G.W. v. Aviva Insurance Canada, 2020 CanLII 34457

Citation: GW vs. Aviva Insurance Canada, 2020 ONLAT 19-001122/AABS

Released Date: 04/28/2020
File Number: 19-001122/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:

G. W.

Applicant

and

Aviva Insurance Canada

Respondent

DECISION

ADJUDICATOR: Derek Grant

APPEARANCES:

For the Applicant: John Russell, Counsel

For the Respondent: Annemarie White, Counsel

HEARD: By way of Written Submissions

OVERVIEW

1The applicant, G.W., was involved in an automobile accident on October 6, 2015 (the “accident”) and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the ''Schedule''). This dispute focuses on the respondent’s, Aviva, denial of G.W.’s entitlement to medical benefits.

2G.W. submits that, as a result of injuries he sustained in the accident, the treatment he seeks is reasonable and necessary.

3Aviva argues that G.W. has not established that the treatment plans are reasonable and necessary.

ISSUES

4The issues to be decided are as follows:

i. Is the medical benefit in the amount of $2,824.70 for physiotherapy treatment recommended by In Motion Rehabilitation and Wellness Centre Inc. in a treatment plan (OCF-18) submitted on January 27, 2017, and denied on January 31, 2017, reasonable and necessary?

ii. Is the medical benefit in the amount of $2,202.98 for physiotherapy treatment recommended by In Motion Rehabilitation and Wellness Centre Inc. in an OCF-18 submitted on March 10, 2017, and denied on May 11, 2017, reasonable and necessary?

iii. Is the medical benefit in the amount of $4,817.36 for physiotherapy treatment recommended by In Motion Rehabilitation and Wellness Centre Inc. in an OCF-18 submitted on July 7, 2017, and denied on July 12, 2017, reasonable and necessary?

iv. Is the medical benefit in the amount of $2,176.00 for physiotherapy treatment recommended by In Motion Rehabilitation and Wellness Centre Inc. in an OCF-18 submitted on March 20, 2018, and denied on March 29, 2018, reasonable and necessary?

v. Is the medical benefit in the amount of $2,406.62 for physiotherapy treatment recommended by In Motion Rehabilitation and Wellness Centre Inc. in an OCF-18 submitted on January 15, 2018, and denied on March 29, 2018, reasonable and necessary?

vi. Is the medical benefit in the amount of $2,406.62 for physiotherapy treatment recommended by In Motion Rehabilitation and Wellness Centre Inc. in an OCF-18 submitted on November 1, 2017, and denied on March 29, 2018, reasonable and necessary?

vii. Is G.W. entitled to interest on any overdue payment of benefits?

FINDING

5I find that G.W. has not proven his entitlement to medical benefits. His application is denied. No benefits are overdue and therefore no interest is payable.

LAW

6Sections 14 and 15 of the Schedule provide that an insurer is only liable to pay for reasonable and necessary medical expenses incurred as a result of an accident. The applicant bears the onus of proving on a balance of probabilities that any proposed treatment or assessment plan is reasonable and necessary.¹

ANALYSIS

7G.W.’s submissions on the medical benefits lack any analysis of how the claimed OCF-18s were reasonable and necessary to address his alleged injuries. Attached to G.W.’s submissions were a hospital discharge summary from Trillium Health Centre and an Ambulance Call Report. Neither of these documents offer evidence to support that the treatment G.W. seeks is reasonable and necessary. There is no persuasive evidence to support any of his claims. I found nothing in his appended documentation to assist me.

8I find that G.W. has failed prima facie to meet the burden of proof with respect to his medical benefits claims. Further, G.W. appears to rely mainly on his submissions, which are not evidence, in support of his claims for treatment.

9G.W.’s submissions allude to evidence that wasn’t included. Further, the submissions require me to make leaps of reasoning that are not readily apparent based on the evidence.

10Submissions that have no evidentiary support for their assertions are known as “bald assertions”. I find this to be the case with G.W.’s submissions.

11Accordingly, I do not find it necessary to set out Aviva’s rebuttal evidence or arguments. I do note that Aviva provided evidence that all of its denials were based on medical evidence and reports from its own assessors and from G.W.’s claims documents.

CONCLUSIONS

12G.W. has not proven his entitlement to any of the claimed benefits. Accordingly, no interest is payable.

Footnotes

1. 1Scarlett v. Belair Insurance, 2015 ONSC 3635.