Licence Appeal Tribunal
Citation: Gonzalez v. Certas Direct Insurance Company, 2021 CanLII 31263 Release Date: 03/29/2021
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:
Leandro Gonzalez Applicant
and
Certas Direct Insurance Company Respondent
DECISION
ADJUDICATOR: Lindsay Lake
APPEARANCES:
For the Applicant: Sevda Guliyeva, Paralegal
For the Respondent: Jessica Mahabir, Counsel
HEARD: By way of written submissions
OVERVIEW
1The applicant, Leandro Gonzalez (“Mr. Gonzalez”), was injured in an automobile accident on May 17, 2017 and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 20101 from Certas Direct Insurance Company (“Certas”), the respondent.
2Certas denied Mr. Gonzalez’s claims for a psychological assessment, psychological treatment and other physical treatments because it had determined that all of Mr. Gonzalez’s injuries fit the definition of “minor injury” as prescribed by s. 3(1) of the Schedule and, therefore, fall within the Minor Injury Guideline (the “MIG”).2 As a result, Mr. Gonzalez submitted an application to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”).
3A case conference was held on May 25, 2020 and the matter proceeded to a written hearing.
ISSUES IN DISPUTE
4The following issues are to be decided:
(i) Are Mr. Gonzalez’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?
(ii) Is Mr. Gonzalez entitled to $1,920.53 for a psychological assessment recommended by Mediwise Healthcare Clinic (“Mediwise”) in a treatment plan (“OCF-18”) dated October 2, 2017, and denied on October 6, 2017?
(iii) Is Mr. Gonzalez entitled to $4,463.96 for psychological treatment recommended by Mediwise in an OCF-18 dated February 17, 2018,