Released Date: 10/14/2020
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:
B.E.T.
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
PRELIMINARY ISSUE DECISION
ADJUDICATOR:
Jesse A. Boyce
APPEARANCES:
For the Applicant:
Tara M. Sweeney
For the Respondent:
James M. Brown
HEARD:
By way of written submissions
OVERVIEW
1B.E.T. was injured in an accident on November 17, 2013. As a result of her impairments, she received non-catastrophic medical benefits, attendant care benefits (“ACB”) and a non-earner benefit (“NEB”) for several years from the respondent, Wawanesa, pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (''Schedule'').
2Over time, B.E.T.’s physical impairments began to improve; she graduated to become a phlebotomist, began to work full-time and was able to care for herself and her family. In January 2016, Wawanesa scheduled B.E.T. for an Insurer’s Examination (“IE”) to assess her continuing eligibility for the NEB. It was determined that she did not demonstrate a complete inability to carry on a normal life. Accordingly, in a letter dated January 28, 2016, Wawanesa advised B.E.T. that she was no longer entitled to a NEB.
3However, following this termination, B.E.T.’s psychological condition started to decline. By June 2018, her condition was such that she was unable to maintain employment due to her new accident-related impairments, which were primarily chronic pain and psychological impairments. On July 19, 2018, an updated Disability Certificate (“OCF-3