Citation: Shpati v. Travelers Canada, 2021 ONLAT 19-008988/AABS

Released Date: 06/02/2021

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:

Silva Shpati

Applicant

and

Travelers Canada Direct Insurance Company

Respondent

DECISION

ADJUDICATOR:

Brian Norris

APPEARANCES:

For the Applicant:

Julia Logoutova, Paralegal

For the Respondent:

Sara Baum, Counsel

Heard by way of written submissions

OVERVIEW

1Silva Shpati, “the Applicant”, was injured in an automobile accident on May 8, 2018 and sought benefits from the respondent pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010, O. Reg. 34/10 (the “Schedule”).

2Travelers Canada, “the respondent”, determined the applicant’s injuries fell within the Minor Injury Guideline (the “MIG”) and refused to pay for certain medical benefits. As a result, the applicant applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of this dispute.

ISSUES

3The disputed claims in this hearing are:

1. Did the applicant sustain predominantly minor injuries as defined under the Schedule?
2. Is the applicant entitled to a medical and rehabilitation benefit in the remainder amount of $112.11 [original amount of $1,212,11 – partially approved amount of $1,100.00] for chiropractic treatment recommended by East Sheppard Rehab, in a treatment plan (OCF-18) submitted on August 20, 2018 and denied on August 27, 2018?
3. Is the applicant entitled to a medical and rehabilitation benefit in the amount of $2,641.62 for aquatherapy treatment recommended by 2430307, in a treatment plan (OCF-18) submitted on September 7, 2018 and denied on September 14, 2018? The type of service was amended from chiropractic services to aquatherapy. The service provider was amended from East Sheppard Rehab to 2430307.
4. Is the applicant entitled to a medical and rehabilitation benefit in the amount of $2,894.33 for chiropractic treatment recommended by East Sheppard Rehab, in a treatment plan (OCF-18) submitted on October 2, 2018 and denied on October 10, 2018? The date of denial was amended from November 29, 2018 to October 10, 2018.
5. Is the applicant entitled to a medical and rehabilitation benefit in the amount of $1,094.73 for physiotherapy treatment recommended by East Sheppard Rehab, in a treatment plan (OCF-18) submitted on May 6, 2019 and denied on May 8, 2019?
6. Is the applicant entitled to a medical and rehabilitation benefit in the amount of $1,487.19 for chiropractic treatment recommended by East Sheppard Rehab, in a treatment plan (OCF-18) submitted on March 5, 2019 and denied on March 11, 2019?
7. Is the applicant entitled to the cost of an examination, in the amount of $1,999.82 for psychological assessment, recommended by NorMed Assessment, in a treatment plan (OCF-18) denied on June 22, 2018?
8. Is the applicant entitled to the cost of an examination, in the amount of $2,000.00 for an orthopaedic assessment, recommended by NorMed Assessment, in a treatment plan (OCF-18) submitted on April 15, 2019 and denied on April 18, 2019?
9. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

4The applicant is unsuccessful on all issues.

BACKGROUND

5The Applicant was the driver of a vehicle which was struck from behind in heavy traffic on an urban street. She reported headaches and a sore neck at the scene, and she was transported to hospital by paramedics. She was assessed at the hospital and diagnosed with neck muscle pain and advised to take ibuprofen every six hours for the next two days. She started treatment at East Sheppard Rehabilitation Clinic about two weeks following the accident, and pursuant to the MIG.

THE MINOR INJURY GUIDELINE

6The MIG establishes a treatment framework available to injured persons who sustain a minor injury as a result of an accident. A “minor injury” is defined in the Schedule and includes sprains, strains, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae. The MIG provides that a strain is an injury to one or more muscles and includes a partial tear. Minor injuries are subject to the treatment methodologies outlined in the MIG and, under section 18 of the Schedule, injuries that are defined as minor are subject to a $3,500.00 funding limit on treatment.

7If an insurer deems an applicant’s injuries to be minor in