Nassar v. BelairDirect Insurance Company, 2022 CanLII 23410

REASONS FOR DECISION AND ORDER

BACKGROUND

1The applicant was involved in an automobile accident on February 10, 2018, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016).¹

2The applicant claims that based on her pre-existing conditions and accident-related injuries she should receive treatment beyond the $3,500.00 Minor Injury Guideline (MIG)² limit.

3Based on the initial application, medical reports and assessments, the respondent determined the applicant’s injuries fell within the MIG and denied any benefits over the MIG limit.

4As a result of the respondent’s denial, the applicant submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”) for dispute resolution.³

ISSUES

5The issues to be determined in this hearing are:

a. Are the applicant’s injuries predominantly minor as defined in s. 3(1) of the Schedule and therefore subject to treatment within the $3,500.00 limit and in the Minor Injury Guideline?

b. Is the applicant entitled to $1,299.75 for an in-home assessment recommended by DMA Rehability in a treatment plan (OCF-18) dated October 2, 2018?

c. Is the applicant entitled to $2,527.95 for physiotherapy and massage therapy recommended by Neuphysio Rehabilitation in a treatment plan (OCF-18) dated September 30, 2020?

d. Is the respondent liable to pay an award under Regulation 664 because it unreasonably withheld or delayed payments to the applicant