Longboat v. BelairDirect Insurance Company
Release date: 2021/03/08
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:
Pamela Longboat
Applicant
and
BelairDirect Insurance Company
Respondent
DECISION
ADJUDICATOR:
Robert Watt, Adjudicator
APPEARANCES:
For the Applicant:
Marina Korshunova, Counsel
For the Respondent:
Kristen M. Bailey, Counsel
HEARD:
by way of written submissions
OVERVIEW
1The applicant was injured in an accident on August 19, 2017, and sought various benefits from the respondent, pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 20101 (''Schedule''). The respondent denied the benefits in dispute on the basis of its determination that the applicant’s accident-related impairments were predominantly minor injuries and therefore subject to treatment within the Minor Injury Guideline (“MIG”). The applicant disagreed and submitted an application to the Tribunal for resolution of the dispute.
ISSUES IN DISPUTE
2The following issues are in dispute:
- Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 limit and in the MIG?
- If the applicant’s injuries are not considered to be predominantly minor, i. Is the applicant entitled to a medical benefit in the amount of $2,243.00 for physiotherapy services recommended by Dr. J. Rajesh in a treatment plan submitted on January 22, 2018 and denied by the respondent on May 24, 2018?
- Is the applicant entitled to receive a non-earner benefit in the amount of $185.00 per week, from the period of May 28, 2018 to date and ongoing?
- Is the applicant entitled to interest on any overdue payment of benefits?
3The applicant in her written submissions has withdrawn the benefit claimed in paragraph [2] 3, being the non-earner benefit.