Licence Appeal Tribunal File Number: 20-009071/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:
Jing Lin
Applicant
and
Certas Direct Insurance Company
Respondent
DECISION
ADJUDICATOR:
Ulana Pahuta
APPEARANCES:
For the Applicant:
Yu Jiang, Paralegal
For the Respondent:
Sana Malik, Counsel
HEARD: BY WAY OF WRITTEN SUBMISSIONS
BACKGROUND
1Jing Lin (the “applicant”) was involved in an automobile accident on February 27, 2019 and sought benefits pursuant to the Statutory Accident Benefits Schedule, Effective - September 1, 2010 (including amendments effective June 1, 2016) (“Schedule”)1. The applicant was denied certain benefits by the respondent and submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”).
2The respondent determined that the applicant’s injuries fit the definition of “minor injury” prescribed by s.3(1) of the Schedule and, therefore, fall within the Minor Injury Guideline (“MIG”)2. The respondent submits that even if these injuries are found not to be a minor injury, the disputed benefits are not reasonable or necessary.
3The applicant’s position is that her injuries do not fall within the MIG; she submits that her chronic pain and psychological injuries remove her from such. She further submits that the disputed treatment plans are reasonable and necessary as a result of the accident and claims interest on overdue treatment.
ISSUES IN DISPUTE
4The following issues are to be decided:
(i) Are the applicant’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?