J.C. v. Aviva Insurance Canada
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:
[J.C]
Applicant
and
Aviva Insurance Canada
Respondent
DECISION
PANEL:
Eleanor White
APPEARANCES:
For the Applicant:
Volha Vinahradava, Counsel
For the Respondent:
Michael Silver, Counsel
HEARD: In Writing
June 21, 2019
OVERVIEW
1The applicant, J.C., was involved in an automobile accident on April 6, 2016, and sought benefits from the respondent, Aviva Insurance Canada, pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the ''Schedule''). As a result of the accident, J. C. alleges that he sustained injuries to his neck, lower and mid-scapular back, shoulder and knee with concurrent headaches, as well as mood changes, fatigue and sleep difficulties.
2J.C. applied for and received income replacement benefits for 29 weeks, until he voluntarily returned to work. He also applied for medical and rehabilitation benefits that were denied on the basis that his injuries were predominantly “minor” in nature and, therefore, treatable under the Minor Injury Guideline (“MIG”). J.C. did not agree with the denial of the benefits and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for dispute resolution. As the parties were unable to resolve the issues in dispute at the case conference, the issues proceeded to a written hearing.
ISSUES
3The issues in dispute are as follows:
i. Did the applicant sustain predominantly minor injuries as defined under the Schedule?
ii. If the applicant did not sustain predominantly minor injuries as defined under the Schedule;
a. Is the applicant entitled to a medical benefit in the amount of $3,948.91 for chiropractic treatment recommended by Inline Rehabilitation in a treatment plan dated August 17, 2016 and denied by the respondent on November 8, 2016?
b. Is the applicant entitled to a medical benefit in the amount of $1315.02 for chiropractic services recommended by Inline Rehabilitation in a treatment plan dated July 22, 2017 and denied by the respondent on August 11, 2017?
iii. Is the applicant entitled to interest on any overdue payment of benefits