Licence Appeal Tribunal
Tribunal File Number: 19-002341/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:
S.R.S.
Applicant
and
Aviva Insurance Company
Respondent
DECISION
ADJUDICATOR:
Brian Norris
APPEARANCES:
For the Applicant:
Jessie Vi Tran
For the Respondent:
Maggie Morgan
Heard by way of written submissions
OVERVIEW
1The applicant was injured in an automobile accident on August 13, 2016 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 for certain benefits and the applicant applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of this dispute.
ISSUES
2The disputed claims in this hearing are:
(i) Did the applicant sustain predominantly minor injuries as defined under the Schedule?
(ii) Is the applicant entitled to medical benefits from Pain Rehabilitation Clinic as follows;
(a) $2,200.00 for a social work assessment proposed in a treatment and assessment plan dated March 23, 2017;
(b) $1,250.00, less $989.67 approved by the respondent, for physiotherapy services recommended in a treatment and assessment plan dated November 23, 2016;
(c) $2,000,00 for physiotherapy recommended in a treatment and assessment plan dated August 23, 2017;
(d) $1,900.00 for a massage therapy recommended in a treatment and assessment plan dated December 14, 2018; and
(e) The costs of disability certificates dated March 24 and August 23, 2017?
(iii) Is the applicant entitled to interest on the overdue payment of benefits?
(iv) Is the applicant entitled to costs of the proceeding?
RESULT
3The applicant sustained injuries which fall outside the Minor Injury Guideline (the “MIG”). He is not bound by methodologies in the MIG and the $3,500.00 funding limit on treatment.
4The disputed treatment plans are not reasonable and necessary for the applicant’s accident-related injuries.
5The applicant is not entitled to payment for the two disability certificates.
6No interest or costs are payable.
BACKGROUND
7Two vehicles collided in an intersection causing one of them to strike the vehicle the applicant was driving. The applicant was not treated for injuries at the scene of the accident