Citation: Brown v. Wawanesa Mutual Insurance Company, 2022 ONLAT 19-010425/AABS
Licence Appeal Tribunal File Number: 19-010425/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:
Nadine Brown
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR: Monica Chakravarti
APPEARANCES:
For the Applicant: Nadine Brown, Applicant Frank McNally, Counsel
For the Respondent: Darrell March, Counsel
HEARD: Via Written Submissions
BACKGROUND
1The applicant was involved in a motor vehicle accident on September 15, 2010 wherein she sustained injuries. The applicant sought medical and rehabilitation benefits from the respondent for physiotherapy treatment pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 20101 (the “Schedule”). While the respondent agreed that the applicant meets the threshold for catastrophic impairment under the Schedule the respondent disagreed with the applicant that the medical and rehabilitation benefits for physiotherapy treatment are reasonable and necessary. The applicant applied to the Tribunal to resolve the dispute.
ISSUES IN DISPUTE
2The issues to be determined it the hearing are:
a. Is the applicant entitled to receive a medical benefit in the amount of $1,566.25 for physiotherapy treatment recommended by Eleanor Cox Sport and Spinal Injury Clinic in a treatment plan submitted March 15, 2019?
b. Is the applicant entitled to receive a medical benefit in the amount of $1,566.25 for physiotherapy treatment recommended by Eleanor Cox Sport and Spinal Injury Clinic in a treatment plan submitted March 15, 2019?
c. Is the applicant entitled to receive a medical benefit in the amount of $1,566.25 for physiotherapy treatment recommended by Eleanor Cox Sport and Spinal Injury Clinic in a treatment plan submitted July 8, 2019?
d. Is the applicant entitled to interest on any overdue payment of benefits?
Procedural Issue
3The Order of the Tribunal setting this matter down for a hearing set out the timetable and page limits for the written submissions for this hearing. The submissions for this hearing followed the usual course, of the applicant’s submissions, followed by the respondent’s submission with the final submissions being the applicant’s reply submissions.
4The respondent without an order, without seeking leave and without bringing a motion provided a sur-reply. As might be expected, the applicant sent correspondence to the Tribunal objecting to same and the respondent then sent correspondence responding to the applicant