S.E. vs. Aviva General Insurance, 2020 ONLAT 18-000787/AABS
Released Date: 03/11/2020
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:
[S.E.]
Applicant
and
Aviva General Insurance
Respondent
DECISION AND ORDER
ADJUDICATOR: Aggrey Msosa
APPERANCES:
For the Applicant: David Carranza, Paralegal
For the Respondent: Petros Yannakis, Counsel
HEARD: In Writing: May 6, 2019
OVERVIEW
1The applicant was involved in an automobile accident on September 1, 2015 and sought benefits from the respondent pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010, O Reg. 34/10 (the “Schedule”). The respondent refused to pay certain costs of examination and, the applicant applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”) for resolution of this dispute.
ISSUES
2The issues to be determined are as follows:
i. Is the applicant entitled to payments for the cost of examinations in the amount of $2,267.80 less $1,389.87 approved by the respondent, for a psychological assessment, recommended by Dr. Pilowsky in a treatment plan submitted on January 26, 2016, and denied by the respondent on March 22, 2016?
ii. Is the applicant entitled to interest on overdue payment of benefits for the cost of examination?
RESULTS
3Having reviewed the parties’ submissions and evidence, I find as follows:
i. The applicant is entitled to the balance of unpaid psychological cost of examinations in the amount of $877.93.
ii. The applicant is entitled to interest in accordance with the Schedule on the balance of the cost of examination noted above.
BACKGROUND
4The applicant was a driver of a vehicle that was involved in an accident on September 1, 2015, and while changing lanes, she rear ended the car in front of her that had suddenly stopped. She saw her family doctor, Dr. Mustafa Abdulhussein on September 3, 2015 complaining of chest pain, pain in her back and ribs and driving anxiety. On October 28, 2015, the applicant applied to the respondent for accident benefits.
5On November 11, 2015, Dr. Abdulhussein submitted a disability certificate to the respondent and diagnosed the applicant with a whiplash grade 2 injury, lumbar back strain; hip/pelvis strain, facial/nose trauma,