum Insurance Company
Respondent
DECISION
ADJUDICATOR: Avvy Go
APPEARANCES:
For the Applicant: Arash Goneh-Farahani, paralegal
For the Respondent: Ramandeep Pandher, counsel
Hearing in Writing: October 19,2018
OVERVIEW
1The applicant, N.K., was injured in a motor vehicle accident on July 27, 2015, when the vehicle being operated by her husband was rear-ended. No ambulance was called. The applicant sought treatment from her family physician two days after the accident. The applicant reported physical injuries and pain, as well as emotional issues as a result of the accident.
2The applicant sought certain benefits pursuant to the Statutory Accident Benefits Schedule – Effective after September 1, 2010 (the “Schedule”), including a claim for Non-Earner Benefits (NEB). After paying the applicant the NEB for a short period, the respondent stopped the payment. The applicant submitted an application for dispute resolution services to the Licence Appeal Tribunal (the “Tribunal”).
ISSUES IN DISPUTE
3I have been asked to decide the following issues:
a) Are the applicant’s injuries predominantly minor as defined in the Schedule and subject to treatment within the Minor Injury Guideline?
b) Is the applicant entitled to receive an NEB in the amount of $185.00 weekly for the period June 13, 2016 to date and ongoing, denied by the respondent on June 13, 2016?
c) Is the applicant entitled to receive interest on the overdue amounts?
RESULT
4For the reasons set out below, I find that the applicant is not entitled to the benefits claimed and, thus, no interest is payable.
ANALYSIS
Preliminary Issue: When did the respondent deny the applicant NEB and when was the applicant notified of the denial? Was the NEB improperly denied by the respondent?
5Before addressing the substantive issue of the applicant’s eligibility to receive the NEB, I must first address some preliminary disputes with respect to the effective date of the respondent’s denial of the NEB. The applicant submitted that, while the decision to deny her NEB was made in March 2016, she was only notified of the denial on January 10, 2018. The applicant then submitted an application to the Tribunal on March 8, 2018. The applicant argued that she should be entitled to receive the NEB because there has been a breach of procedural fairness by the respondent.
6The respondent, on the other hand, submitted that the NEB was denied by a letter dated March 31, 2016, and that there has been no procedural fairness breached.
7For the reasons that follow, I find that the applicant was notified of the denial of the NEB on January 10, 2018 and that her NEB was denied effective March 31, 2016. I also find that there has not been a breach of procedural fairness by the respondent.
8The applicant submitted an NEB claim to the respondent on September 15, 2