R.N. v. Aviva General Insurance
Released Date: 03/20/2020
Tribunal File Number: 18-009117/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:
[R.N.]
Applicant
and
Aviva General Insurance
Respondent
DECISION
ADJUDICATOR:
Eleanor White, Vice Chair
APPEARANCES:
For the Applicant:
Doina Marinescu, Paralegal
For the Respondent:
Michael Silver, Counsel
Written Hearing on:
June 3, 2019
OVERVIEW
1The applicant was injured in an automobile accident on September 11, 2016 and sought benefits from the respondent, Aviva Insurance Canada (Aviva), pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the ''Schedule'').
2The applicant applied for certain medical benefits and costs of examination that were denied by Aviva on the grounds that the applicant was designated as having injuries that were predominantly treatable under the Minor Injury Guideline (MIG) and thus the treatments and assessments were not reasonable and necessary. Accordingly, the applicant disagreed with Aviva’s decision and submitted an Application to the Licence Appeal Tribunal – Automobile Accident Benefits Service (Tribunal) for dispute resolution. A case conference was scheduled during which the parties were unable to resolve the issues in dispute and proceeded to this hearing in writing.
3The applicant is disputing the denial of recommended physical therapies for continuing pain in his neck, lower back, right shoulder and wrist as well as psychological assessment and treatment for related continuing difficulties with sleeping and mood, affecting his participation in daily activities. Due to these disputes, the applicant bears the onus to prove that his injuries do not predominantly fall within the definition of “minor injury” in the Schedule.
ISSUES TO BE DECIDED
4The following issues in dispute were set out in the case conference order of Adjudicator Kershaw on February 5, 2020:
(i) Did the applicant sustain predominantly minor injuries as defined under the Schedule?
(ii) Is the applicant entitled to a medical/rehabilitation benefit in the amount of $141.04 ($1,236.84 less the partially approved amount of $1,095.81) for chiropractic treatment recommended by Alexander Yu in a treatment plan (OCF-18) submitted on November 4, 2016 and denied on November 18, 2016?
(iii) Is the applicant entitled to a medical/rehabilitation benefit in the amount of $3,355.20 for chiropractic treatment recommended by Tam Pham in a treatment plan (OCF-18) submitted on November 16, 2016 and denied on November 25, 2016?
(iv) Is the applicant entitled to a medical benefit in the amount of $4,266.47 for psychological services recommended by Svetlana Gabidulina in a treatment plan (OCF-18) submitted on January 9, 2017 and denied on January 16, 2017?
(v) Is the applicant entitled to a medical/rehabilitation benefit in the amount of $3,074.62 for chiropractic treatment recommended by Tam Pham in a treatment plan (OCF-18) submitted on January 6, 2017 and denied on January 16, 2017?
(vi) Is the applicant entitled to a medical/rehabilitation benefit in the amount of $2,695.22 for chiropractic treatment recommended by Tam Pham in a treatment plan (OCF-18) submitted on April 9, 2017 and denied on April 25,