Citation: Pu v. Economical Insurance Company, 2022 ONLAT 20-007001/AABS

Licence Appeal Tribunal File Number: 20-007001/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:

Yung-Tze Pu

Applicant

and

Economical Insurance Company

Respondent

DECISION

ADJUDICATOR:

Derek Grant

APPEARANCES:

For the Applicant:

Jae Cho, Paralegal

For the Respondent:

Jonathan Charland, Counsel

HEARD:

By way of written submissions

OVERVIEW

1YTP was involved in an automobile accident on January 20, 2018 and sought benefits from Economical pursuant to the Statutory Accident Benefits Schedule- Effective September 1, 2010¹ (the “Schedule”). Economical denied the benefits in dispute on the basis that it determined that YTP’s accident-related injuries were predominantly minor injuries and therefore subject to treatment within the Minor Injury Guidelines (the “MIG”). YTP disagreed and submitted an application to the Tribunal for resolution of the dispute.

ISSUES

2The issues to be decided in the hearing are:

1. Are YTP’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?

2. Is YTP entitled to a non-earner benefit (“NEB”) in the amount of $185.00 per week from January 20, 2018 to date and ongoing?

3. Is the medical benefit in the amount of $95.77 ($1,295.77 of which $1,200.00 was approved) for physiotherapy services recommended by North York Physiotherapy Clinic in a treatment plan (OCF-18) submitted on June 14, 2018, reasonable and necessary?

4. Is the medical benefit in the amount of $1,295.77 for physiotherapy services recommended by North York Physiotherapy in a treatment plan (OCF-18) submitted on August 2, 2018, reasonable and necessary?

5. Is YTP entitled to interest on any overdue payment of benefits?

FINDING

3YTP has failed to demonstrate entitlement to any of the disputed benefits. No benefits are overdue therefore no interest is payable.

ANALYSIS

4Sections 14 and 15 of the Schedule provide that an insurer is only liable to pay for reasonable and necessary medical expenses incurred as a result of an accident. The applicant bears the onus of proving on a balance of probabilities that the claimed medical benefits are reasonable and necessary and that she suffers a complete inability to carry on a normal life as a result of the accident.

5YTP’s submissions on the medical benefits lack any analysis of how the OCF-18s are reasonable and necessary to address her alleged injuries. Further, YTP failed to provide me with any supporting documentary evidence. As such, there is no evidence to support that the treatment YTP seeks is reasonable and necessary. Additionally, the submissions and evidence failed to address or demonstrate that YTP suffered a complete inability to carry on a normal life, thereby failing to satisfy the test of entitlement to an NEB. There is no persuasive evidence to support any of her claims.

6I find that YTP has failed to meet the burden of proof with respect to her claims for benefits. Essentially, YTP relies solely on her submissions, which are not evidence.

7YTP’s submissions allude to evidence that was not filed with the Tribunal. In the absence of any evidence filed in support of her claim, I am unable to make a decision in the YTP’s favour.

8Accordingly, I do not find it necessary to set out Economical’s rebuttal evidence or arguments. I do note that Economical provided evidence that its denials were based on medical evidence and reports from its assessors and from YTP’s claim documents. Consequently, I see no reason to interfere with Economical’s determination.

CONCLUSION

9For all of the above reasons, YTP is not entitled to any of the dispute benefits.

Footnotes

1. 1O. Reg. 34/10, as amended.